ANXIETY, DEPRESSION & other stuff!

The EVERYPERSON,‟s HEALTH PROGRAM
Manual constructed and edited by Denisia Hockley Psychologist/Psychotherapist/Facilitator Dip.Psy.,BA.,BSci.(Hon) Masters Mental Health (Psychotherapy) 2009 Edition

The user friendly, straight talk, manual for Defeating Anxiety & Depression AND coping with life in general!!!!!!!!!!!!

Acknowledgement In compiling this manual clearly I have drawn on the works and wisdom of many of psychology’s forefathers. In particular Albert Ellis, Beck, Pavlov, there’s even a smidgen of Freud in there. Writings are also influenced by the teachings of Rudolph Dreikurs , Peter Honzako, Peter Heibloome Snr., and many others along the journey since 1985 when I began my quest for personal growth and empowerment;

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WELCOME TO THE END OF STRESS, ANXIETY & DEPRESSION
You have just achieved the hardest part: Deciding to change!
Work through these 10 sessions and you will learn many skills that will help you deal with depression, anxiety, and life in general. Like anything else the more you put in the more you get back! It‟s easy! It‟s full of valuable skills! AND………It‟s even FUN! Yes – depressed people are allowed to have fun! In fact you are about to find out how NORMAL you really are! This manual provides an overview of the things covered in each session – however sessions will vary from one group to another, because no two groups of people are exactly the same. Although written for use in a group this material is also appropriate for individual therapy and self-help.

COME ALONG KEEP AN OPEN MIND ALLOW YOURSELF TO HAVE SOME FUN IN THE PROCESS

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We will cover
 Learning about depression, anxiety, LIFE (AND OTHER STUFF…)  Dealing with other people You know, like the ones who say “snap out of it”  Relaxation and Breathing (You may actually learn some things you haven‟t already heard)  Problem Solving  Sleep (Yes: most people have trouble with sleep)  How your brain works with your thoughts and behaviour...  Assertiveness  Self Esteem  Irrational Thinking Styles (WE ALL ENGAGE IN THEM!)  How/Why you have been beating yourself up all these years: Why and what to do about it!  Bullying -V- Self-Esteem  Loneliness  How to move forward from here……………………….  BUT WAIT……THERE‟S MORE!!!!!!!!!!!!!!!!!!!!!!!!!!!!
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ACHIEVEMENT, LIKE BEHAVIOURS IS NOT WHO YOU ARE!!!!!
DOING ONE STUPID ACT DOES NOT MAKE YOU STUPID! FAILING AT SOME THINGS DOES NOT MAKE YOU A FAILURE! ACTING OUT BAD BEHAVIOUR DOES NOT IN ITSELF MAKE YOU (OR OTHERS) A BAD PERSON. THINK ABOUT IT…YOU MAY BE A PERSON WITH A DISABILITY, A PERSON WITH LOTS OF MONEY OR A LARGE DEBT, A PERSON WITH A DRINKING PROBLEM, A PERSON WITH TWO BIG TOES ON ONE FOOT – WHATEVER! YOU ARE ALSO MANY OTHER THINGS LIKE A PERSON WITH A DOG, A PERSON WHO LIKES CHOCOLATE, WHO SWIMS, WORKS, AND DOES GOOD STUFF - ETC ETC ETC.

“Try not to focus on the small things”

Are you getting the message yet???? One aspect of your life is not your whole identity…So you have depression/anxiety… THAT IS NOT WHO YOU ARE!
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RESISTANCES TO THERAPY
There are a large number of ways in which people consciously or unconsciously do things which reduce the effectiveness of therapy, or make it harder for the therapy to work. The following are some of them:

♦ Choosing not to do homework exercises or doing them half-heartedly ♦ Trying to apply your new skills to every single problem all at once and then giving up because it doesn‟t work, rather than working through your problems systematically and at a reasonable rate. ♦ Denying improvement ♦ Being overly defensive ♦ Refusing to believe that therapy can work, for example: “CBT won‟t work because my depression is biological” ♦ Choosing to give up ♦ Using any excuse to drop out ♦ Not asking questions ♦ Skipping sessions and then finding it hard to catch up ♦ Finding arguments against what is said in therapy ♦ Expecting immediate results, eg: “I have been coming to therapy for three weeks and I‟m not getting any better” 6

POSSIBLE REASONS FOR NOT DOING HOMEWORK The following are some reasons various people have given for not doing their homework during the course of therapy. It is important for you to try and pinpoint any of these that may interfere with you doing your tasks, especially when you are in a situation where you are reluctant. ♦ It seems that nothing can help me so there is no point in trying ♦ I really can‟t see the point of what the therapist has asked me to do ♦ I am willing, but I keep forgetting ♦ I do not have enough time, I am too busy ♦ I feel helpless, I don‟t think I can help myself ♦ If I do something the therapist suggests it‟s not as good as if I come up with my own ideas ♦ I have the feeling that the therapist is trying to boss me around or control me ♦ I fear the therapist‟s disapproval or criticism.

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Types of depression: Reactive- In simple terms something happens in your life which is
more than you can cope with at this time. Perhaps you have been coping with a number of stressors and this event is the last straw. Perhaps you were happy and healthy when this event occurred and now you have fallen in a heap. YOUR DEPRESSION/ ANXIETY IS A „REACTION‟ „RESPONSE‟ TO STRESSFUL EVENT/S. Usually this means that with a little time and support, medication maybe, you will gradually get better as you resolve or get used to what has happened. NOTE: Some people may not understand why you have „dropped your bundle‟ especially if you have always appeared to others as a strong confident person! Before you judge someone‟s inability to cope, remember, you do not know just how big their bundle became before they dropped it! Pre-dispositional (aka- endogenous) Endogenous tends to imply that it comes from within in you, that you are a depressive or anxious type of person, I suggest that pre-dispositional is somewhat more accuratemeaning that for whatever reason you are more sensitive or vulnerable to stressful situations. It does not mean that you are destined to be depressed; it does mean that you need to work a little harder, than some other people, at coping with life‟s ups and downs. You can still learn life/coping skills that will enable you to lead a happy healthy life.

Who gets depressed? - Mental health does not discriminate! It affects the
poor and the wealthy! The smart and the not-so-smart! In fact – the more intelligent you are the more vulnerable you may be – that‟s right? You thought you were stupid because you have not been able to beat this thing? WRONG! Chances are you spend a lot of time thinking and analysing situations; it is also likely that you expect a lot of yourself. Ask yourself – are you harder on yourself than on others!!

Symptoms: Be careful when assessing your own symptoms because most
symptoms can have a number of explanations. When your therapist or doctor investigates your symptoms they take them in context with a number of other variables. The following are things that MAY indicate that you are clinically depressed and/or anxious –
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Sleep patterns – to much, too little, restless, poor quality… Eating- too much, too little, comfort eating… Thoughts – worry, rumination, simple paranoia (NO THAT DOESNT MEAN YOU ARE PSYCHOTIC), self defeating, hopelessness, over-reactive, over-sensitive, unusually judgemental, pessimistic, fearful, destructive… Physical symptoms- stress can cause just about any physical symptomincluding nausea, headaches, dizziness, heartburn, back pain or pain anywhere in your body, intestinal disturbances (I.B.S), menstrual problems….BUT Make sure you get any symptoms checked out by your doctor, do not assume they are caused by your stress. Lack of motivation and/or energy- Lack of control – feeling you have no control over your responses, your emotions, your body, your life….. You know what you need to do, what you „should do‟ AND you really want to, BUT your body and your emotions won‟t behave in the way you want/need them to. HEY IT IS HARD! YES YOU CAN BEAT IT BUT IT‟S STILL DAMN HARD! (Now we have acknowledged that we won‟t say it again, later in the „RAS‟ section we will explain why we don‟t verbalise the negatives) The trick is to approach each day separately, that is, each day you try to do the things you need to, if you fail today - GET OVER IT and try again tomorrow! and tomorrow, and all the tomorrows until you get there…. As you work through the manual you will learn how to do this… No one understands- feeling isolated, misunderstood – even your doctor/therapist does not seem to understand that no matter how hard you try to feel better, to get on with your life, to carry out therapy homework, sometimes you just cannot……!!!!!!!!!!!!!!!!! (Or at least that is how it feels) If controlling your own mind is hard, changing how you feel can be even harder – But you can do it!! Yes it is a daily struggle AND Yes there are days when you want to give up trying! AT THE END OF THE DAY THERE ARE ONLY TWO OUTCOMES – YOU GIVE UP! OR YOU KEEP FIGHTING UNTIL YOU WIN! Giving up is really not an option now is it!
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Medication: (The following is intended to provide a simplistic lay person‟s understanding of medication, it is not fully comprehensive and is not intended to replace or contradict formal medical or pharmacological opinion) Types: Generally speaking the types of medication you need to be aware of are:- SSRIs (SNRIs): Antidepressants most used today- There are several on the market and essentially they are all as good as each other. **It is generally not possible to know which will be the best for you. Chances are the first one you try will work for you, however you may have to try several before you and your doctor find the one that is perfect for you. You may need patience and perseverance to find the right one. A long list of possible side effects includes nausea, head-spins, headaches, dizziness, anxiety – and many more. You will not experience all of these; you may not experience any of these. If you do get side effects they will usually settle in the first 2 weeks but do not put up with them for more than six weeks, its too long, go talk to your therapist/doctor. Do not give up on your meds in the first 2 weeks unless the side effects are unbearable, chances are they will settle. Do not keep taking meds that are not working for you after a reasonable length of time – go talk to your therapist/doctor. The more information you give your doctor the better chance he has of choosing an SSRI/SNRI most likely to suite you BUT your bio chemistry is unique to you, and your doctor cannot know for sure which will suite you. The good news is that it is extremely rare for anyone not to suit at least one of the SSRI‟s and once settled the results can be amazing – a client once said “wow, this must be what normal people feel like” (be sure to read section on washout and weaning off meds) TCAs : Antidepressants used before SSRIs came along- still appropriate for some people/situations tpday. Use as prescribed, make sure your doctor explains use, abuse. Benzodiazepines: you know them as Valium, Serapax, Xanax, Temazapan, Normison (if not sure check the label) – “Supa-glue & Bandaides” they certainly do have their place and they can really help you hold it together in a stressful situation but if you over-use them they will not only cease to help you but will have a paradoxical effect – that is, using too many or using them too often can actually make you more depressed/anxious.

**2009 Biofeedback technology may now be able to help us chose the right antidepressant medication for you...
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Over-use will mean that they will not work for you when you really need them. Unfortunately most people build up a tolerance to these meds, meaning that you have to keep taking more to get the same effect then after awhile you will not only become dependant but they will start to make you more anxious and depressed. This is one med you really must treat with respect and use sparingly and only as prescribed. Sleeping pills: Temazapan, Normison, Stillnox & Others; Use only as a last resort and only for very short periods of time. In the long term they will not resolve your sleeping problems (see session on sleep). Different people report different side effects- talk to your doctor immediately if you get side effects. These meds also lead to dependence and tolerance effects if overused. Be wary of over-the counter sleep remedies – many people over-use these medication because they think over-the-counter means take as many as you like – Not So! Based on many patient reports I would stay well away from Stillnox the side effects for MANY people can be horrific! Natural or Herbal remedies: You must advise your doctor if you are taking these as some will have a bad interaction with your prescription meds. eg; St John‟s Wort must not be taken with SSRI‟s Stigma: In a perfect world there would be no stigma attached to taking antidepressant medication; essentially it is your business, if the people around you are judgemental and insensitive – do not tell them. Wash out: If it is necessary for you to change your meds your therapist/doctor will explain the wash out period, which is different depending on which meds you are changing from/to. And again, people handle wash out differently. During this change-over time (usually only a few days) you need to be prepared for temporary side effects such as nausea, head-spins etc., if you understand that these are normal for wash out you should be able to cope by taking a little extra care of yourself and avoid doing too much during this period. It helps to know why you feel the way you do and that it will soon pass. Weaning off the meds: Too often people decide to stop their meds abruptly because they are finally feeling well. Very few people can cease antidepressant meds abruptly without experiencing some very uncomfortable side effects. IF the time is right to stop your meds AND you have discussed this with your therapist/doctor REMEMBER the more time you take to wean off your meds the more likely you will be able to stay off them, Depending on your dosage start by reducing by a quarter of the dose (you may
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be able to break your tablet or you may need to get a lower dosage pill prescribed). You MUST discuss this with your doctor! Stay on the reduced dose until you feel as well as you did on the full dose. Gradually reduce meds in this manner – take your time… Do Not Be In a Hurry, it is quite ok to take months to wean off these meds. NEVER, NEVER, NEVER USE YOUR FRIEND’S MEDS OR SHARE YOUR MEDS WITH A FRIEND – THEY MAY BE PERFECT FOR YOU BUT MAY BE DANGEROUSE FOR SOMEONE ELSE Choosing your doctor…Your doctor should be someone with whom you feel comfortable, respected and whom you respect and trust. You should feel that your doctor listens to you and understands. However you must understand that your doctor is not psychic, will not remember everything you told him/her last time and probably does have too many patients to remember everything about your case. IT IS YOUR RESPONSIBILITY to remind doctor of your allergies, to ask questions, tell him/her if you disagree and/or need clarification. It is perfectly OK to ask for a second opinion! You should not feel intimidated or helpless when communicating with your doctor or therapist.

THE DOCTOR/THERAPIST PATIENT RELATIONSHIP SHOULD BE BASED ON GOOD COMMUNICATION, RESPECT AND UNDERSTANDING
Dealing with other people. People can be cruel, judgemental and insensitive. They may tell you to „snap out of it‟ „stop being negative‟ they may mean well, but if it was that simple to „snap out of depression” I would not be writing this manual! Mostly the people around you feel helpless, they may want to help but simply do not know how. Many people do not know how to „listen‟ without feeling a need to „fix‟ you, which or course they cannot. Some people will end up avoiding you because they do not know what else to do; others may get mad at you for the same reason. It is not their fault and it is not yours! Unfortunately most people do not understand poor mental health unless they have experienced it themselves. You may need to avoid people who make you feel worse – at least until you are feeling stronger. You essentially need a counsellor, therapist or selected person to talk to on a regular basis –

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! Breathing…Relaxation….Alpha Brain Rhythms.
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WHAT ARE BRAIN WAVES? & WHAT DO THEY DO?
EEG devices we can measure the brain waves as they are produced by our brain. Brain waves are the electrical fluctuations in the brain associated with various states of cortical arousal (thinking, learning, relaxing, recuperating etc.). Brain waves are all oscillating electrical voltages in the brain, but they are very tiny voltages, just a few millionths of a volt. Brain waves are measured in terms of Hertz (Hz). Research has demonstrated that the brain has the quality of neural-plasticity, (able to change and learn new pathways) therefore our brain can be trained to produce certain brainwaves at certain parts of the brain thus enabling us to move from one state of cortical arousal to another depending on our goals. Brain entrainment uses sound and rhythm to allow you to enter certain states and then move out of them once the entrainment has stopped. Neuro-Biofeedback teaches the brain to hardwire itself into a more harmonious function. Not all brainwaves are present at all times, for example during deep sleep Delta and Theta are the most predominate waves. Obviously you would have insomnia if you were unable to enter into a delta or Theta brain wave. It is thought that a true genius is someone who can turn on particular brain waves at the appropriate times at the appropriate locations in the brain.

DELTA 0.5- 3 Hz
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Known Functions
Present during deep sleep Large & slow waves Human Growth Hormone Release Beneficial for healing & Regeneration High Delta Ratio whilst awake can indicate depression & exhaustion Access to collective unconscious Intuition, ESP Detached awareness

Neuro-biofeedback Training For:

Reduction of Anxiety

It is thought that Delta is the first primal or core frequency that is produced in the RAS. The care frequency of Delta is then altered by various brain structures to produce all the other waves

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THETA 4 - 7 Hz

Known Functions
Super learning (children tend to activate Theta whilst learning) Theta can activate stored painful memories ADD/ADHD individual usually produce too 14

Neuro-biofeedback Training For:
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Insomnia control Increase in Creativity Stuttering ADD/ADHD

Theta is also known as the twilight state which we normally only

experience fleetingly as we rise up out of the depths of delta upon waking, or drifting off to sleep. In Theta, we are in a waking dream, vivid imagery flashes before the mind's eye and we are receptive to information beyond our normal conscious awareness. Theta has also been identified as the gateway to learning and memory. In Theta state, brain cells are able to restore their sodium and potassium levels, which is essential for proper brain functioning. The sodium & potassium levels are involved in osmosis which is the chemical process that transports chemicals into and out of your brain cells. After an extended period in the Beta state the ratio between potassium and sodium is out of balance. This the main cause of what is known as "mental fatigue". A brief period in Theta (about 5 - 15min) can restore the ratio to normal resulting in mental refreshment

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much Theta in relation to Beta feelings of silence and being one with the universe; revelation moving beyond knowledge into knowing Heightened receptivity Reprogramming the Mind

ALPHA 8-12 Hz
 

Known Functions
Peak performance less anxiety and, correspondingly, stronger immune systems associated with light relaxation super learning/enhanced learning mode positive thinking mind/body integration intuition extra sensory perception day dreaming self reflection bridge between conscious & unconscious 15

Neuro-biofeedback Training For:
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The brain waves called "Alpha" were the first to be discovered (around 1908, by an Austrian Psychiatrist named Hans Berger).

Alpha brainwaves originate in the occipital lobe and move up towards the frontal lobes. When individual's do not produce sufficient alpha or alpha of insufficient power, then it never reaches the frontal lobes and they tend to operate in Beta which generates varying levels of anxiety

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Relief from pain Drug, Alcohol, Cigarette Addiction Hypertension Obtaining the state of Zen Clearing of past trauma Increased physical performance Increased creativity

and stress. This range (between 7– 8 Hz) encompasses the resonant frequency of the earth and ionosphere, and is known to aid in migraine/headache alleviation with visualization techniques. The Alpha and theta border also helps to boost the body's immune functions. Neuro- chemical levels of norepinephrine, serotonin and Beta-endorphins are increased.

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emotional balance & mood elevation inner awareness Associated with earth's magnetic field Enhances serotonin release Facilitates nicotine withdrawal Deficient in Alcoholics Excess can cause spaceness expanded awareness sense of peace & wellbeing

SMR 12- 15 Hz
SMR stands for Sensory Motor Rhythm, it is this brainwave that we use for passive intellectual activities. Ideally we should use SMR for everyday function and reserve Beta for more intense situation, However, for many Beta is the brainwave habitually used.
   

Known Functions
Training SMR can help ameliate Epilepsy Reduces anxiety Strengthen basic physiological functions Strengthen the Mind and conscious Ego in a positive way Calm intellectual processing

Neuro-biofeedback Training For:
                 

Anxiety Reduction ADD/ADHD Fearfulness lack of body awareness migraines stomach aches with stress Aspergers Chronic fatigue Difficulty falling asleep Epilepsy Fibromyalgia Menopausal symptoms Panic attacks Premenstrual Syndrome Improve maths conceptualisation Nightmares Improved spatial skills Reduction of Type A personality traits

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BETA 14- 37 Hz

Known Functions
highly abstract, complex mental functioning Strengthens basic physiological functions Strengthens the Mind and Ego in a positive way Excess - hypertension, anxiety, muscular tension, exhaustion alertness, concentration

Neuro-biofeedback Training For:
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 

From an evolutionary point of view beta allows us to assess and learn new information quickly, Beta activates all systems, it main function was for survival. However, Beta demands and uses large amounts of physical resources and when Beta goes into overdrive it eventually results in physical exhaustion. Think of constantly running through a jungle and not knowing were the next tiger is going to spring from!

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ADD/ADHD Anxiety Increase sequential processing Improved articulation/Langua ge Chronic Pain Addictions Depression Diabetes Difficulty staying asleep Dyslexia Fatigue Tension headaches Hypoglycaemia Insomnia Irregular Menstrual Cycle Improved sense of wellbeing Menopausal symptoms Panic attacks Improved maths & language skills sugar cravings inattentive learning difficulties social anxiety spacey

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GAMMA 38- 90 Hz
Known Functions
Gamma is a 'newer' brainwave only because it is difficult to get instrumentation to accurately measure it. It is thought the Gamma is the harmonizing frequency - for example when you are observing an object, its colour, size, texture etc are all perceived and processed by different parts of the brain, it is thought that Gamma allows for unification of all the different information.
  

Neuro-biofeedback Training For:
Harmonizing & Healing High level information processing Disappear with general anaesthesia

***Above information was current and correct at time of writing 2008

OK LET ME DIGRESS….. SOME INTERESTING INFO ABOUT YOUR BRAIN…. IF YOU’R HIGHLY SCEPTICAL YOU MAY WANT TO SKIP THE NEXT COUPLE OF PAGES AND COME BACK TO IT LATER……. RETICULAR ACTIVATING SYSTEM. (RAS)
The 2 main functions of RAS are to SORT DATA & SEARCH FOR ANSWERS!! Every 1/18th of a second your brain is subjected to 1850 bits of information, internal sensations such as a pain or an itch and external stimuli from your 5 senses, ( or 7 according to parapsychologists) that is 33300 per second,,,,,,,, what do you think would happen if you had to try and consciously process or attend to all this information…..???????????? just under 2 million bits of date a minute…….. Sensory overload! Meltdown. YOU WOULD MOST LIKELY GO INSANE RIGHT?????? 18

OBVIOUSLY SOME OF THIS INFORMATION IS MORE IMPORTANT TO YOU THAN THE REST……BUT HOW DOES YOUR BRAIN KNOW WHAT YOU WANT TO ATTEND TO AND WHAT YOU WANT STORED AWAY IN YOUR SUBCONSCIOUS?????? IMAGINE YOU HAVE A SUPER EFFICIANT PERSONAL ASSISTANT WHO HOLDS ALL YOUR CALLS AND ONLY PUTS THRU THE ONES YOU WANT OR NEED TO ATTEND TO…. WELL THAT IS WHAT YOUR RAS DOES BUT ON A MUCH LARGER SCALE……IT SORTs THE IMPORTANT STUFF (CRITERIA WE REFER TO AS DIPI) INTO YOUR CONSCIOUS AWARENESS AND FILES ALL THE REST (THE NON-DIPI DATA) INTO YOUR SUBCONSCIOUSE . OK SO WHAT SORT OF INFORMATION DO YOU THINK YOU WOULD WANT TO BECOME INSTANTLY AWARE OF???????? HOW ABOUT THAT WHICH IS DANGEOUSE…… SOMEONE IS DRIVNG TOWARD YOU AT 80 MILE AN HOUR ON THE WRONG SIDE OF THE ROAD, I WOULD SAY YOU WOULD WANT TO NOTICE THAT IN TIME TO SWERVE OR HIT THE BRAKES RIGHT!!!!! IF YOU WORK IN A POTENTIALLY DANGEROUS ENVIRONMENT HOW WOULD IT BE TO HAVE YOUR BRAIN FINELY TUNED SO THAT YOU ARE EVER AWARE OF POTENTIALLY DANGEROUS EVENTS. ………. things that threaten your safety ……. a piece of machinery that doesn‟t sound quite right, the feint smell of gas, a minute puddle of liquid near an electrical source! you can train your RAS to locate and define what is important or threatening to your survival. A PERFECT EXAMPLE OF YOUR RAS AT WORK IS WHEN YOU ARE DRIVING A CAR, PROBABLY THE MOST POTENTIALLY DANGEROUS THING THAT WE ALL DO ON A REGULAR BASIS. The radio is going; the kids in the back are playing. You may be talking on your phone,. There is stimuli all around, ADVERTISING bill boards designed to attract your attention, designed to attract your RAS by using pleasurable and novel stimuli!!! With all that going on you are still, for the most part, able to pick up on dysfunctional engine sounds, the feel of an under inflated tyre, MORE IMPORTANTLY YOU HOPEFULLY MANAGE TO NOTICE AND BE PREPARED FOR,A CHILD ABOUT TO RUN ON THE ROAD OR A SPEEDING CAR THAT SEEMS TO COME FROM NO WHERE… OR DO YOU! IF OVER TIME YOU HAVE BECOME A BIT COMPLACENT YOU CAN RETRAIN YOUR RAS TO ATTEND MORE TO POTENTIALLY DANGEROUS EVENTS AND LESS TO OTHER DIPI STIMULI.. ONE OF THE REASONS ALCOHOL IS SO DANGEROUS TO DRIVING AND OPERATING MECHANICAL EQUIPMENT IS THAT IT INTERFERES WITH RAS FUNCTION OK „D‟ is for Dangerous! SO WHAT ABOUT THINGS THAT ARE IMPORTANT TO YOU…. Mothers of young babies can often sleep through all sorts of noise but the moment their baby stirs they are awake 19

YOU HAVE JUST DECIDED THAT YOU WANT TO BUY A NEW CAR, A HOT BLACK SPIDER WITH LEATHER UPHOLSTERY, VERY NICE. ONCE YOUR BRAIN, YOUR RAS, HAS A PICTURE OF WHAT YOU WANT YOU WILL FIND THAT YOU WILL ZERO IN ON EVERY SIMILAR CAR THAT YOU PASS IN FACT IF YOU LISTEN TO YOUR „INTUITION‟ YOUR RAS MAY EVEN GUIDE YOU TO ONE THAT YOU DROVE PAST A WEEK AGO BUT AT THAT TIME IT WAS NOT „DIPI‟ TO YOU, OK SO „INTUITION‟ IS A CONTROVERSDIAL SUBJECT. CONTROVERSIAL USUALLY MEANS „WE DON‟T UNDERSTAND SOMETHING SO WE FEAR OR STIGMATISE IT‟ One „SCIENTIFIC‟ theory regarding Intuition is that it may well be auditory responses OR little messages to us, generated by our RAS I is for Important!! P FOR PLEASURE…….YOU ARE AT A CONFERENCE WITH 2000 SUITES DISCUSSING QUANTUM PHYSICS AND AS CINTILATING AS THE CONVERSATION IS YOU FIND YOUR ATTENTION IS DRAWN WAY ACROSS THE OTHER SIDE OF THE ROOM TO A TALL DARK HONEY WITH BIG BROWN EYES, BROAD SHOULDERS…BIG ARMS ..OH WAIT….. THAT‟S MY RAS… OK YOU NOTICE A BLONDE IN A MINI SKIRT OR THE LAST PIECE OF APPLE PIE ON THE BANQUET TABLE…because you skipped breakfast WE ALL KNOW THAT ADVERTISING COMPANIES USE SEXY MODELS TO GET YOUR ATTENTION AND THEY HAVE BEEN PREDOMENANTLY FEMALE BECAUSE HISTORICALLY IT HAS BEEN MEN WHO MADE THE FINAL DECISIONS ON MAJOR PURCHASES …YOU MAY NOTICE THEY ARE STARTING TO USE HUNKY GUYS IN ADDS .. Because these days the girls have to buy their own tyres and sports cars.

I IS FOR INTERESTING OR NOVEL OR UNUSUAL.. OUR TALL DARK HONEY IN THE CORNER TAKES OFF HIS SHIRT AND JACKET AND REVEALS A HUGE YELLOW TATTOO OF TWEETY BIRD ON HIS CHEST…..MALE OR FEMALE MOST PEOPLES‟ RAS WILL BE DRAWN TO THAT BECAUSE IT IS OUT OF THE NORMAL SCOPE OF PERCEPTUAL STIMULI *****OK SO dipi data GOES INTO YOUR CONSCOUS AWARESS SO THAT YOU CAN ATTEND TO IT IMMEDIATELY AND NON DIPI GOES INTO YOUR SUBCONSCIOUS OR YOUR WAREHOUSE OF INFORMATION THAT YOU MAY OR MAY NOT NEED OR USE SOMEDAY..

ANOTHER EXCITING FUNCTION OF YOUR RAS IS ITS ABILITY TO RESPOND TO QUESTIONS OR COMMANDS THAT YOU GIVE IT…IN FACT IT IS ACTIVATED BY QUESTIONS YOU ASK YOURSELF!!!
YOU HAVE BEEN DOING THIS ALL YOUR LIFE , HOWEVER IF YOU HAVENT KNOWN HOW TO ASK CORRECTLY YOU MAY HAVE GOTTEN RESULTS YOU DID NOT WANT. 20

Remember earlier I said we were going to talk about WHY we do not say things are hard (when they are) or I can‟t etc etc. Your RAS actually is guided by your words so this is why you need to speak in the positive.. just takes some practice…. Have you heard the expression what we fear we create….to get the best from your RAS you need to know how to ask positive powerful questions instead of negative destructive ones. Self fulfilling prophecies may come from you talking yourself into situations or states. Ask your RAS (your mind) to identify the risks in your environment, alert you to where they are and how to manage or avoid them. Ask your RAS to help your find the perfect job at the perfect time… HEY TRY IT! WHAT DO YOU HAVE TO LOSE???? If you tell a child not to fall on stairs it immediately think and creates a picture of the stars and falling, so what happens… You have heard that the optimist sees the glass as half full and the pessimist sees it as half empty….. actually they both SEE the same but they interpret and verbalise it differently the optimist SAYs the glass is half full, or this cold is temporary I will be well by tomorrow –or I am going to get this job the pessimist with the half empty glass might say, I have the flu and I‟m dying OR why can I not find the perfect job for me

OK BACK TO NORMAL STUFF……

Great but how do you get to this wonderful brain state……? You can control your brain rhythms by controlled breathing – and self talk - by practicing correct breathing on a daily basis it will eventually become automatic – it may take time but it will happen! The CD with this manual will take you there easily – all you need to do is play it on a daily basis, do not over-think or make a chore out of it – just lay back and let it work for you. The less you try the easier it will work for you! People have told you for years to „BREATH‟ but has anyone ever explained just how powerful correct breathing is……Did you know that breathing affects your brain rhythms, your release of hormones and
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other natural chemicals….as well as your heart and blood pressure…
Don‟t wait till you have an anxiety attack to breath, start learning now so that it becomes your normal way of breathing. In this way you will begin to function at a slower rhythm (ie. Alpha) so when you face a challenge and your brain rhythms speed up, guess what…. You will still be operating at a rate that allows you to take charge of the situation and cope much better. (Demonstration of correct breathing from diaphragm )

C.B.T. (What is that????)
Simple really; You think, you feel, you behave! Much of psychology today is based on the concept that your emotions and behaviours are largely determined by your thoughts!
Your thoughts are essentially based on (interpreted by) past attitudes, beliefs & experiences. So where did your beliefs etc, come from? Schemas, blueprints, models; in short – you learned them, they were probably modelled for you by others, you probably believe that all your beliefs are the absolute truth! (That isn’t very likely now is it?) BUT: You have been basing a lot of your attitudes, behaviour and responses on these blue prints!

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One of your blue prints may say that unless you succeed at everything you are a failure! One of your schemas might be that if a person cries they are weak… You may believe that you are silly or stupid because you were told that once (or many times)… So…You act off these beliefs…
Learning about CBT (Cognitive Behaviour Therapy) and how it relates to you will help you…  Recognise the connection between Thoughts. Emotions & Behaviours.  Monitor your own negative/automatic thoughts (cognitions)  Identify and alter distorted beliefs and thinking styles which predispose you to distort your (interpretation)experiences  To substitute irrational beliefs for interpretations/ideas which are more factual and realistic  To increase behaviours that work for you instead of against you…  AND to combat ANXIETY & DEPRESSION!!!!!!!

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THOUGHTS

Control Thoughts, ie., I‟m stupid, Why? When will I learn? I‟m useless, worthless, I can‟t

Interpret Behaviour Locate attitude, belief, or blue print FEELINGS
i.e. Gambling Drinking Self doubt Giving up

Feelings
I.e. Guilt, Shame, Disappointment, Fear, Worry, Stress, Anxiety, Depression

Window of opportunity

Learn to listen to your thinking……… Use your window of opportunity to change the way you interpret your surroundings and events you are involved in or exposed to… By changing your interpretation you are in a better space to try to change your response /reaction…. Become aware of your feelings…..

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As we grow we develop „Cognitive Maps,‟ blue prints that help us make sense of the world….Stereotypes, Attitudes, Beliefs and Choices (all of these can be positive, negative or neutral) How our “HELD” beliefs (cognitive maps) influence our view of the world affects how we interpret events, situations and feedback from people and the environment. HOW CAN WE EXPLAIN CAUSE AND EFFECT ie: Because of X and Y it must be Z……but in fact there are many other variables and explanations!!!!!!!!!!! Correct attribution gives us control over our life, that is, our world views are consistent with reality. HOWEVER if they are incorrect or faulty! We can become socially anxious; i.e. people are laughing at you, talking about you etc etc etc when in fact they are not! SO when you MISINTERPRET FEEDBACK you might become depressed or unhappy. Think of this in terms of internal and external locus of control! Can you think of personal examples of when you do this? In general Internal Locus of Control gives you power where external is quite literally out of your control and may make you feel inadequate as though it makes no difference what you do, obviously in terms of the weather and other peoples behaviour you have little or no control, however you ALWAYS have some control over your responses and choices. IF YOU HAVE BEEN ABUSED AS A CHILD YOUR PERCEPTIONS OF CONTROL MAY BE SERIOUSLY DAMAGED (Not however, beyond repair)

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Locus of Control Scale
For each question, choose the answer that best applies to your beliefs. 1. A. B. A. B. 3. A. B. A. B. 5. A. B. Making a lot of money is largely a matter of getting the right breaks. Success is achieved through working smart and being persistent.. The number of divorces suggest that more and more people are not trying to make their marriages work. Marriage is largely a gamble. It is silly to think that one can really influence another person‟s basic attitudes. When I am right I can convince others. In our society a person‟s future earning power is dependent upon his/her attitudes and ability. Getting promoted is really a matter of being a little luckier than the other person. Sometimes I feel that I have little to do with the rewards I get. In my case the rewards I get are the result of my own efforts; luck has little or nothing to do with it. People like me can change the course of world affairs if we make ourselves heard. It is only wishful thinking to believe that one can really influence what happens in society at large. I am the master of my fate. A great deal that happens to me is probably a matter of chance. It is almost impossible to figure out how to please some people. Getting along with people is a skill that must be practiced. If it goes right it is luck. If it goes wrong it is my doing.

2.

4.

6

A. B.

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A. B. A. B. A. B.

8

9

See if you can pick out External/Internal locus of control

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PROBLEM SOLVING: Problem………List all possible solutions no matter how impossible or improbable they may seem. Look at preferred solution/s. List reasons for and against taking this solution. What is needed to carry this out? Assess these possibilities. What will work? What MAY work? What won’t work? Be realistic, optimistic and totally honest (No that is not a contradiction). If preferred solution doesn’t look viable then look at next preference. Do the same assessment of how, why and what is needed. Keep going down the list until you find a solution that works for you. NOTE: It is important that you assess what you can and can’t do without being emotional; try to imagine it is someone else’s problem and you are helping them with it. Some situations are genuinely out of your hands….

….

So MAYBE ALL YOU CAN DO IS TRY TO STAY CALM AND KEEP YOUR HEAD…..FORTUNATELY YOU HAVE SOME DEGREE OF CONTROL IN MOST SITUATIONS
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Relaxation Practice Record For each relaxation practice, indicate your anxiety/tension before you begin and again after you have finished using the following scale. 0 10 20 30 40 50 60 70 80 90 100
Severe Tension/Anxiety

No Tension/Anxiety

Moderate Tension/Anxiety

Practice 1 Day/Date
Anxiety/Tension Before Anxiety/Tension After

Practice 2
Anxiety/Tension Before Anxiety/Tension After

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Relaxation Practice Record For each relaxation practice, indicate your anxiety/tension before you begin and again after you have finished using the following scale. 0 10 20 30 40 50 60 70 80 90 100
Severe Tension/Anxiety

No Tension/Anxiety

Moderate Tension/Anxiety

Practice 1 Day/Date
Anxiety/Tension Before Anxiety/Tension After

Practice 2
Anxiety/Tension Before Anxiety/Tension After

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SUGGESTIONS FOR DOING HOMEWORK
1. Plan your day 2. Try for the same time each day if possible 3. Reward yourself 4. If you set 30 minutes homework time and find it is too long, then try for 2 x 15 minutes or 3 x 10. Every little bit helps 5. Keep reminding yourself of the benefits of homework…even if you haven‟t seen them yet

☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺☺
It won‟t happen over night…but it WILL HAPPEN 6. CHALLENGE thoughts that say “what if” I fail… (instead think about how you will feel when you succeed) 7. Try not to leave it to the last minute

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(Source unknown)

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ANXIETY & DEPRESSION
CHAPTER 2 - Overview
 Review previous week  How did relaxation & breathing go  Sleep - Lethargy o Sleep cycles o Brain Rhythm o Basic necessities of life  Main model (CBT)  Activity Plan  Make up your own activity plan  Motivation  Homework; read handout o Continue with relaxation o Practice sleep o Play CD everyday

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Getting to Sleep and Staying There
 You have been given a really good CD, USE IT! IT WORKS! It has a build up effect, so use it regularly  Try and have a routine (if possible)  Go to bed when you are sleepy  Do not nap during the day  Try and get up the same time each day (even on weekends)  Try to keep bed for sleeping and romance! If possible avoid watching TV and studying in bed. We want your mind to associate bed with a cue to “go to sleep now”  AVOID CAFFEINE: That‟s coffee, coke, etc…It does keep you awake, so work out what time you have to stop having caffeine if you are to sleep that night  Alcohol and drugs make you sleep in the short term, BUT it isn‟t the right sort of sleep and it MAY make your ongoing sleep problem worse  THE SAME with sleeping pills, they can be a great short-term fix, or a means to catch up on some sleep, but in the LONG-TERM you need some SLEEP SKILLS  Laying in bed WORRYING stimulates your mind and keeps you awake SO if you can‟t put it out of your mind – write it down for attention tomorrow. Then put something else in your mind – like music, or your sleep CD  Use your problem solving techniques before bed time so that you can tell yourself you have a plan to deal with those worries…  Obviously if you haven‟t expended any energy during the day you won‟t be tired…  EXERCISE during the day will help you sleep (it may not happen over night but it WILL happen)  Eat regularly and avoid large meals before bed time. Indigestion OR empty tummy noises will keep you awake…  Make sure your bed room is dark, quiet, and have the TV off  A hot drink (especially MILK) before bed DOES help  Or a hot bath before bed  Don‟t put yourself in a position where you are looking at the clock all night, if need be get rid of it or cover it up
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A GUIDE TO SLEEP
Poor sleeping habits have a profound impact on your ability to function, and the symptoms vary; Physical Symptoms Pounding heart Cold hands/feet Sweating Nausea Diarrhoea Constipation Back pain Digestive difficulties Headaches Irregular breathing Fatigue Tension Voice/hand tremors Dry mouth Dizziness Impaired immune system Shortness of breath High blood pressure Vague aches/pains Difficulty breathing through nostrils

Psychological Symptoms Depression Boredom Nightmares Confusion Helplessness Tearfulness Dissociation Lethargy Urge to escape Fretfulness Anxiety 36

- Paranoia - Nervousness - Impaired focus - Negativity Behavioural Symptoms Fidgeting Smoking Substance abuse Reliance on medication Impulsiveness Reclusion Defensiveness Disorganisation Eating disorders Decreased sex drive Aggression Clumsiness Inflexibility Cynicism Impaired efficiency Decline in performance Nagging Poor self-care Withdrawal from supportive relationships

The purpose of breathing The purpose of breathing is to bring vitality and oxygen into our blood stream. But there are also many other crucial aspects in breathing; such as assisting the heart‟s pumping action, the flow of endocrine hormonal emission from the organs as well as the movement of the cerebral spinal fluid in the spinal cord. - Sat Chuen Hon, The Tao of Breath Human sleep patterns Our sleep patterns are intimately related to the natural world. The planet turns on its axis once every twenty-four hours, giving us cycles of light and darkness, and living organisms seem to cycle with it, as seen in diurnal changes known as circadian rhythms. These rhythms show up in daily fluctuations in the release of neurotransmitters in the brain and nervous system and in the biochemistry of all our cells. We have these basic planetary rhythms built into our systems. In fact, biologists speak of a „biological clock‟ controlled by the hypothalamus, which regulates our sleep/wake cycle and which can be disrupted by jet travel, working the night shift, by stress, and lifestyle patterns.

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„We cycle with the planet, and our sleep pattern reflects this connection. When it is disrupted, it takes us some time to readjust, to get back to our normal pattern.‟
- Jon Kabat-Zinn, Full Catastrophe Living

____________________________________________________________________________________ Circadian rhythm The circadian rhythm is the twenty-four hour cycle and regulates the body‟s rhythms from digestion and elimination to the growth and renewal of cells, inhalation, exhalation, and the rise and fall of body temperature. All these processes are triggered through a network of chemical messengers (hormones) and nerves via signals from the hypothalamus. The circadian rhythm ensures that body functions and sleep patterns run to a cycle of approximately twenty-four hours, irrespective of our environment. Melatonin Melatonin is produced by a pea-sized gland at the base of the brain called the pineal gland. It is the hormone that causes sleepiness and sound sleep. Darkness is one of the main triggers for melatonin production to increase, causing the body to start slowing down in preparation for sleep. Light entering the eye through the retina causes melatonin production to reduce, causing the body to awaken. The pineal gland‟s capacity to keep up the production of melatonin declines with age. Ultradian rhythm A one-and-a-half-hour cycle, the ultradian rhythm produces altered states of awareness naturally and rhythmically throughout the day and night. Each cycle lasts twenty minutes and seems to be the natural healing state of the mind and body. These cycles provide a natural „time out‟ when conscious awareness is toned down. We need to learn to recognise this rhythm in ourselves and flow with it without resistance. The stages of sleep Stage One An electroencephalogram (EEG) displays wavy lines during this stage – fairly regular, small undulations; Drowsiness dominates; a light phase, lasting approximately five minutes You can be awoken by a sharp sound All muscles slightly relax 38

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Your eyes slowly roll back and forth, not REM (Rapid Eye Movement – eyes jerking back and forth under closed eyelids) Your thinking is less logical Your dreams are remembered if you awaken

Stage Two It is a little harder to awaken Two new types of brainwaves appear – sleep spindles and K-complexes. These occur regularly and last only two to three seconds A sleep spindle is a sudden, short burst of pointed waves with frequency of 2/3 times (the background of theta waves) K-complexes are large waves that seem to come out of nowhere, and are thought to reflect massive changes in the processing of sensory information in the brain Most sleep talking and tooth-grinding takes place during this stage

Stage Three Occurs after another five to ten minutes You slip into moderately deep sleep It is now difficult to be awaken Delta waves; larger, more regular waves – come into play Theta waves, spindles, and K-complexes are still occurring, is harder to detect Delta waves become increasingly dominant

Stage Four Slow wave sleep The deepest level of sleep You are now extremely difficult to awaken All sleepwalking, bedwetting, and night terrors occur during this stage Your heartbeat and breathing are regular The growth hormone is released Blood cells and body tissue rebuild, especially your skin Energy levels are slowly restored There is no conscious thought Some dreaming, but you will have no memory of it if awoken

NOTE: Artificial sedatives significantly decrease REM sleep
Chronic Insomnia Chronic insomnia may develop slowly or as a result of a long lasting emotional or physical situation that has not been resolved. Four main factors need to be considered: Psychological factors Anxiety Stress Arguments Depression 39

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Loneliness Grief Dissatisfaction Illnesses such as schizophrenia

Medical factors Heart disease Lung disease PMT Asthma Ear, nose, throat infections Thyroid functions

Chemical factors Side effects of prescribed medications Alcohol Tobacco Narcotics Caffeine (tea, coffee, cola, chocolate)

Sensitivities Allergies to foods, chemicals or mould With rare exceptions, insomnia is a symptom, not the cause. Consult your doctor

Caffeine A strong stimulant that ultimately results in tiredness. Caffeine is found in coffee, tea, cola drinks, chocolate and cocoa.

Alcohol A depressant, alcohol may send you to sleep quickly but your sleep does not reach the deeper delta levels and you are likely to awaken in the early hours or sleep fitfully.
Nicotine Another stimulant, nicotine raises blood pressure, alters breathing, and triggers adrenaline (which also interferes with digestion) Prescribed medication Chemicals always have side effects, and a common one is sleep disturbance. Always check with your doctor before changing or ceasing to use medications. Starch, salt, sugar All three can keep you awake 40

Some lucky people can sleep anywhere…. Sleeping tips Keep your room dark Keep work out of your bedroom Don‟t read or chat on the phone in bed If you can‟t sleep, get up and do something mindless and/or repetitive – Get to bed at the same time every night Listen to soothing music Have a hot bath sprinkled with lavender oil Practice inhaling, holding for a count of ten, exhaling, holding for a count of ten, and keep doing this until you feel tired Practise calming visualisations Gently massage your wrists and temples

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Relaxation Practice Record For each relaxation practice, indicate your anxiety/tension before you begin and again after you have finished using the following scale. 0 10 20 30 40 50 60 70 80 90 100
Severe Tension/Anxiety

No Tension/Anxiety

Moderate Tension/Anxiety

Practice 1 Day/Date
Anxiety/Tension Before Anxiety/Tension After

Practice 2
Anxiety/Tension Before Anxiety/Tension After

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Basic Needs in life                          SUN FUN MODERATION GOOD FOOD EXERCISE AFFECTION PHYSICAL SAFETY AND SECURITY FINANCIAL SECURITY - ENOUGH TO MANAGE FRIENDSHIP BEING LISTENED TO FEELING HEARD GUIDANCE RESPECT VALIDATION EXPRESSING FEELINGS: INCLUDING ANGER SENSE OF BELONGING NURTURING INTIMACY SEXUAL EXPRESSION LOYALTY AND TRUST SENSE OF ACHIEVEMENT THE RIGHT TO BE WRONG TO FEEL WORTHY HOPE SENSE OF FREEDOME AND INDEPENDENCE NOT NECESSARILY IN THIS ORDER

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PREVIOUS EXPERIENCE UPBRINGING PARENTAL INFLUENCE PEERS SCHOOL LIFE SIBLING RELATIONSHIPS PRIOR TRAUMA ILLNESS RELIGIOSITY MEMORIES FUNDAMENTAL THOUGHTS ATTITUDES BELIEF SYSTEMS HOW YOU INTERPRET LIFE EVENTS AND

HOW YOU RESPOND

HOW YOU SITUATIONS THINK AND/OR FEEL

If you lack confidence and/or self-esteem…

EVENT STIMULUS LIFE SOMEONE SAYS SOMETHING TO YOU SOMETHING HAPPENS OR An idea or memory is triggered

YOU RESPOND

BECAUSE YOUR
Eg. Get Angry Worry Drink Cry Feel Bed Have Bad Thoughts Etc Etc Etc OR You respond appropriately OR You challenge that thought

INTERPRETATION WAS

Internal Control Factors

External Control Factors

MASTERY

HELPLESSNESS

Belief system was faulty: Everyone hates me; is talking about me, I SHOULD ……… I MUST BE a good… I am a failure…… …………… …

WITH (OR TO BUILD) CONFIDENCE AND A HEALTHY SELF ESTEEM

YOU CAN‟T RESPOND WITHOUT HAVING SOME THOUGHTS/INTERPRETATIONS

CHOSE: EVENT STIMULUS PERSON THOUGHTS *********** IF THOUGHTS ARE NEGATIVE, HOPELESS, FAULTY, IRRATIONAL OR IN ANY WAY DESTRUCTIVE OR UNHEALTHY.... CHALLENGE THEM: LOOK FOR OTHER EXPLANATIONS CONTROL – CHANGE RESPONSE, BEHAVIOUR. AND SUBSEQUENT THOUGHTS AND FEELINGS

WHATEVER HAPPENED THINGS YOU CAN CONTROL THINGS YOU CAN‟T CONTROL MEMORIES SOMEONE‟S BEHAVIOUR

FEELINGS *********

Getting Active
Activities consist of  Things you NEED to do  Things you WANT to do  AND things you can „get around to‟ if and when you feel like it…… WHEN DEPRESSED YOU DON‟T FEEL LIKE DOING MUCH SO YOU HAVE TO FORCE YOURSELF TO DO SOME THINGS – Often you end up feeling a sense of achievement that you actually got SOMETHING done! EXERCISE: Plan your day/week or if that‟s TOO hard start with planning the next few hours: BREAK IT UP into: Pleasure activities……(it is essential to incorporate pleasure/leisure/fun activities into everyday) Daily living requirements……At first this may just be getting up, showering and eating… Longer term living requirements…eg: paying bills, making phone calls, organising your life… SO!!!!!!!!! Start NOW! Your first activity is TO DO THIS EXERCISE! IF YOU WAIT UNTIL YOU FEEL LIKE DOING IT, IT WONT GET DONE! So encourage yourself NOW!

Day 1

ACTIVITY

CATEGORY (Pleasure or what??)

% COMPLETE

LEVEL OF SATISFACTION

TRY AND HAVE A BALANCE BETWEEN THINGS YOU HAVE TO DO, THINGS YOU WANT TO DO AND THINGS THAT ARE GOOD FOR YOU TO DO

NEGATIVE THOUGHTS ARE ACTIVITY BLOCKERS……THOUGHTS SUCH AS..     NO POINT IN TRYING NOT GOOD ENOUGH NOT SMART ENOUGH ETC ETC ETC

SELF DEFEATING FEELINGS AND THOUGHT LEAVE YOU DISCOURAGED.FEELING INADEQUATE, HELPLESS, HOPELESS, AND USELESS!!!

THIS RESULTS IN DISINTEREST POOR MOTIVATION AND MORE DEPRESSION

Normal Moods:

Moods are an important part of our everyday experiences and add certain richness to our quality of life. From time to time everyone feels “down” or “fed-up” or “out of sorts.” Sadness, concern, disappointment and annoyance can be useful emotional responses in situations that didn‟t turn out the way you would have liked them to. These feelings are often an indication that some effort is required to re-adjust or that something constructive must be done to deal with your feeling or to change the situation. Start using your “stress energy”
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Keeping a Mood Diary…… When we feel depressed, our view of the world tends to be darker and we are more likely to recall low feelings rather than happy feelings. Sometimes when people are depressed, they find it difficult to recall how they felt on a particular day last week, for instance. They also find it hard sometimes to gauge whether their mood is improving or not and what events trigger changes in mood. Keeping a mood diary for a few days a week doesn’t take too much time or work and it gives a much more accurate measure of how you’ve been feeling at different times of the day on different days of the week. A mood diary will also assist in measuring change in your feelings over a longer period of time – perhaps weeks or months. This gives us an idea of whether your depression is lessening. What to do:  Three times each day, take 5 minutes to rate your mood and anxiety level. Try to keep it to the same time e.g. after breakfast, before lunch etc.  If there has been something significant about your day, write it down.  If you miss a time or miss a whole day – don’t worry, just continue with the next rating time.  The most important part of this activity is to report How you feel at that particular time.

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ANXIETY & DEPRESSION
CHAPTER 3 - Overview
         Review last week Discuss Main Model (CBT) Conditioning Problem Solving o Cost Benefit Analysis o Decisional Balance Sheet Thought challenging Self Talk Coping with setbacks Overcoming problems Basics of Life o Breathe o Eat o Sleep o Exercise o LAUGH Link ABC Model to Our Model Homework; read handout o Play CD o Can‟t……vs……will/wont/choices o Do CBA on Problems/Decisions

 

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Discuss Main Model… Everything we talk about will find its way back to these main ideas..     What is the evidence…. Challenge your beliefs…attitudes…..programs ....blue prints Where did these blue prints originate… Challenge the evidence

Discuss illusions, false perceptions…

FACT

- OPINION

- EMOTIONAL RESPONSE

Explain conditioning… eg: You are conditioned to stop at red lights… You are conditioned to clean your teeth each morning… How many of your attitudes, beliefs, opinions have been conditioned into you? Are you racist, like your father before you??????? Do you have a low self image because that was your conditioning? Have you conditioned yourself to fail, give up, OR are you conditioned to keep going, to keep getting back up…. Discuss problem solving………………………… PROBLEM TO BE SOLVED:

List solutions (even ones that may seem impossible 1. 6. 2. 7. 3. 8. 4. 9. 5. 10
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Now one by one, think of ALL the reasons FOR and AGAINST each possible solution. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

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DECISIONAL BALANCE SHEET CONTINUING BENEFITS AS BEFORE COSTS MAKING A CHANGE BENEFITS COSTS

POSITIVE SELF TALK What do I have to do? How can I plan for it? PLANNING IS BETTER THAN GETTING ANXIOUS/WORRYING!!!!!!!!!

***If worry was a successful strategy we would all be incredibly successful at everything we do!!***
ANXIETY IS FEAR when anxious complete the sentence, “I am AFRAID of ………………………………………! Keep answering this until you arrive at the most specific answer.
Then break down the fear: How likely is this (thing I fear) to happen? Can I do anything about it/to prevent it/differently? What is the WORST that can happen? How likely IS that? How rational am I being (if not sure ask a trusted person for their opinion) OK SO IT’S STRESSFULL! IT’S SCARY! WHAT ARE YOUR CHOICES? How good will you feel if you beat this thing? What are the rewards for giving it a go? NOW     Plan One step at a time Go back a couple of steps if necessary before proceeding to next stage Psych yourself up, you can do it, the world won‟t end if you get it wrong!

Try to remove emotion when it‟s something you have to do but it is unpleasant, put one foot in front of the other and do what you have to do. Imagine your friend has to do this thing, what would you advise them…Follow your own advice!
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Pause, Breathe, admit your fear (after all it may be reasonable or appropriate??? )Check it out?? Sometimes a small amount of apprehension is not only normal but wise…learn what is rational and reasonable and act accordingly.

AT THE END OF THE DAY MAKE CHOICES YOU CAN LIVE WITH. It is ok to be wrong!!!!! It is ok NOT to be perfect!!!! It is ok to be AVERAGE!!!

“Well you look pretty strange to me…”.

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ESSENTIAL FACTORS OF COPING   

ACCEPTANCE ADAPTING ATTITUDE

ACCEPT THAT THERE IS A PROBLEM/ISSUE WHATEVER YOU WANT TO CALL IT: DENIAL IS SOMETIMES OK, BUT ONLY FOR A VERY LITTLE TIME AND ONLY TO GIVE YOU TIME TO CATCH YOUR BREATH; IT POSTPONES ACTION, IT DOES NOT REPLACE IT.

Get information: Knowledge and Insight are powerful tools to help you understand yourself, others and life.
KNOWLEDGE IS POWER SELF-EMPOWERMENT PROMOTES SELF ESTEEM RELIEVES ANXIETY AND COMBATS DEPRESSION

COPING WITH SETBACKS Occasional setbacks are inevitable; they are inevitable in life as well as depression programs. We can predict that it is highly likely that you will experience setbacks when events occur in your lives which involve dramatic change of some sort (eg. moving house, changing jobs). At such times, negative thoughts and feelings may take hold of you and are hard to shake off. The big mistake here is to become alarmed and think that all has been in vain that you will revert back to your original condition. Chose NOT to revert back to the way you once were. Even if you do slip backwards, you will not slip backwards all the way. You have not failed! If you think you have failed this will trigger more negative thoughts. Remember the road to recovery is often a rocky - rarely smooth. With the right attitude and proper planning you will soon feel better and be able to tackle the things you used to do before the setback. When you do experience a setback, the following guidelines are recommended:  Try to identify what has lead to the setback and attempt to solve it while at the same time learning more about yourself and the disorder.  Reread these sessions to remind yourself of all the things you have learned.
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 Tackle one or two things only, things that you‟ve previously successfully mastered.  Go back to scratch and start again. It won‟t take long to get back up again! Make sure that you attribute your setback to correct causes. Don‟t blame yourself for something that you couldn‟t help or foresee, something that you had no control over. Illness and accidents can happen to anyone, and no-one can foresee the future. On the other hand claim responsibility for making yourself feel better as quickly as possible. Better still, use the setback as a new opportunity for learning and watch yourself emerge as a stronger more confident and more effective personality.

PROTECTIVE FACTORS To assist you in protecting yourself from getting depressed try the following:  Allow yourself to be YOU  Allow yourself to make mistakes  Build up your self esteem (if others won‟t tell you how good you are TELL YOURSELF)  Everyone has some good qualities (even if they are hard to find)  Express your feelings and thoughts ASSERTIVELY & APPROPRIATELY  Establish social supports; this can be a tough one, but what do you have to lose? There are so many other people out there JUST LIKE YOU, ask for help in finding them!  Reduce unnecessary stress by planning, time management and being realistic about what you can reasonably do (Today! In the short term! In the long term!)  DO WHAT YOU CAN PLUS A TINY BIT MORE!
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Eat good food!

Smile as often as you can

Cuddle someone you love.
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This model describes how emotion and behaviour are direct consequences of our thinking A Activating Event
The activating event can be anything – something that happens to us, something that somebody says or does, even something internal – an idea or memory that is triggered off

B

Thoughts and Beliefs
Can be beliefs or attitudes such as: A REAL MAN MUST PROVIDE FOR HIS FAMILY: They can be visual images like an image of your father

standing over you, or they can be brief automatic thoughts such as I’m a FAILURE. This also includes the constant chatter of self-talk that goes on in our head

C

Consequence
This includes anything that follows as a consequence of A-B, For example: feelings, behaviours, sensations, other

thoughts include depression, anxiety, and anger and avoidance behaviour (Link to our Main Model)

START CHALLENGING ALL YOUR THOUGHTS TODAY!!!!!!!
Session Exercise Errors of logic, or cognitive distortions/non-productive thinking styles, are quite common in everyday thinking and are not used just by depressed or anxious people, as the following exercise may demonstrate. Read through the following examples of non-productive thinking/cognitive distortions/errors in logic and try to recall a personal example of each.

***Overgeneralisation refers to drawing global conclusions about worth, ability or performance on the basis of a single fact. Consider a person who fails to fix a leaky tap in the house. Many people would call a plumber and then forget about it. But the depressed person may overgeneralise and may go as far as to believe they are a poor person who is unable to fix ANYTHING, just because they failed to fix this thing. ***Magnification and Minimisation are gross errors of evaluation, in which small bad events are magnified and large good events are minimised. The inability to find the right colour shirt is considered a disaster, but a large raise and praise from work is considered trivial. ***Personalisation (something we all do sometimes) refers to incorrectly taking responsibility for bad events. A neighbour slips on a piece of litter outside the depressed person‟s house and falls, the person blames themselves for not anticipating and preventing the accident.

Arbitrary Inference: (jumping to conclusions). You make a negative interpretation even though there are no definite facts to support your conclusion, eg. Fortune telling, i.e. predicting the future; mind-reading, i.e. concluding people think negatively of your actions before checking it out. Personal Example:

Selective Abstraction: (mental filters). You pick out a single negative detail and dwell on it so that your vision of reality becomes darkened, like the drop of ink that discolours the beaker of water. Personal Example: Overgeneralisation: You see a single event as a never ending pattern of defeat. Personal Example: Magnification, Catastrophising, or Minimising: You exaggerate the importance of mistakes or diminish the importance of your achievements. Personal Example:

Personalisation: You tend to see yourself as the cause for negative events which you were not responsible for. Personal Example: All or Nothing Thinking: (Black & White Dichotomous Thinking). You see things in black and white categories, eg. if your performance falls short of the perfect you see yourself as a failure. There is no middle ground. Beware of words such as always, never, everyone, no-one, everything, and nothing. Personal Example: Disqualifying the Positive: (Extreme form of minimisation). You reject the positive experiences by insisting they don‟t count. In this way you maintain a negative belief that is contradicted by everyday experiences. Personal Example: Emotional Reasoning: You assume your negative emotions reflect the way things really are. Personal Example: Should Statements: (Using ultimatums). These statements reflect the need to be right all the time, never making a mistake, the need to be always perfect. The consequence of these thoughts is that you develop guilt when you fall short of your standard, and anger/frustration at not achieving at your expected level. Personal Example:
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Labelling and Mislabelling: This represents an extreme form of overgeneralisation. You make an error and then describe yourself as a loser; there is a tendency to attach negative labels to yourself. There is also a tendency to do the same to others, seeing them in a very negative light. Often events are seen in a very dramatic way and described very emotionally. Personal Example: Concentrating on Weaknesses and Forgetting Strengths: You focus on your weaknesses, giving an unbalanced view of yourself. Strengths are seen as unimportant, or not considered at all. Personal Example: Using double standards: You expect of yourself what you would not expect of others. Personal Example: Overestimating the Chances of Disaster: A form of catastrophising where you overestimate the probability that something may go wrong. Personal Example: Exaggerating the Importance of Events: You don‟t stop and ask yourself, “What difference will it make in a week, or in 10 years? Will I feel the same way?” Personal Example: Taking a Pessimistic View of Your Ability to Change a Situation: You give up trying because you don‟t think you can change the situation (can lead to depression, helplessness, and lowered self-esteem). Personal Example: Blaming the Past: You blame the events of yesterday/year for how you are today, without taking responsibility for changing yourself and/or your present/future. Personal Example:

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ANXIETY & DEPRESSION
CHAPTER 4 - Overview
 Assertiveness o Conflict VS Resolution o Power o Rights o Violence o Abuse o Emotional Boundaries o Body Language o Listening  Effects of Childhood Trauma o Good parents make mistakes too o Raising the bar o Power of words o Teasing/Bullying

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The three A‟s – awareness, answering and acting.
Awareness: Record your experiences-continue to use your diary to help you identify the thought patterns regarding your depression. This is important for increasing your awareness of and insight into your condition. Answering: Simple awareness that you have a bad habit isn‟t going to mean that you are going to give up that bad habit. You need to

actually challenge your thinking. First step is to ask yourself WHY

DO I BELIEVE my own thoughts? Quite simply, the more

often you think something the more likely you are to believe it.

Many of your automatic thoughts have been with you for years and because of their familiarity you are less likely to question them.

Your automatic thoughts are based on belief systems taught to you by your family and are often reinforced by friends and society.

Remember that just because an idea is commonly held, it is not necessarily valid or true.
Other people‟s beliefs are not necessarily right for you. Recognise that many of your thoughts are not facts. They are merely assumptions, which determine how you feel and what you do. Acting: Acting as though the new positive, rational thoughts are true will, over time, become the new habit. Simple repetition is a major factor.
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EXAMPLE: A B You have been asked to go to a party “I won‟t be able to handle it” “People will stare at me because I‟m depressed”

C Feeling hopeless and therefore avoid going to the party. Before you can experience any event, you must process it with your mind and give it meaning. You must understand what is happening to you before you can feel it. Therefore it is not the actual

events that cause you distress, but your perceptions that result in changes in mood. So when you are depressed or anxious, your thinking may be illogical, unrealistic and thus irrational. When
you are depressed next time try to identify any thinking that you have. We will discuss B in more detail and how to challenge it. What are the advantages and disadvantages of this way of thinking? Sometimes people are ambivalent about challenging certain beliefs, particularly perfectionism. There is a belief or thought that you have, that causes you problems or distress, but you believe you have to live by, or you think you have to accept it because it was taught to you – then ask yourself: - Am I happy with things the way they are? - Are my thoughts/beliefs helping me to achieve what I want out of life? - Are my thoughts/beliefs helping me get along with others whom I care about?
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- Is my thinking helping me to feel good about myself and my life? - Do the advantages of thinking this way outweigh the disadvantages? When you identify your own beliefs either from being at group or writing them down, try to rewrite the belief and make it more rational and less problematic. Eg. Core belief – I have to be liked by everybody or I am worthless Rational response – I would like to be liked by everybody but sometimes this is not possible and my worth should not depend on it. The core belief in the example would result in a lot of distress whereas the rational response would be more conducive to liking yourself, achieving your goals and getting on better with other people. If a lot of your irrational thoughts are similar it may mean that there is a common core belief responsible for these irrational thoughts. Once you have done this ask yourself how your behaviour and feelings will change with your new rational response compared to believing in your core irrational beliefs. Priming: Put together a list of positive thoughts, especially ones that focus on your good qualities. Write them onto small cards and put them in your purse or wallet or pocket. Every hour take a card out and read it. Have you been thinking like this in the past hour, or thinking the usual negative stuff? You may want to repeat the thought 10-20 times, and then replace the card. You may also add
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blank cards, which means you have to spend the next 60 seconds thinking positive and of picking up where your thinking went wrong not long after it has actually occurred. Cueing: Use behaviours, which you do on a daily basis to remind you to pay attention to your thinking and to consciously practice thinking positive thoughts. Eg. Brushing teeth, combing hair, having a cup of coffee. If you drive a lot, every time you pass a service station or stop at a set of traffic lights check your thinking. Journal: You need to keep some form of written journal going, and to include in it those things you did well, the successes as well as the failures and problems. You need to get into the habit of periodically looking back and noticing things you‟ve accomplished and that you can feel good about it in some way. This redirecting attention to where it belongs. On the positive.

IF YOU DO WHAT YOU HAVE ALWAYS DONE YOU WILL GET WHAT YOU HAVE ALWAYS GOT.

Awareness
Thought catching – by firstly identifying your tracks or clues you will then start to identify the thinking that result in your distress such as depression. Remember to catch your thoughts you need to pay attention to negative feelings such as guilt, key words or phrases such as must and should, things you avoid/put off doing and unpleasant body sensations such as anxiety.
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Answering:
Challenging your thinking means critically scrutinising each automatic thought that leads to some distress or unpleasantness. Changing your thinking is sometimes like having debating teams inside your head. There are two teams, Healthy Voice VS Pathological Critic. One represents the distorted, negative thoughts that you are familiar with. The other team provides the newer positive thoughts. Each time you give attention to the negative team you must give equal time to the position team.

Eight techniques are involved and we will examine each one individually:

1. 2. 3. 4.

Evidence Alternative explanations De-catastrophising Advantages & disadvantages of thinking this way

5. Rational Responses 6. Priming 7. Cueing 8. Journal

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ASSERTIVENESS TRAINING
How you react with others can be a source of considerable stress in your life. Assertiveness training can reduce that stress by teaching you to stand up for your legitimate rights. Without bullying! Or letting others bully you! Look at the following examples and write below each, how you would usually respond to these situations. 1. You buy something from a shop and after walking out you discover your change is short $3.
……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… 2. At a restaurant the meal you were served is not what you ordered. ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… 3. You are giving a friend a lift to work but when you pick him up he fusses around and it is likely to make you both late. ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… 4. You book your car in for service and you have been quoted $150. You left them your mobile phone number. When you collect the car they have done extra work and the bill is $250. ……………………………………………………………………………………………… ……………………………………………………………………………………………… ………………………………………………………………………………………………
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……………………………………………………………………………………………… ……………………………………………………………………………………………… 5. You are relaxing in front of the TV and your partner hands you a list and says “run down to the supermarket and get these for me.” ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… 6. You are next to be served but the shop assistant serves another person before you. ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… WE WILL RETURN TO THESE ANSWERS LATER ON

ASSERTIVENESS: EXPRESSING PERSONAL RIGHTS AND FEELINGS!
Studies have found that nearly everyone can be assertive in some situations and then be a “doormat” in others. GOAL: To increase the amount of situations where YOU are assertive. AND Decrease: Situations where you become hostile, blow up, and lose the plot (and end up not getting what you want).

You know you are being assertive when:
 You stand up for your rights in such a way that the rights of others are not being violated! Not just by demanding.  By expressing your personal likes and interests spontaneously  You can talk about yourself without being self-conscious  You can accept compliments (if you can‟t say something good just say „thank-you‟)  You can disagree with someone!
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 You can ask for clarification!  You can ask WHY!  YOU CAN SAY NO

ASSERTIVENESS IS NOT BEING MANIPULATIVE, MEAN OR PUSHY!

Lack of assertiveness is usually lack of self-esteem, not believing you have a right to have feelings, opinions, beliefs, THINKING that others are always more right or more important than you are!

ASSERTIVENESS TRAINING
Assertiveness training has been found to be effective in dealing with depression, anger, resentment, and interpersonal anxiety, especially when these symptoms have been brought about by unfair circumstances. As you become more assertive, you begin to lay claim to your right to relax, and are able to take time for yourself. Assertiveness Training Steps: Step One: Interpersonal Styles The first step in assertiveness training is to identify the basic styles of interpersonal behaviour. Aggressive Style: Typical examples of aggressive behaviour are fighting, accusing, threatening and generally stepping on people without regard for their feelings. The advantage of this kind of behaviour is that people generally do not push the aggressive person around. The disadvantage is that people do not want to be around aggressive people. Essentially, the aggressive person is saying that they are more important than anyone else.
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Passive Style: A person is behaving passively when they let others push them around, when they do not stand up for themselves, and when they do as they are told, regardless of how they feel about it. The advantage of being passive is that you rarely experience direct rejection. The disadvantage is that you are taken advantage of, and you store up a heavy burden of resentment and anger. Essentially, the passive person is saying that they are less important than anyone else. Passive-Aggressive Style: A person is behaving passive-aggressively when they don’t stand up for themselves in the situation, and agree to do as they are told, but either don’t do it, or do it badly, deliberately, or some other behaviour which subverts the supposed agreement. The advantage of being passive-aggressive is that people are less likely to ask you to do things twice. The disadvantage is that people will resent your actions, and won’t trust you, even if later you willingly agree and intend to do as asked. Essentially, the passive-aggressive person is saying that, outwardly, they are less important than anyone else but, inwardly, believe themselves to be more important than anyone else. Assertive Style: A person is behaving assertively when they stand up for themselves, express their true feelings, and does not let others take advantage of them. At the same time, they are considerate of others’ feelings. The advantage of being assertive is that you get what you want, usually without making others mad. If you are assertive, you can act in your own best interest and not feel guilty or wrong about it. Essentially, the assertive person is saying that they respect both themselves and the other person and recognises that both have equal rights. Meekness and withdrawal, attack and blame are no longer needed with the mastery of assertive behaviour. They are seen for what they are – inadequate strategies of escape that can cause more pain and stress than they prevent. Before assertive behaviour can be achieved, the fact that the passive and aggressive styles often fail to get the desired result must be recognised.
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Exercise: To test your ability to distinguish interpersonal styles, label person A‟s behaviour in the following scenes as aggressive, passive or assertive. Scene 1 A: Is that a new dent I see in the car? B: Look, I just got home, it was a wretched day and I don’t want to talk about it now. A: This is important to me, and we’re going to talk about it now. B: Have a heart. A: Let’s decide now who is going to pay to have it fixed, when and where. B: I’ll take care of it. Now leave me alone, for heavens sake! A’s behaviour is □ Aggressive □ Passive □ Assertive

Scene 2 A: You left me by myself at that party…I really felt abandoned. B: You were being a party pooper. A: I didn’t know anybody – the least you could have done is introduce me to some of your friends. B: Listen, you’re grown up. You can take care of yourself. I’m tired of your nagging to be taken care of all the time. A: And I’m tired or your lack of consideration. B: Okay, I’ll stick to you like glue next time. A’s behaviour is □ Aggressive □ Passive □ Assertive Scene 3 A: Would you mind helping me a minute with this file? B: I’m busy with this report. Catch me later. A: Well I really hate to bother you, but it’s important. B: Look, I have a 4 o’clock deadline. A: Okay, I understand. I know it’s hard to be interrupted. A’s behaviour is □ Aggressive □ Passive
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□ Assertive

Scene 4 A: I got a letter from mum this morning. She wants to come and spend two weeks with us. I’d really like to see her. B: Oh no, not your mother! And right on the heels of your sister. When do we get a little time to ourselves? A: Well, I do want her to come, but I know you need to spend some time without in-laws under foot. I’d like to invite her to come in a month, and instead of two weeks, I think one would be enough. What do you say to that? B: That’s a big relief to me. A’s behaviour is □ Aggressive □ Passive □ Assertive

Scene 5 A: Boy, you’re looking great today! B: Who do you think you’re kidding? My hair is a fright and my clothes aren’t fit for the Goodwill box. A: Have it your way. B: And I feel just as bad as I look today. A: Right. I’ve got to run now. A’s behaviour is □ Aggressive □ Passive □ Assertive

Are there any scenes above in which B could be potentially passiveaggressive? Step Two: Identifying Situations You Want to Work On Step two in assertiveness training is to identify those situations in which you want to be more effective. Exercise: Having clarified the interpersonal styles, now re-examine your responses to the 5 problem situations you responded to at the beginning of this session. Label your own responses as falling
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primarily in the aggressive, passive, passive-aggressive, or assertive style. This is a start in objectively analysing your own behaviour and finding out where assertiveness training can most help you. Identifying those situations in which you would like to be more assertive requires the answering of three questions – When? Who? What? Use the space below to identify situations where you feel uncomfortable about being assertive. Rate your situations from 1 (Very Comfortable) to 5 (Unbearably Threatening). Some examples have been provided to get you started, if these are also applicable to you rate them as well.

When do you behave non-assertively? Comfort Rating 0-5           ASKING FOR HELP STATING A DIFFERENT OF OPINION RECEIVING NEGATIVE FEELINGS EXPRESSING NEGATIVE FEELINGS RECEIVING POSITIVE FEELINGS SPEAKING UP ABOUT SOMETHING THAT ANNOYS YOU MAKING REQUESTS OF AUTHORITY FIGURES ASKING QUESTIONS ASKING FOR A DATE ASKING FOR AN APPOINTMENT

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Who are the people with whom you are non-assertive? Comfort Rating 0-5            PARENTS FELLOW STUDENTS STRANGERS OLD FRIENDS SPOUSE OR PARTNER EMPLOYER RELATIVES CHILDREN ACQUAINTANCES SALES PEOPLE MORE THAN TWO OR THREE PEOPLE IN A GROUP

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What do you want that you have been unable to achieve with non-assertive styles? Comfort Rating 0-5      APPROVAL FOR THINGS YOU HAVE DONE TO GET HELP WITH CERTAIN TASKS MORE ATTENTION, OR TIME WITH YOUR PARTNER
TO BE LISTENED TO AND UNDERSTOOD

CONFIDENCE IN SPEAKING UP WHEN SOMETHING IS IMPORTANT
TO YOU

 CONFIDENCE IN ASKING FOR CONTACT WITH PEOPLE YOU FIND
ATTRACTIVE

 TO OVERCOME FEELINGS OF HOPELESSNESS AND THE SENSE THAT
NOTHING REALLY CHANGES

 TO INITIATE SATISFYING SEXUAL EXPERIENCES  TO DO SOMETHING TOTALLY DIFFERENT AND NOVEL  TO HAVE TIME BY YOURSELF

Examine your answers, and analyse them for an overall picture of what situations and people threaten you. How does non-assertive behaviour contribute to the specific items you checked on the “what” list? In constructing your own assertiveness program, it will be initially useful to focus on items you rated in the 2-3 range. These are the situations that you will find easiest to change. Items that are very uncomfortable or threatening can be tackled later.
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Step Three: Describing Your Problem Scenes Step three in assertiveness training is to describe your problem scenes. Select a mildly to moderately uncomfortable situation that suggests itself from items you’ve marked above. Write out a description of the scene, being certain to include who the person involved is, when it takes place (time and setting), what bothers you about the situation, how you’ve dealt with it, your fear of what will take place if you are assertive, and your goal. Always be specific! Generalisations will make it difficult later on to write a script that will make assertive behaviour possible in this situation. The following is an example of a poor scene description: I have a lot of trouble persuading some of my friends to listen to me for a change. They never stop talking, and I never get a word in edgewise. It would be nice for me if I could participate more in the conversation. I feel that I’m letting them run over me. Notice that the description doesn’t specify who the particular friend is, when this problem is most likely to occur, how the nonassertive person acts, what fears are involved in being assertive, and a specific goal for increased involvement in the conversation. The scene might be rewritten as follows: My friend Joan (who), when we meet for a drink after work (when), often goes on non-stop about her marriage problems (what). I am just there and I try to be interested (how). If I interrupt her, I’m afraid she’ll think I just don’t care (fear). I’d like to be able to change the subject and talk sometimes about my own life (goal). Exercise: Write three or four problem scenes, and for each scene try to relive your thoughts and feelings when you were actually experiencing it. You might notice, for example, that in each problem scene you pull yourself down with negative thoughts (“I can’t do it,” “I’m blowing it again,” “Boy do I look stupid” etc), or you usually feel tense in the stomach and seem to be breathing way up in your chest. Strategies in
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the earlier workshop sessions will help you cope with habitual thoughts and physical reactions that make you uncomfortable when you act assertively. Coping skills training , deep muscle relaxation, breathing exercises, etc, should all be useful with these uncomfortable thoughts and feelings. At this point however, we will concern ourselves with behaviour – changing your habitual way of dealing with these problem situations. Step Four: Your Script for Change The fourth step in assertiveness training is writing your script for change. A script is a working plan for dealing with the problem scene assertively. There are six elements in a script: 1. Look at your rights, what you want, what you need, and your feelings about the situation. Let go of blame, the desire to hurt, and self pity. Define your goal and keep it in mind when you negotiate for change. 2. Arrange a time and place to discuss your problem that is convenient for you and for the other person. This step may be excluded when dealing with spontaneous situations in which you choose to be assertive, such as when a person cuts ahead of you in line. 3. Define the problem situation as specifically as possible. This is essential for focussing the discussion. Here is your opportunity to state the facts as you see them and share your opinion and beliefs. For example; “It’s time to make a decision about where we are going to eat tonight. I know you love Mexican food, but we’ve eaten at Tijuana Joe’s the last three times we’ve gone out for dinner. We’re in a rut!” 4. Describe your feelings so that the other person has a better understanding of how important an issue this is to you. Once they are expressed, your feelings can often play a major role in helping you get what you want, especially when your opinion differs markedly from that of your listener. If nothing else, the listener may be able to relate and to understand your feelings about an issue even when they totally disagree with your perspective. When you share your feelings, you become less of an adversary. There are three important rules to remember when assertively expressing your feelings:
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 Do not substitute an opinion for a feeling (“I feel that Mexican food should be abolished!”). The more accurate feeling statement is, “I hate Mexican food!”  Use “I” messages that express your feelings without evaluating or blaming others. Rather than saying, “You are inconsiderate” or “You hurt me,” the I message would be, “I feel hurt.” Thus owning your feelings and taking responsibility for how you feel.  “I” messages connect the feeling statement with specific behaviours of the other person. For example, “I feel hurt when you ignore my wishes about where we eat.” Contrast the clarity of this message with the vague blame statement, “I feel hurt because you are inconsiderate.” 5. Express your request in one or two easy-to-understand sentences. Be specific and firm! Instead of expecting others to read your mind and magically meet your needs, as in the case of the passive individual, you state clearly your wishes and needs. Rather than assuming that you are always right and entitled to getting your way, as an aggressive person might, you state your wants as preferences, not commands. Example, “I would really like to go to a French restaurant tonight.” 6. Reinforce the other person to give you what you want. The best reinforcement is to describe positive consequences. “We’ll save money…We’ll have more time together…I’ll give you a backrub…My mother will only stay a week…I’ll be less tired and more fun to be with…I’ll be able to get my work in on time…etc.” When you’re dealing with someone who has a history of being resistant and uncooperative, positive reinforcement may not be terribly motivating. Consider, instead, describing some negative consequences for failure to cooperate. The most effective negative consequences are descriptions of the alternative way you will take care of yourself if your wishes aren’t accommodated. It should be noted that negative reinforcement is often not necessary, and that positive reinforcement
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may require no more than the assurance that you will feel good if a certain behaviour change is made. Elaborate promises can usually be avoided. Eg. If we can’t leave on time, I’ll have to leave without you. Then you’ll have to come over later on your own. If you can’t clean the bathroom, I’ll hire someone to do it once a week and add it to your rent. If you keep talking in this loud, attacking way, I’ll leave. We can talk again tomorrow if you are calmer. Notice that these examples are different from threats. The consequences of non-cooperation are that the speaker takes care of their interests. The consequences are not designed to hurt, merely to protect. Threats don’t usually work because they make people angry. If you do make a threat, make sure you are willing and able to back it up. Even then it will often do more harm than good. The first letters of each script element combine to spell “LADDER”. You may find this a useful mnemonic device to recall the steps toward assertive behaviour. The LADDER script can be used to rewrite your problem scenes so that you can assert what you want. Initially, LADDER scripts should be written out and practiced well in advance of the problem situation for which they are created. Writing the script forces you to clarify your needs and increases your confidence in success. As an example of a ladder script, we’ll use the example of a person who wants to assert their right to half an hour each day of uninterrupted peace and quiet while their do their relaxation exercises. The person is often interrupted by questions and other attentiongetting manoeuvres. Their script goes like this: Look at your rights, what you want, and what you need (LOOK AT):
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It’s my responsibility to ensure that my needs are respected, and I am certainly entitled to some time to myself. Arrange a time and a place to discuss the situation (ARRANGE): I’ll ask X if they’re willing to discuss this problem when they get home tonight. If they aren’t, we’ll set a time and place to talk about it in the next day or two. Define the problem specifically (DEFINE): At least once, and sometimes more often, I’m interrupted during my relaxation exercises – even though I’ve shut the door and asked for the time to myself. My concentration is broken and it becomes harder to achieve the relaxation. Describe your feelings using “I” messages (DESCRIBE): I feel angry when my time alone is broken into, and frustrated that the exercises are then made more difficult. Express your request simply and firmly (EXPRESS): I would like not to be interrupted, except in dire emergency, when my door is closed. As long as it is closed, assume that I am still doing the exercises and want to be alone. Reinforce the possibility of getting what you want (REINFORCE): If I’m not interrupted, I’ll come in afterward and chat with you. If I am interrupted, it will increase the time I take doing exercises. This script, like the problem scenes earlier, is specific and detailed. The statement of the problem is clear and to the point, without blaming, accusing, or being passive. The feelings are expressed with “I” messages and are linked to specific events of behaviours, not to evaluation of the other person. “I” messages provide a tremendous amount of safety for the assertive individual because they usually keep the other person from getting defensive and angry. You are not accusing anyone of being a bad person, you are merely stating what you want or feel entitled to.

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Successful LADDER scripts do the following:
 When appropriate, establish a mutually agreeable time and place to assert your needs.  Describe behaviour objectively, without judging or devaluing.  Describe clearly, using specific references to time, place and frequency.  Express feelings calmly and directly.  Confine your feeling response to the specific problem behaviour, not the whole person.  Avoid delivering put-downs disguised as “honest feelings”.  Ask for changes that are reasonably possible, and small enough not to incur a lot of resistance.  Ask for no more than one or two specific changes at a time.  Make the reinforcements explicit, offering something that is really desirable to the other person.  Avoid threats or negative consequences that you’re not willing or able to follow through  Keep your mind on your rights and goals when being assertive.

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Exercise: Write your own LADDER script, using one of the areas you identified earlier LOOK AT:

ARRANGE:

DEFINE:

DESCRIBE:

EXPRESS:

REINFORCE:

Using your written scripts, rehearse in front of a mirror. If possible, audio record your rehearsals to further refine your assertive style. It can be helpful to rehearse scripts with a friend and get immediate feedback. Let yourself imagine, or better yet, act out, the worst possible response that could be made to your assertive request. Get desensitised to the “nightmare” response by facing it, and then preparing your own countermeasures. Though, in the actual situation, beware of misinterpreting slight negative reactions as the “nightmare” coming true.

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Short Form Assertiveness Technique The short form assertiveness technique is designed for situations where you lack the time or energy to prepare an entire LADDER script. Assertiveness can be condensed to three basic statements: 1. Your Thoughts about the problematic situation. This is nonblaming, non-pejorative description of the problem as you see it. You stick as closely as possible to objective facts, making no inferences about the motives or feelings of others. 2. Your Feelings. These are “I” statements about your emotional reaction to the problem. Try to avoid the implication that you are holding the other person responsible for your feelings. You’re angry, sad, hurt, or disappointed. But your main message should be that you are trying to solve a problem, not blame or prove the other person wrong. 3. Your Wants. As in the LADDER script, make your request specific and behavioural. Don’t ask your tardy partner to be “more considerate”. Request specifically that they call if more than 15 minutes late. Whenever you’re in a situation that requires an assertive response, quickly run through the three short form components in your mind…I think…I feel…I want… Step Five: Assertive Body Language The fifth step in assertiveness training is to develop body language. Practice with the mirror, this will help you follow these basic rules: 1. Face person with both head and body 2. Use an open posture 3. Speak clearly, audibly, and firmly
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4. Make non-confrontational eye contact (confrontational = constant/staring) 5. Make use of gestures and facial expression for emphasis 6. Use a neutral tone 7. Use the other persons’ name Step Six: Learning How to Listen The sixth step of assertiveness training involves learning how to listen. As you practice using your LADDER in real life situations, you will find that sometimes you need to deal with an issue that is important to the other person before they will be able to focus on what you have to say. This is especially true when what you want directly conflicts with long unspoken and unmet needs of the listener. Example: “You say you want an hour of silence when you first get home from uni? Well, I haven’t said this to you before, because you are working so hard, but I’m ready to flip after spending all day at the restaurant. I have needs too, you know”. At this point, it might be wise to practice assertive listening. In listening assertively, you focus your attention on the other person so that you can accurately hear the speaker‟s opinions, feelings, and wishes. Assertive listening involves three steps: 1. Prepare. Become aware of your own feelings and needs. Are you ready to listen? Are you sure that the other person is really ready to speak? 2. Listen and Clarify. Giving your full attention to the other person, listen to the speaker’s perspective, feelings, and wants. If you are uncertain about one of these three elements, ask the speaker to clarify with more information.

Examples: “I’m not quite sure how you view the situation…could you say more about it?” “How do you feel
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about this?” “I don’t understand what you want…could you be more specific?”
3. Acknowledge. Communicate to the other person that you heard the speaker’s position. For example: “I hear you don’t want to take on this new project because you are feeling overwhelmed with your current responsibilities and want to catch up.” Another way to acknowledge the other person’s feelings is to share your own about what has been said: “I’m feeling overwhelmed too, and I feel terrible about having to ask you to do more work.” Exercise: The following are important “Do’s” and “Don’ts” in assertive listening, summarising the previous two steps. For each of them identify the message you would be sending the other person if used: ASSERTIVE LISTENING SKILL Basics Face person with both head and body Use an open posture Speak clearly, audibly, and firmly Make non-confrontative eye contact (Confrontative = constant/staring) Make use of gestures and facial expression for emphasis Use a neutral tone Use other person’s name
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CONSEQUENCES OF USE

The DO‟s Wait until the person has stopped talking Summarise what they have said and ask whether that is what they are saying Clarify their perspective Clarify their feelings Clarify their assumptions about the problem (there may not even be one) Clarify your assumptions about what they have said Re-summarise the whole issue from their perspective before moving on Present your argument in a calm way (non-hurried and nonpersecutory) The DO NOT‟s Interrupt them Be tempted with the “Yes…But” answer Answer their argument immediately with your own Be tempted to come up with a quick fix for enduring problems
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Stay if the person is being abusive or physically threatening. Instead - Acknowledge their emotion - Suggest you talk about it later when emotions are not as high - Arrange a time and place for the follow-up discussion Assertive listening shows that you respect the other person. It does not necessarily mean that you either agree with them or that you will agree with them. You may end up agreeing to disagree, however, you will do so at least with a sound understanding of both sides of the agreement and knowing that the issues have not been clouded by emotions. In the face of sarcasm or anger, for instance, use assertive listening and continue to clarify and acknowledge until you understand the problem. Then you have the opportunity to reach a more balanced conclusion. If you are being very reasonable, respecting the other person‟s rights to be heard, it will become difficult for the other person to maintain any defensive emotion, so they will begin to respond to you in the same manner with which you are communicating with them. Step Seven: Arriving at a Workable Compromise The seventh step in assertiveness training is learning to arrive at a workable compromise. When two people’s interests are in dire conflict, a fair compromise that totally satisfies both parties is difficult, if not impossible to achieve. Instead, look for a workable compromise you can both live with, at least for a while. Although compromise may naturally emerge in your discussion, sometimes you might need to make a list of all alternative solutions you can think of. Cross off the ones which are not mutually acceptable. Finally decide on a compromise you both can live with, perhaps by ranking the remaining alternatives in order of preference and then “averaging” (summing
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and then dividing by the number of raters) the preference numbers to see which solution is, on average, the better for both parties. This brainstorming process is most effective if you let your imaginations run wild while generating idea. It’s best to agree to review a workable compromise in a specified length of time, like a month. At that time you can examine the results of your changed behaviour. If you aren’t both sufficiently satisfied, you can then renegotiate. If you feel unhappy with brainstorming and making a list of alternatives, try this simpler approach. When a person doesn’t want to give you what you want, ask for a counterproposal. If the counterproposal isn’t acceptable to you, make a new one of your own. But first do a little assertive listening to uncover the other person’s feelings and needs in the situation. Keep going back and forth with counterproposals until something works for both of you. A second route to compromise is to ask the question: “What would you need from me to feel okay doing this my way?” The answer may surprise you and offer solutions you never thought of. Step Eight: Avoiding Manipulation The eighth and final step to becoming an assertive person is learning how to avoid manipulation. Inevitably, you will encounter blocking gambits from those who seek to ignore your assertive requests. The following techniques are proven ways of overcoming those standard blocking gambits. Broken Record: When you find that you are dealing with someone who won’t take no for an answer or refuses to grant you a reasonable request, you can carefully choose a concise sentence to use as your broken record and say it over and over again. Briefly acknowledge that you have heard the other person’s point or argument, and then calmly repeat your Broken Record without getting sidetracked by irrelevant issues, eg. “I understand that you have a no refund policy however I want you to give me back my money for this defective radio.”
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Content-to-Process Shift: Shift the focus of the discussion from the topic to an analysis of what is going on between you, eg. “We seem to have got off the point”, “You appear to be upset with me.” Defusing: Ignore the content of someone’s anger, and put off further discussion until they have calmed down, eg. “I can see that you are very upset and angry right now. Let’s discuss this later this afternoon. Assertive Delay: Put off a response to a challenging statement until you are calm, and able to deal with it appropriately, eg. “Yes…very interesting point…I’ll have to reserve judgement on that…I don’t want to talk about it at this time.” Assertive Agreement: Acknowledge criticism with which you agree. You don’t need to give an explanation unless you wish to, eg. “You’re right; I am half an hour late…my car broke down.” Clouding: When someone is putting you down as a person, acknowledge something in the criticism with which you can agree, and ignore the rest. Agree in part, “You’re right, I am late with my assignment.” Agree in the principle (agreeing with the logic without the premise): “If I were late as often as you say, it certainly would be a problem.” When clouding, rephrase the critic’s words so that you can honestly concur. By giving the appearance of agreeing without promising to change, you soon deplete the critic of any reason to criticise you. Assertive Inquiry: Prompt criticism in order to find out what is really bothering the other person, eg. “What is it about it that bothered you?” It can be helpful to prepare yourself against a number of typical blocking gambits that will be used to attack and derail your assertive requests. Some of the most troublesome blocking gambits include:

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Laughing it Off: Your assertion is responded to with a joke. Use the Content-to-Process Shift (“Humour is getting us off the point”) and the Broken Record (“Quite true, however I still want…”) Accusing Gambit: You are blamed for the problem (eg. “You are always so late cooking dinner; I’m too tired to do the dishes afterward.”). Use Clouding (“That may be so, but you are still breaking your commitment”) or simply disagree (“9.00 is not too late for the dishes”). The Beat-Up: Your assertion is responded to with a personal attack such as, “Who are you to worry about being interrupted; you’re the biggest loudmouth around here.” The best strategies to use are Assertive Irony (“Thank you”) in conjunction with the Broken Record or Diffusing (“I can see you’re angry right now, let’s talk about it later this evening”). Delaying Gambit: Your assertion is met with “Not now, I’m too tired”. Use the Broken Record, or insist on setting a specific time when the problem can be discussed. Why Gambit: Every assertive statement is blocked with a series of “why” questions. The best response is to use the Content-to-Process Shift, (“Why isn’t the point here. The issue is that…”), or the Broken Record. Self-Pity Gambit: Your assertion is met with tears and the covert message that you are being sadistic. Try to keep going through your script using Assertive Agreement (I know this is upsetting to you, but we need to get this resolved”). Quibbling: The other person wants to debate with you about the legitimacy of what you feel, or the magnitude of the problem, and so on. Use the Content-to-Process Shift (“We seem to have gotten off the main point”) with the assertion of your right to feel the way you do.
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Threats: You are threatened with statements like, “If you keep on at me like that you are going to need to find another partner,” use Assertive Inquiry, “What is it about what I said that bothers you?” as well as the Content-to-Process Shift, (“This seems to be a threat”). Denial: You are told “I didn’t do that,” OR “You have really misinterpreted me”. Assert what you have observed and experienced, and use Clouding…”It may seem that way to you, but I observed”.

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A good book on assertiveness.

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TYPES OF POWER COERCIVE POWER Basically using fear to make people comply. There is an underlying or silent threat of punishment or negative consequences if the person does not comply. Coercive power frequently causes people to avoid the person and to like him/her less. People may do what the person who uses the coercive power wants, but they tend to avoid interacting with that person. REWARD POWER Is based on the person‟s ability to provide rewards, deliver positive consequence or remove negative consequences in response to their behaviour. The person‟s power will be greater the more others value the reward, the more they believe the person can hand out the reward, and the less their chances appear of getting the reward from someone else. The use of reward power generally produces a “moving towards” the person. Others will comply with the person‟s requests, seek him/her out, increase their liking for him/her and communicate effectively with him/her. LEGITIMATE POWER The person has influence over others because of his/her position in the group or because of his/her special responsibilities. Others believe it their duty to follow the commands of a person with legally responsible power, even when that means restricting themselves to a limited set of behaviours. Eg. Leader, boss, police, doctor. REFERENT POWER The person has influence over others because of his/her personality. Others identify with or want to be like him/her and therefore do what he/she wants out of respect, admiration and liking and wanting to be liked. The more the person is liked, the more others will identify with the person. EXPERT POWER The person has influence over others because of his/her possession of knowhow, skill and knowledge which gain the respect and trust of others. Others believe that he/she is not trying to mislead them for selfish purposes but he/she is seen as possessing the skill to facilitate the behaviour of others. The successful use of expert power results in movement towards the person, because others are persuaded by his/her behaviour. Eg. Teacher, police, doctor, leader, expert in field.
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Personal Bill of Rights
1. I have the right to ask for what I want. 2. I have the right to say no to requests or demands I can‟t meet. 3. I have the right to express all of my feelings, positive or negative. 4. I have the right to change my mind. 5. I have the right to make mistakes and not have to be perfect. 6. I have the right to follow my own values and standards. 7. I have the right to say no to anything when I feel I am not ready, it is unsafe, or it violates my values. 8. I have the right to determine my own priorities. 9. I have the right not to be responsible for others‟ behaviour, actions, feelings, or problems. 10. I have the right to expect honesty from others 11. I have the right to be angry at someone I love. 12. I have the right to be uniquely myself. 13. I have the right to feel scared and say “I‟m afraid”. 14. I have the right to say “I don‟t know”. 15. I have the right not to give excuses or reasons for my behaviour. 16. I have the right to make decisions based on my feelings. 17. I have the right to my own needs for personal space and time. 18. I have the right to be playful and frivolous. 19. I have the right to be healthier than those around me. 20. I have the right to be in a non-abusive environment. 21. I have the right to make friends and be comfortable around people. 22. I have the right to change and grow. 23. I have the right to have my needs and wants respected by others. 24. I have the right to be treated with dignity and respect. 25. I have the right to be happy.

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A pattern which ahs been called “the cycle of violence” operates in many marriages.

BUILD UP PHASE – Tension builds within the perpetrator for various reasons – family pressures, work stresses, or their own thought patterns. Other individuals and couples will have a range of reactions to this tension which do not include violence, but in the abusive relationship it leads to the… STAND-OVER PHASE – Because of physical strength and realistic and frightening threats to hurt her, the woman feels she is under her husband‟s control. His verbal attacks will weaken her further. EXPLOSION PHASE – The assault is usually carried out in a fit of self righteous rage. After the assault the husband enters the…REMORSE PHASE – He often feels ashamed and may be afraid of the consequences – but he will deny and play down his actions as far as possible; “She knows I get mad when she does that”, “It was only a bit of a shove”. Unfortunately, the woman may go along with this,

IT SHOULD BE NOTED THAT IT CAN BE THE WIFE WHO IS THE ABUSER AND/OR PHYSICALLY STRONGER PERSON!
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WHAT IS ABUSIVE To abuse is to violate another‟s Physical, Sexual, Emotional, Intellectual or Spiritual boundary. The following are some specific examples.
EXTERNAL PHYSICAL BOUNDARY VIOLATION        Standing too close to a person without his/her permission. Touching a person without his/her permission. Getting into a person‟s personal belongings and living space such as one‟s purse wallet, mail and closet. Listening to a person‟s personal conversations or telephone conversations without his/her permission. Not allowing a person to have privacy or violating a person‟s right to privacy. Exposing others to physical illness due to you having a contagious disease. Smoking around non-smokers in an identified non-smoking area.

SEXUAL BOUDARY VIOLATIONS        Touching a person sexually without his/her permission. Not negotiating when, where, and how to engage in sexual activity. Demanding unsafe sexual practices. Leaving pornography where others who do not wish to or should not see it may see it. Exposing oneself to others without their consent. Staring or looking at another person lustily (voyeurism) without his/her permission. Exposing visually and/or auditorily others to your sexual activities without their consent.

EMOTIONAL BOUNDARY VIOLATIONS
      Insults Blaming Shaming, put-downs Inflicting guilt Disgracing, shaming Laughing at 104       Manipulating Trickling Hurting Belittling Yelling, screaming Name calling

                  

Dumping anger Degrading Criticising Joking about Teasing Deceiving, lying Threatening Inflicting fear Withdrawing, cutting off Not taking seriously Misleading Demanding perfection Disrespecting feelings

            

Ridiculing Breaking promises Betraying Being cruel Patronising Overpowering, bullying Withholding affection Discrediting Disapproving Raising hopes falsely Intimidating Using sarcasm Lying

Humiliating, embarrassing ESPECIALLY in front of others Underhanded comments, statements Making light of, mocking or minimising, discounting, trivialising feelings, needs, wants Responding inconsistently or arbitrarily Making vague demands Telling a person how s/he should be or what s/he should do eg. “You shouldn‟t feel such and such,” “If only you were…(better, different)”, or “You should be…”.

Body language…………… Listening…………..

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ASSERTIVENESS TRAINING (2)

Without looking at your previous responses, answer these situations again, this time using your new assertiveness skills… 1. You buy something from a shop and after walking out you discover your change is short $3. …………………………………………………………………………… ………… ……………………………………………………………………………… 2. At a restaurant the meal you ordered is wrong. ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… 3. You are giving a friend a lift to work but when you pick him up he fusses around and it is likely to make you both late. ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… 4. You book your car in for service and you have been quoted $150. You left them your mobile phone number. When you collect the car they have done extra work and the bill is $250. ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… 5. You are relaxing in front of the TV and your partner hands you a list and says “run down to the supermarket and get these for me.” ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… 6. You are next to be served but the shop assistant serves another person before you. ……………………………………………………………………………………………… ……………………………………………………………………………………………… ………………………………………………………………………………………………

How do these responses differ from your earlier ones?

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Discuss in length the effects of childhood trauma  Parenting  Raising the bar  Power of words  Teasing and Bullying

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ANXIETY & DEPRESSION
CHAPTER 5 - Overview
    Assertiveness practice (REVIEW) Relaxation (REVIEW) Sleep (REVIEW) Cognitive Therapy (VISUAL AIDS…some fun) o Irrational Beliefs o Faulty Thinking (some mythical thinking) o Some things in life you can control and some you just can‟t o Automatic Thoughts o REBT self help form o Mastery VS Helplessness (link back to Main Model) o Master list of Irrational Beliefs  Homework: o Play CD daily o Make notes of daily thoughts o Check for rationality of thoughts

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 I must be loved and approved of by all the important people in my life.  To be worthwhile I must always cope with everything and always be successful. I must be completely, perfectly competent, make no mistakes, and achieve in every possible way, if I am to be considered worthwhile. Being successful means being the best.  People who act unfairly or badly (even myself) should be blamed or punished.  If things don’t turn out the way I want them to be then it’s a total disaster and unbearable.  Happiness and my own bad feelings are caused by external factors that are outside of my control. Little can be done about them.  If something is (or may be) dangerous or frightening, then I should be extremely concerned about it and keep dwelling on it.  It’s easier to avoid and put off something difficult or unpleasant than to face certain problems in life.  I should be dependant on others and need someone stronger than myself to rely on.  My problem(s) were caused by event(s) in my past, and that’s why I have my problem(s) now

 I should be upset by other people’s problems and difficulties.

1. I want to be loved or liked and approved of by some of the people in my life. I will feel disappointed or lonely when that doesn’t happen, but I can cope with those feelings and I can take constructive steps to make and keep better relationships. 2. I want to do some things well, most of the time. Like everybody, I will occasionally fail or make a mistake. Then I will feel bad, but I can cope with that, and I can take constructive steps to do better next time. Being personally successful means doing my best, not beating others. 3. It is sad that most of us do some bad things from time to time, and some people do a lot of bad things. But making myself very upset wont change that. 4. It is disappointing when things aren’t how I would like them to be, but I can cope with that. Usually I can take constructive steps to make things more as I would like them to be. But if I can’t, it doesn’t help me to exaggerate my disappointment. 5. My problem(s) may be influenced by factors outside my control, but my thoughts and actions also influence my problem(s), and they are under my control. 6. Worrying about something that might go wrong won’t stop it from happening. It just makes me unhappy now. I can take constructive steps to prepare for possible problems and that’s as much as anyone can do. So don’t dwell on the future now 7. Facing difficult situations will make me feel bad at the time, but I can cope with that. Putting off problems doesn’t make them any easier. It just gives me longer to worry about them. 8. It’s good to get support from other when I want it, but the only person I really need to rely on is myself. 9. My problem(s) may have started in some past event, but what keeps it (them) going now are my thoughts and actions, and they are under my control. 10. It is sad to see other people in trouble, but I don’t help them by making myself miserable. I can cope with feeling sad and sometimes I can take constructive steps to help them.

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Black & White Thinking (All or Nothing Thinking) – our experiences are usually variations between two extremes, NO MIDDLE GROUND Seeing things in terms of absolutes or extremes only as and ignoring all the greys. Hence people are either good or bad; things are either perfect or disastrous. You are either weak, competent or an idiot. The trouble is that the world is rarely black or white and this sort of thinking leaves no room for mistakes or for just being average or sometimes good and sometimes bad. Eg. “I know that chest pain means that I will have a heart attack & I’m going to die.” Saying things like, “This will happen,” OR “This won’t work.” Words used, “Hopeless, failure, loser.” SOLUTION - Develop the ability to be open-minded - Allowing for all possibilities rather than making definite statements o “May” instead of “Will” o “I did not do (such & such) as well as I would have liked”

Setting Unrealistic Expectations Setting higher and more unattainable goals than other people; ensuring they are doomed to fail in their own eyes, “setting yourself up for failure – or disappointment.” It is when we attempt to be perfect at the things that we do and being in control of situations is when unrealistic expectations occur. This sort of thinking leads to little patience and tolerance with your own or other’s weaknesses and bad habits. Eg. SOLUTIONS “I must (do it perfectly)” “I have to (have a completely tidy house)” Reminds you of what you’re - Decide whether you want to do it or not “I’ve got to (stick at it)” not doing & creates - Accept you are not perfect, don’t make “I should (be doing something better with my life)” unnecessary guilt & yourself feel worse “I need (someone to care for me)” disappointment. - You don’t have to live up to ideals (your own or others) SOLUTION - “I would prefer (to get there on time) → I must (be there on time)” - “I would like (to try to relax) → I have (to relax)” - “I choose to (lose weight & begin exercising) → I should (lose weight & do more exercises)” 112

Tunnel Vision – selective thinking, looking on the dark side. Focusing only on one part of a situation and ignoring everything else. People all have their own individual tunnels. Eg. Anxious people are often supersensitive to anything which suggests danger, and ignore all the safety signals (which far outnumber the danger signs). People with anger problems tend to notice anything which suggests unfairness or criticism. The trouble here is that pulling isolated things out of context and dwelling on them tends to make them seem much larger and much more important than they really are. This also leads to beliefs that only bad things will happen, and wonder why your life is miserable than others’. Eg. Looking at the world through dark coloured glasses Only compare self to other people that are more successful than themselves SOLUTION - Develop a more balanced perspective on people and events - Focus on pleasant events that happened to you as soon as you notice yourself dwelling on things - Write lists of positive things that happened to you on a day to day basis Converting Positive Into Negatives – being a cynic. Turning positive experiences into an unpleasant or neutral one by not giving yourself credit for your talents or achievements. People tend to dismiss compliments and depriving themselves of a boost to their confidence levels. This type of thinking prevents the building of your own self-esteem; as well as pessimistic thinking and results in one becoming suspicious and cynical of people’s motives. Eg. Refusing to accept compliments, “What is he after”, “They’re just saying that because they know how bad I feel, but don’t really mean it” SOLUTION - Become aware when you dismiss praise/compliments - Allow yourself to feel pride in you abilities and achievements and realise that you play a part in creating opportunities and pleasant experiences - Give yourself CREDIT

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Overgeneralising – Drawing generalisations from a single instance. When things have gone wrong in the past, they will continue to do so. Thinking in this style it may increase the chance of unpleasant things happening by the expectations you set. This leads to labelling; judgements of self are based on one or two instances of behaviour, rather than your overall performance. As well as creating negative expectations for all instances, “bound to always happen”. Eg. If you blow one job interview because of nerves, an overgeneralisation thought would be, “I’ll never succeed in job interviews” (I didn’t succeed in this one, I’ll keep trying until I’m successful) Been let down in a relationship – never trust again SOLUTION - Develop a balanced perspective - Be specific rather than general with your negative thoughts - Being specific about why you are unhappy – you are immediately in a better position to fix it - “It’s all too much for me” → “I am finding it hard to concentrate” Mind Reading When you “just know” what someone else is thinking (usually negative things about you, as we seldom mind read positive things about us). Mind readers often imagine everyone else think and feels the way they do. Eg. If you get hurt by rejection you assume that everyone else is and therefore you tend to be unassertive so as not to hurt the feelings of others. SOLUTION - Clarify with the individual when appropriate what “they mean by that comment” - In other situations, not reading into things too much as you merely set yourself up for anger, torment, false negative worries (unless otherwise confirmed directly from the other person)

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Magnifying/Exaggerating Unpleasantness – CATASTROPHISING – making mountains out of molehills Focusing on something that may be uncomfortable or unpleasant for anyone and then exaggerate the unpleasantness. The list of imagined catastrophes is usually endless because there is no limit to what a fertile imagination can produce. This kind of thinking only leads to upsetting you more than you need to be, and makes you much more less effective in situations which are important to you, where you may need to function. It also leads you to be constantly alert for the first signs of danger/that disaster is on its way, which makes you overreact to illness symptoms/problems with family health etc. Eg. Going to a job interview, “The train will never come, I’ll be here all day, I’ll never get there on time. I’ll be hopelessly late & won’t get the job” What can go wrong, will go wrong in a big way SOLUTION - Weigh objectively the significance or importance or severity of the event and your reactions (“How serious are the consequences of this happening?” “How important will this seem when I’m 80 years old?” “What can I do to remedy the situation?”) - Change your perception of the importance of what has happened and your reactions to it - Be realistic about chances before jumping in and assuming the worst - Become a statistician; keep sight of difference between POSSIBILITY (0.001%) and PROBABILITY (50% or >) of things happening - “No reason to expect the worst, I will wait until real problems arise before I let myself worry about them” Personalising – It’s all my fault The tendency to relate everything that happens around you as directly related to you in some ways. Taking too much responsibility for other people’s feelings & actions, forgetting that you are in control of their own lives. Eg. When your partner says they’re tired, then it means that they are tired of you. Children are unhappy, it’s because you’re a failure as a parent SOLUTION - Stop blaming yourself for everything that goes wrong & for everyone else’s bad moods - Stop assuming people behave in certain ways just because of you, think of other reasons they must have acted that way. Unsure → ask them - Most people don’t notice silly things you do, mistakes made → check that the assumptions are true

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The Fairness Fallacy Thinking based on the belief that because we are fair and just then the world should also be that way. So if you do the right things and yet people don’t behave as you want them to, or things don’t turn out as you want them to, then thinking becomes preoccupied with “how unfair” it all is. The truth is that the world is not always a fair and just place and dwelling on the fact that it is not/will not solve anything nor will it make you feel better. Eg. “That’s so unfair, I worked the last 2 weeks on this assignment and I only got a C. He said he wrote it last night and got an A for the same piece” SOLUTION - Avoid thinking or dwelling about things that are out of your control - Life is complicated enough without making it worse for yourself by focusing on unimportant issues Emotional Thinking – I feel, therefore I am Believing that because you feel a certain way, then things must automatically be that way. For example, If you feel ugly then it is because you are ugly, or if you feel that you can’t cope then it’s because you can’t really cope or aren’t coping. The mistake here is that emotions have no validity by themselves. They are usually the consequences of our own thinking (which often does not reflect accurately the way things are) and you can therefore change them. Feelings, irrespective of how real they are to you, are not objective facts. Eg. “I feel so fat in this outfit, I must be fat” SOLUTION - Gather evidence to prove/disprove negative feelings. Train yourself to rely on facts - Keep a diary of thoughts and feelings; record strength of feelings at time of event - Feelings diminish over time - Facts don’t change, feelings do (feelings – not a reliable basis on which to form judgements

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Shoulds Shoulds are a list of rigid rules about how you and others should think, feel and act. Naturally these rules are beyond dispute and any deviation from them is “bad”. Consequently if you deviate from them then, you are bad, and if others deviate from them you are left feeling frustrated, irritated or angry. Eg. “I should be a perfect parent/lover/friend/spouse/student” “I should always be generous/considerate/selfless” “I should never let anything upset me” “I should never feel hurt or unhappy” “I should always plan the future correctly” “I should never feel angry/jealous/greedy” SOLUTION - Cognitive restructuring/coping statements - Acknowledging negatives and replace with alternative, eg. “I should be a perfect parent,” WITH “I can’t expect to be a perfect parent, I can try my best to do all I know how to do well.”

Jumping to Negative Conclusions Drawing negative conclusions from a situation with no evidence to support it, may be conflicting evidence which you ignore. This type of thinking leads to negative, self-critical interpretation which upsets you. Eg. Assumptions that someone behaves a certain way without looking for evidence. Assuming people are looking down on you or rejecting you You know what people are thinking Expecting the worst to happen without good reason SOLUTION - Gathering objective evidence (more than 1 or 2 pieces of information - Consider other alternative reasons causing someone to act a certain way - Discussing concerns with others – impartial to situation - Try doing the activity and finding out how it goes rather than stopping yourself with negative predictions

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 AS LONG AS YOU LOVE EACH OTHER PROBLEMS WILL NOT ARISE  YOU AND YOUR PARTNER CAN ALWAYS MEET EACH OTHERS NEEDS  MARRIAGE WILL CURE LONELINESS AND EMPTINESS  GOOD PHYSICAL RELATIONSHIPS JUST HAPPEN SPONTANEOUSLY IF YOU ARE IN LOVE

MYTHS ABOUT MARRIAGE AND OTHER RELATIONSHIPS

 YOUR MARRIAGE IS NOT AS VULNERABLE AS OTHER PEOPLE’S  HAVING CHILDREN WILL FIX YOUR RELATIONSHUP PROBLEMS  THE TWO OF YOU CAN AND SHOULD BECOME AS ONE INDIVIDUAL  MARRIED PEOPLE DON’T NEED ANY INDEPENDENT TIME FROM EACH OTHER  YOU SHOULD SPEND EVERY MINUTE TOGETHER  YOU SHOULD NEVER FIGHT OR DISAGREE  IF YOU DISAGREE THEN THE RELATIONSHIP IS OVER  YOU SHOULD NEVER NEED RELATIONSHIP COUNSELLING

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WORK ON BEING FRIENDS, COMMUNICATION AND BEING REALISTIC! GIVE EACH OTHER ROOM TO BREATHE AND BE INDIVIDUAL PEOPLE AS WELL AS PARTNERS AND REMEMBER YOUR PARTNER IS NOT PSYCHIC S/HE DOES NOT KNOW WHAT YOU ARE THINKING OR WORRYING ABOUT UNLESS YOU TELL THEM (THAT WAS ‘TELL’ NOT ‘BLAME’)

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Focus on what you can control rather than on what you CAN’T!
We have little control over many things in life!  Other people’s behaviour and attitudes
GET THIS AND GET IT GOOD!!!! YOU CANNOT CHANGE OTHER PEOPLE! Other people can choose to change! BUT YOU CAN’T CHANGE THEM! ACCEPT THIS AND YOU ARE HALF WAY THERE!!! WHAT YOU CAN CHANGE IS HOW YOU RESPOND TO THEIR EHAVIOUR!!!

 You also can’t change the weather  Often you can’t do much about your finances (FOR NOW)  Politics  The economy  And the many NEGATIVE issues in the world (...that seem to get YOUR attention more than the positives in the world)  Sometimes the control you have over your health is quite limited – however you always have a degree (at least) of control on the extent of your suffering!  AND ONE FOR THE PEOPLE AROUND YOU…YOU DIDN’T CHOOSE TO BECOME DEPRESSED OR PSYCHOLOGICALLY UNWELL!! OK, A HARD ONE FOR YOU TO ACCEPT BUT YOU CAN CHOOSE TO IMPROVE YOUR SITUATION BY LEARNING AND PRACTICING
Choose not to dwell on how unfair it is that you became unwell or depressed Choose to improve your personal circumstances
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Choose to change your focus from your depression to what you can do about it! There actually is a lot you can do!!! CHANGE WHAT YOU CAN’T ACCEPT AND ACCEPT WHAT YOU CAN’T CHANGE!! CONFRONT ISSUES RATHER THAN AVOID THEM
WORK ON SOLVING PROBLEMS RATHER THAN WORRYING ABOUT THEM!

Remember 95% of the things you worry about never happen and the other 5% you may not be able to change…. It is good to discuss your feelings with others – but do it assertively and rationally, nagging, complaining and blaming; help nothing! IF YOU FEEL GOOD TELL YOUR FRIENDS IF YOU FEEL BAD TELL YOUR THERAPIST!
WHO CAN YOU GO TO FOR SUPPORT AND UNDERSTANDING… MAKE A LIST AND KEEP IT HANDY… Friends… Family member… Community supports… Health professionals…

Learn to ask……it is amazing how much help is there for you if you just ASK…

Don’t be embarrassed to receive help…. Others you know may have depression too, but at least you are doing something about yours!
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Very often a belief is automatic. It is often so quiet it is like working with the stereo on so low in the background that you hardly realise it is on: These are some characteristics of automatic thought:

They occur extremely rapidly after the event, they are short and specific They do not have to occur in sentences and may consist of a few key words or images They do not arise from careful thought They do not occur in a logical series of steps such as in problem solving. They seem to happen just by reflex They seem reasonable at the time The words of the thought may differ but often a person will have automatic thoughts with the same theme – for example how s/he is a failure, worthless etc. People with the same emotional problem have the same kind of automatic thoughts Automatic thoughts have more distortion of reality than other types of thinking

POSITIVE SELF TALK Preparing for a stressful event “What is it I have to do?” You can develop a plan to deal with it. Think about how you can prepare for it. Planning is better than getting anxious. “Don‟t worry. Worry won‟t help anything”. Maybe what you think is anxiety, is eagerness to confront the stressor.

Throughout a stressful event “One step at a time. You can meet this challenge” “Psych” yourself up. You can convince yourself to do it. Don‟t think fear, just focus on what you have to do. Stay focused on the small picture.

Coping with feelings of stress When fear comes, tell yourself to „pause‟. What is it you have to do? Breathe! Don‟t try to eliminate your fear totally. It may represent performance stress. Keep it manageable.

Reflecting on the experience “It worked. I did it. It wasn‟t as bad as I expected.” You may have made more out of the fear than it was worth. Things tend to get better each time. You can be pleased with the progress you have made. You have little control over many things in life – other people‟s behaviour, the weather, politics and the economy. You also don‟t choose to contract an illness or become DEPRESSED! But! As difficult as it seems…we can choose whether or not to dwell on how UNFAIR it is and how it shouldn‟t have happened „to me‟ OR we can focus on doing everything we possibly can to increase our chances of becoming well and improving our personal circumstances.

CHANGE WHAT YOU CAN‟T ACCEPT AND ACCEPT WHAT YOU CAN‟T CHANGE
CONFRONT ISSUES RATHER THAN AVOIDING THEM

TRY TO SOLVE PROBLEMS THAT ARISE RATHER THAN WORRYING ABOUT THEM

Discussing your feelings with others versus keeping them bottled up inside and/or isolating yourself.
Use (seek out) support networks…

WHO CAN YOU GO TO FOR SUPPORT

Name           Medical Community Family Friends

Number

Mobile

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REBT SELF HELP FORM (A) ACTIVATING EVENTS – what was happening immediately before I felt emotionally disturbed or acted self defeatingly (C) CONSEQUENCES – disturbed feelings or self defeating behaviour that I have produced and would like to change (B) BELIEFS – irrational beliefs (IB’s) leading to my consequences. Circle all that apply to these activating events (D) DISPUTES – for each circled irrational belief. Eg. “Why must I do very well?” “Where is it written that I am a bad person?” “Where is the evidence that I must be approved or accepted?” 1. I must do well or very well! 2. I am a bad or worthless person when I act weakly or stupidly. 3. I must be approved or accepted by people I find important! 4. I need to be loved by someone who matter to me a lot. 5. I am a bad unlovable person if I get rejected. 6. People must treat me fairly and give me what I 7. People must live up to my expectations or it is terrible! 8. People who act immorally are undeserving, rotten people! 9. I can’t stand really bad things or very difficult people! 10. My life must have few (or no) major hassles or troubles. 11. It’s awful or horrible when major things don’t go my way! 12. I can’t stand it when life is really unfair! 13. I need a good deal of immediate gratification and have to feel miserable when I don’t get it! 14. Additional Irrational Beliefs. (F) FEELINGS and BEHAVIOURS I experience after arriving at me EFFECTIVE RATIONAL BELIEFS (E) EFFECTIVE RATIONAL BELIEFS to replace my irrational beliefs. Eg. “I’d prefer to do very well but I don’t have to”. “I am a person who acted badly not a bad person?” “There is no evidence that I have to be approved, though I would like to be”.

I WILL WORK HARD TO REPEAT MY EFFECTIVE RATIONAL BELIEFS TO MYSELF FORCEFULLY ON MANY OCCASIONS SO THAT I CAN MAKE MYSELF LESS DISTURBED NOW AND ACT LESS SELF-DEFEATINGLY IN THE FUTURE. Signature ………………………………………………

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MASTERY VS HELPLESSNESS A strong internal locus of control usually results in a sense of mastery over some of the various aspects of your world. However if you have a strong external locus of control, then you can very easily develop a sense of helplessness, a fatalistic and passive acceptance of whatever happens. Helplessness can be looked at in three ways: 1. Personal VS Universal Causes When you see that cause of helplessness as universal it means that you think that no one could ever do anything that mattered. The whybother-we’re-all-going-to-die anyway school of though. When you see that cause of helplessness as personal – as many depression sufferers do then it’s because you’re not brave or strong or clever or competent or healthy enough. 2. Specific VS General Causes Helplessness can be seen as due to a specific cause (eg. “I can’t make friends because I’m bald”). Depression sufferers tend to attribute their feelings of helplessness to general causes. 3. Transient VS Permanent Causes Helplessness can be seen as being due to a transient cause (eg. “I can’t concentrate because I have got a headache”) or a permanent cause (eg. “My memory is terrible”). Depressed people generally attribute their feelings of helplessness to permanent causes. Depressed people tend to attribute their feelings of helplessness to permanent general, permanent causes.

Depressed people tend to attribute their feelings of helplessness to personal general, permanent causes. This means that they tend not to try anything because they might fail, because they’ve always been a failure and will never change. Try interpreting your helplessness in ways that are more specific and transient, and you’ll start noticing some of the things that you could have control over.
(relate back to main model….. challenge thoughts!

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MY MASTER LIST OF IRRATIONAL BELIEFS AND THINKING STYLES -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Questioning Your Thoughts
1. What is the evidence? o What is the evidence that supports this idea? o What is the evidence against this idea? ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ Is there an alternative explanation? ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ 2. How can I put the situation into perspective? o What is the worst that could happen? Could I live through it? o What is the best that could happen? o What is the most realistic outcome? ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ________________________________________________________________________________________________________ 3. What are the pros and cons? o What is the effect of my believing the automatic thought? o What could be the effect of changing my thinking?

4. What should I do about it? ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ________________________________________________________________________________________________________ 5. What would I tell a friend if s/he were in the same situation? ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ________________________________________________________________________________________________________
SITUATION Describe: 1. Actual event leading to unpleasant emotion, or 2. Stream of thoughts, daydream, or recollection, leading to unpleasant emotion. AUTOMATIC THOUGHTS 1. Write automatic thought(s) that preceded emotion(s). 2. Rate belief in automatic thought(s) 0-100% EMOTION(S) 1. Specify sad/anxious/ angry, etc 2. Rate degree of emotion 1-100% RATIONAL RESPONSE 1. Write rational response to automatic thought(s) 2. Rate belief in rational response 0-100% OUTCOME 1. R-rate belief in automatic thought(s) 2. Specify and rate subsequent emotions 0100% FURTHER ACTION

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ANXIETY & DEPRESSION
CHAPTER 6 - Overview
 Self Esteem  Pathological Critic/Healthy Voice!  Review primary concepts  Lapse/Relapse  Crises  Resources  Asking for Help  Homework: o To be allocated in session

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S

SELF IMAGE
IF YOU DON‟T THINK YOU ARE WORTH IT WHO WILL? THERE IS ONLY ONE PERSON WHO CAN CHANGE THE WAY YOU FEEL ABOUT YOURSELF!
YOU ARE LIMITED ONLY BY WHAT YOU BELIEVE TO BE POSSIBLE!!!

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Many people adopt beliefs, which have adverse effects on their selfesteem. Such as;  I must prove that I am worthwhile through my achievements  I must do things perfectly or not at all  I must have everyone‟s approval all the time  I need to be loved by someone in order to be worthwhile  The world must be fair and just 1. Self-esteem based solely on achievements Many people attempt to earn self-esteem through their achievements. External factors can be a great source of self-esteem, but ultimately it‟s the internal factors that are most important. If you learn to derive your good feelings about yourself only from material things and what others say, then if the material things vanish and others treat you negatively, you could be helpless to generate any positive feelings. People, who base their self-esteem only on the things they do, put themselves under great pressures as they attempt to get through an endless list of accomplishments. The striving becomes the goal and they are never satisfied. They miss the chance to stop and feel good about what they have already done. You are a person who is trying to live, the best way you know how. You are as worthwhile as every other person! We all have faults and favours. Whatever you do whatever you contribute should not come from the need to prove your value, but from you being the real and authentic you. Look for a balance of achievement, relationships and leisure pursuits this is important to our psychological well being. 2. Striving for Perfection You may be saying, what‟s wrong with high standards and of course there is nothing wrong with high standards. What‟s wrong is that you say I am no good unless I reach those high standards. Your productivity and sense of achievement are enhanced when you aim to do things well. This is very different from having to do well. The former brings satisfaction, but the latter leads to temporary relief followed by frustration at having to achieve such high standards again. People who attempt to do things perfectly are often motivated by the belief that this is what others expect and their efforts are seen as a major way of getting approval. But you continually raise the bar-making it impossible to ever be good enough.
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“Love me just the way I am” Disadvantages of perfectionism include:  Loneliness due to fear of criticism (social anxiety)  Decreased productivity  Troubled personal relationships  Low self-esteem  Vulnerability to depression  Performance anxiety  Obsessive-compulsive problems Ask yourself the following questions:  What are the advantages of setting such high standards?  If you aim for perfection how do you known when you get there  Whoever said you had to be perfect?  Do you really know a “perfect” person? How  Realise when your expectations (or the expectations of others) are unrealistic and remind yourself that you do not have to agree with them  Become aware that you do not become more valued by doing things perfectly; you just become more overworked and frustrated  Regard mistakes as opportunities to learn  Learn to enjoy your experiences in the present, rather than being preoccupied with the end result  Paradoxically, one significant way of improving your performance involves lowering your standards. Instead of aiming for 100% all of the time, try aiming for 70% or 50%. If you attempt to do reasonably well and to enjoy yourself at the same time, then you are more likely to relax. If you focus on more than just the standard of your performance, you may also obtain more satisfaction from the activity than you anticipated  Test out, for yourself, whether you have to do things perfectly in order to achieve satisfaction

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3. Self esteem based on the approval of others The need for approval begins with the message received in your early years from your family and other significant people. For example, “You must do as we wish, in order to gain our approval”. If you have poor self esteem then you‟ll probably view yourself through other people‟s eyes. This leads you to become too dependent on the praise and the comments of others, because you believe that your own judgements do not count. You will also be vulnerable to others by letting their attitudes and mood influence your feelings and behaviours. How to handle criticism:  Recognise that your worth is not completely based on what you do  Remember that people‟s judgements about your behaviours are only their opinions, which may or may not be valid (who made them the expert on……………..?)  Consider alternative ways of handling criticism  Avoid exaggerating or magnifying the incident

”I am not better, I am just different”

How to handle rejection:

 Challenge you thinking first  Remember that if caused by anger the rejection may be temporary  Recognise that not everyone will like you. Do you like everyone you meet? Be real!  Falling out with a particular person does not mean that you will not have other satisfying relationships in the future
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 Remind yourself that you will eventually get over the anger and disappointment. Don‟t build it up into a catastrophe  Remember that the person is not rejecting all of you, just some of your behaviour  Problems in relationships can occur for many reasons. Don‟t over simplify the situation by blaming yourself or the other person  Consider what you can learn. Are there some characteristics in yourself you would like to change to improve your relationship?  It is important to be able to reject others as well as learning to cope with rejection. If you have difficulty saying “no” it is probably hard for you to accept “no” from others. As you become more comfortable saying “no” it will become easier to accept this from others. Be careful to avoid reading more into the situation than was intended.

“I‟m gonna hold my breath till you say I am OK”

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Questions: 1. What is a story that shows you were assertive? ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ 2. How did I learn to believe I was not good enough? ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ 3. How was I brought up to be a woman/man? What was I told to be? How was I told to behave? How did I learn that “shoulds” rule my life? ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ 4. Where did I learn how I should look? What were the penalties/gains? What is my image of the perfect body? How do I fit that? Does it matter? ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________

1. Name five things I like about myself? ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ 2. How do I put myself down? How do I affirm myself? ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________

PersonalNotes:-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

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TO RE-BUILD YOUR SELF ESTEEM Chances are a lot of people (including yourself) put a lot of time and effort into lowering your self-esteem. Even other kids, when you were at school, helped destroy your self esteem without even knowing or caring who you were…it was how you interpreted their words and their behaviour. How painful is it when you overhear people making a social arrangement that you are not invited to…someone‟s birthday party…drinks after work…You take it personally, well who wouldn‟t…what other explanation can you come up with other than everyone hates you???? Feedback…(limited numbers/tickets, John thought Fred had asked you, it was open and you were just meant to turn up…etc etc Well meaning parents did everything for you. They didn‟t even realise that you interpreted this to mean you were too useless to do things yourself. SO HOW DO YOU FIX IT?????????????? Looking after yourself as though you were someone you cared about! Express your emotions and opinions…as though you actually had a right to… Work on your self talk…Acknowledge when you do something even half right…acknowledge your efforts…if you MUST compare…how about looking at the other end of the scale for a change…

Remember in life there will always be some people who are better and some people who are not as good as you at any given time…The average person is after all just AVERAGE.

Learn to laugh at yourself!

Pathological Critic-v-Healthy Voice Your negative inner voice that attacks and judges you! We all have one, but people with low self esteem seem to take more notice of theirs! Your critic blames you for everything that goes wrong! Compares you with others! Keeps record of your “failures” so that it can keep reminding you…just in case your self esteem should start improving - it can bring you back to earth! Sometimes it sounds like your friend, telling you to be the best, do your best; don‟t concede defeat…because if you don‟t win you are worthless!! Nothing!! A failure!! Your critic is a mind reader too, it tells you what other people are thinking about you…like you are ugly or stupid or annoying to be around… Your critic exaggerates…you are ALWAYS late; you NEVER have any friends… This critic is so good at controlling your thoughts and your self esteem that you don‟t even notice it there half the time… Your healthy voice may have gotten tired of arguing with your critic, it may have gone to sleep on you…you need to encourage it to come out again… It says things like…”don‟t you think you are blowing things out of proportion???”  It wants to challenge the critic…where is the evidence?  It wants to look at other ways of interpreting the situation  It wants to identify and change some of your old beliefs about yourself Sometimes it looks like someone has a good self esteem…but it revolves solely around achievement or maybe one particular area of their life. Someone you know may seem to have a good self esteem; perhaps they spend all their life either at work or asleep… because they feel good about their working self. But not about themselves as an individual. A high achiever can have a low self esteem because (IN THEIR MIND) they are only as good as their last race.

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Primary concepts to think about  Other people‟s responses and reactions  Energy/Motivation/Activity  RELAXATION…brain rhythms  Conditioning  THOUGHTS THINKING STYLES ATTITUDES & BELIEFS  “Blueprints”  Choice  If you do what you have always done you will get what you have always got!!  No person or situation can MAKE you do anything!  Behaviour is determined by thoughts, interpretations and perceptions (perceptions and physiology???)  Are your perceptions always accurate (remember the physiological changes in your body are the same for fear and excitement)    What use does BLAME serve? What is the difference between BLAME and RESPONSIBILITY? Is it ok to be WRONG? IMPERFECT? i.e. “Human”

 Nutrition/Sleep/Sunshine/Exercise/Fun/Laughter (can‟t get away from the basics)  Fact; Opinion; Emotional Response

Finding Purpose
Exercise: Write down the ten most valued aspects in your life:
____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

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Discussion: What have you discovered about your self and your values? _______________________________
____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________

Practical suggestions for enhancing self esteem…  Avoid comparing yourself to others…there will always be people who are better than you and worse than you in any given area…NO ONE IS PERFECT AT EVERYTHING!!

 Accept yourself for who you are and what you are  Remember your goals are basically o Be happy o Do no harm to yourself o Do no harm to others

”I AM COOL!”

 You do not need to be like everyone else as long as you are safe, happy and allow others to be safe and happy around you  Do not label yourself (or others). Avoid put downs and negative judgements  Words are powerful: Make sure your self talk is positive and encouraging  Learn to reduce your anxiety – FEAR feeds low confidence and depression  Make time to have fun and enjoy life, give yourself permission to be happy!

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 BE NICE TO YOU

Treat yourself to a new do!

 Make a list of your achievements and keep adding to it  Write down the things you (and/or other‟s) like about yourself  Discover your skills/talents (yes you do have some) – then use them frequently  Learn to accept compliments  Stop feeling you have to justify yourself to everyone

“My Mummy loves me just the way I am”

Master List of My Qualities ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Now turn page over and list some more!
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Excellent Book On Self Esteem and other life management skills!
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ANXIETY & DEPRESSION
CHAPTER 7 - Overview
 Review last week o Self Esteem – what can you do to improve yours? o What do you notice about YOUR pathological critic and YOUR healthy voice?  Anxiety o What is it? o What does it feel like/look like? o What happens to your body? o Does FEAR have a place? o Is all fear bad? o Anxiety medication, tranquilisers, band aides & superglue  Anxiety is sometimes normal!  Problems – Solutions – Planning  FEAR – how rational is yours?  WORRY – Can I use my thought challenging techniques here? (Perceptions/Interpretations/Responses  QUESTION: At the end of the day, does this situation/thing really matter?

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WHAT IS THE WORST THING THAT CAN HAPPEN & HOW LIKELY IS IT?

95% OF WHAT YOU FEAR NEVER HAPPENS, AND THE OTHER 5% MAY BE OUT OF YOUR HANDS. CHANGE WHAT YOU CAN‟T ACCEPT AND ACCEPT WHAT YOU CAN‟T CHANGE.

FIGHT

FLIGHT

FREEZE (When are each of these appropriate responses?)

Breathing: Get it down pat before you need it; practice daily so it becomes your automatic response.

AVOIDANCE IS OK IN THE SHORT TERM; DESENSITISATION AND RATIONAL THINKING ARE LONGER TERM TOOLS. What does anxiety/panic/FEAR feel like? Where do you feel it in your body? How? What do you usually do about it?

What is your thinking like when you panic? How rational? How productive? What? ANXIETY „NORMAL‟!!!!!!!!!!!!!!!!!!!!!!!!!!!!! When is FEAR a good thing….? What would happen if you never felt PAIN? How are PAIN & FEAR similar?

Discuss medications:

„Superglue & Bandaids”

… Types, pros and cons of using medication….. Most things have their place- USE, MISUSE and ABUSE…. Learn how to use medication wisely so that it will work for you and not against you! Can Anxiety Lead to Depression?
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As we’ve seen, no matter what the animal, survival of the species has been a paramount goal. The mechanisms of survival used by animals has varied from adopting skin colours that camouflage them, to feeding at certain periods of the day so as to escape predators, to adopting behaviours which ensue that only the fittest survive. Whatever these behaviours are they enhance survival, all animals take risks that place their life in danger. To deal with these dangers animals also learn to either fight or flee. This is often referred to as a flight or fight (or freeze) response to some threat. As in other species this flight / fight/ freeze response is found in humans. Whilst this response is born into us it is also refined in learning about our environment. For example, if as a postal worker delivering mail to a particular house you are almost bitten by a dog, it is likely that the response caused by the attack will be placed in your memory to prepare for similar future occurrences. Being fast learners most of us will tend to avoid the risky situation, and to undertake other behaviours which reduce the chance of being harmed. Children usually learn such protective behaviour early in life. If they touch a hot plate they quickly learn to avoid it next time so as to avoid the possibility of pain. While this behaviour is very useful and has helped us to survive, it does have a down side. Someone who is robbed on a
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bus may develop avoidance of buses and transportation so as to avoid the risk of being robbed again. This does reduce the risk of robbery on a bus; however, it also affects the person’s lifestyle. The outcome of avoidance behaviour may be quite different from the outcome for a child who avoids a hot plate. Unfortunately, avoidance is a powerful behaviour. As it reduces anxiety that may accompany novel tasks or activities which may be associated with an unpleasant behaviour such as being robbed, it also tends to lead to a repeated pattern of behaviour or habit in response to the unusual task or the activity. Such avoidance may be to events, places, or people who may be connected with the development of anxiety.

So how can anxiety and avoidance lead to depression?
Avoidance includes withdrawing from things you would normally do, perhaps spending long hours hunched in a chair or laying in bed. Ordinary pleasures like reading or watching TV become difficult or burdensome because it is hard to concentrate and remember what has been said or read. You become preoccupied with how bad you feel and with apparently insoluble difficulties that face you. Even basic bodily functions may be disturbed. Sleep, appetite, sexual desire – are some of the things that
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fluctuate or become unstable and perhaps unenjoyable. Most dangerously, as time goes by you lose hope; it seems that nothing can be done to change your state. Hopelessness grows and can lead to a desire ‘not to be here any longer,’ a desire for death, perhaps you just want to go to sleep and never wake up. HOPELESSNESS & WORTHLESSNESS. Cognitive features of depression: Specific cognitive aspects appear to be instrumental in maintaining depression. These aspects can be best explained as the cognitive triad; 1. A negative conception of the self, 2. A negative interpretation of life experiences, and 3. A nihilistic view of the future. Negative thoughts about self consist of the depressed person‟s beliefs that they are a defective, worthless, inadequate failure. Low self-esteem comes from these beliefs. When things go wrong they attribute them to personal unworthiness and failure. Believing they are defective they tend to believe they will never be happy. The depressed person‟s negative thoughts about experiences consist of their interpretation that what happened to them is bad. They misinterpret small obstacles as impassable barriers. Even when there are more plausible positive views of their experience, they are drawn to the most negative possible interpretation of what has happened.
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The depressed person‟s negative view of the future is one of hopelessness. When they think of the future they believe that the negative things that are happening now will continue unabated because of their own personal deficits. In most cases

DEPRESSION IS USUALLY TIME LIMITED; IT DOES END EVENTUALLY! As well as these negative thoughts another cognitive mechanism is also thought to be responsible for producing depression. Errors in logic, there are 5 major logical errors in thinking, which depressed people tend to make. - Arbitrary inference - Overgeneralisation - Magnification - Minimisation - Personalisation See previous pages for definitions of these!

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Maintain a child-like curiosity….Never stop investigating new things!

SOME NEGATIVE THOUGHTS THAT WE ALL USE SOMETIMES - THEY BLOCK US FROM DOING THE THINGS WE WANT TO OR NEED TO DO!!!     NO POINT IN TRYING IT‟S USELESS I‟M HOPELESS I‟M A FAILURE

SELF DEFEATING IDEAS AND FEELINGS DISCOURAGE YOU, MAKE YOU FEEL INADEQUATE NOT TRYING RESULTS IN MORE DISINTEREST, MORE DEPRESSION AND MORE FEELINGS OF FAILURE
WHAT IS ANXIETY? Anxiety is a normal emotion, which everyone experiences. It is a protective mechanism we have to protect ourselves from danger, fear or threat.

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When our mind interprets a situation as dangerous, fearful or threatening, physiological changes start happening to prepare our body to protect itself from the danger or threat. These physiological changes are what we commonly identify as anxiety. THE FIGHT / FLIGHT/ FREEZE MECHANISM The FFF Mechanism is the same as anxiety. It is the body‟s response to danger, fear or threat. When our mind recognises danger (either real or perceived), the body reacts in a particular way. It prepares us, through a number of physiological changes, to protect ourselves from the danger or threat with two main outcomes: TO FIGHT OR TO FLEE OR FREEZE For example, if we take ourselves back to the days of the cave man we would agree that he was in real danger on a regular basis. At times he may have been confronted with tigers, lions and other animals hunting him for his life. At other times he may have been confronted with other cave men willing to kill him to steal his food. The cave man had to protect himself and his life. The FFF mechanism or the anxiety response gave the cave man a greater chance of surviving the danger or threat. This response has a number of components: 1. PSYCHOLOGICAL COMPONENT Firstly we must perceive fear, threat or danger. We do this by having a thought that is based on fear, threat or danger. For example, “What if I die?” “What if I make a fool of myself?” “What if I cannot escape?” WHAT Ifs .......................
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2. PHYSIOLOGICAL COMPONENT Our body will then automatically respond by providing us with „extra‟ energy in order to escape the fear, threat or danger, or fight it. This extra energy serves the purpose of protecting us from the danger we perceive. Some of the physiological changes that take place to provide us with this „extra‟ energy include:  Large amount of adrenaline pumped into the body to put us in a state of increased alertness  Blood is redirected away from the extremities to the large muscles of the body  The heart starts working harder to move the blood to the large muscle groups as quickly as it can  Increase in Respiratory Rate  Release of red blood cells  Release of sugar by liver  Increase in metabolic rate
These physiological changes have particular side effects and it is the side effects of these changes that we commonly recognise as symptoms of anxiety. The table below explain this relationship: Psychological Awareness of Fear, Threat or Danger “What if I die?” “What if I cannot escape?” “What if they think I‟m an idiot?” Automatic Physiological Response Large amount of adrenaline pumped into the body to put us in a state of increased alertness Side Effects (Symptoms of Anxiety) Sweating Trembling & Shaking Nausea Pins & Needles and/or feeling dizzy Cold hands and feet

Blood is redirected away from the extremities to the large muscles of the body

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The heart starts working harder to move the blood to the large muscle groups as quickly as it can Increase in Respiratory Rate to bring more oxygen into the body Release of red blood cells to carry more oxygen to the major muscle groups of the body Release of sugar by liver as an instant form of energy Increase in metabolic rate to break down the sugar for energy

Racing Heart

Increased Respiratory Rate

Urge to run Urge to run

See if you can identify with any of the side effects of the physiological changes that take place in response to having a fearful thought. If you notice these symptoms when you are feelings anxious, then your body is working properly. It is protecting you from the danger you perceive. However, in our life as it is today, we don’t really need that sort of protection, and most of the time it only makes us feel very uncomfortable. If you experience these symptoms in everyday life, it is important to work backwards, and try and identify the fear based thought you had which resulted in your symptoms of anxiety. Ask yourself if the fear you perceive is really warranted.

3. BEHAVIOURAL COMPONENT After we have been provided with this „extra‟ energy, we will have a great urge to get away from the situation, or fight the danger, i.e. “fight” or “flight”. If we don‟t‟ actually “fight” or “flee” we do not expend all the potential energy our body has made available to us as a protective mechanism.

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WHAT HAPPENS TO THIS EXTRA ENERGY? This energy is stored as tension in our muscles. Over a long period or time this tension will make us feel ‟on edge‟, unable to relax. We will have problems sleeping, relaxing and feeling healthy. When someone is living with these heightened levels of anxiety/tension, life becomes very uncomfortable twenty four hours a day and this is when we would talk about someone having an Anxiety Disorder. THE FREEZE RESPONSE........ Certain animals take the „freeze‟ option when in danger, that is, in certain situations they find keeping perfectly still and even changing their colour to blend in with the background can be effective protection in certain circumstances. Oftentimes the victim of a violent assault has said “why didn‟t I fight back.....” “why did I just freeze up instead of protecting myself” (never mind that their attacker was bigger, stronger or even armed ) my answer is that more than likely you intuitively knew that in that particular circumstance, your assault would have resulted in even worse abuse than you suffered. Quite possibly „freezing‟ saved your life....!!!!!!!!!!!!!!!!!!!!! Certainly something to think about! Think of other situations when doing nothing can be the safest option................ I know of at least one situation where remaining calm and talking softly saved a 19 year old girl from rape and probably worse... she did not feel calm, she could not even explain how/why she handled the situation the way she did...... but her innate „freeze‟ response worked for her that day!

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ANXIETY: The Maintenance of Avoidance and its Consequences

Negative thoughts eg. What if I make a mistake? Anxiety-provoking situation

ANXIETY Eg. heart racing, sweating, feeling hot desire to escape the situation

Family/friends may be unknowingly encouraging avoidance Eg. by doing things for the anxious person AVOIDANCE of anxiety-provoking situations in future

SHORT-TERM relief from anxiety

Long-term increase in anxiety in more and more situations and necessity to avoid more and more situations

Decreased ability to function eg. work, relationships 155

SITUATIONAL EXPOSURE RECORD
Date Situation Order in Hierarchy (eg. st nd 1 , 2 , etc) Degree of Anxiety it elicited (0-100) Highest Anxiety Experienced During Exposure (0-100) Lowest Anxiety Experienced During Exposure (0-100) Duration of exposure (minutes)

Discussion Exercise: A Model of Depression (Early) Experience
(eg. rejected by someone you‟re attracted to)

Formation of Dysfunctional Assumptions, Schemata About Ourselves and the World – Ability to Predict & Make Sense of Your World
(eg. formation of a self-schema as not being one of “the beautiful people”)

Critical Incident(s)
(eg. another person you‟re attracted to, who also isn‟t one of “the beautiful people”, rejects you)

Assumptions Activated

Upsurge of Negative Automatic Thoughts
(eg. “I‟m ugly”, “I‟ll never find someone to accept me” “There‟s no point in trying” “This is so embarrassing, I can‟t face my friends” etc)

Symptoms of Depression

Behavioural
(eg. lowered activity levels, withdrawal)

Physical/Somatic
(eg. loss of appetite, loss of sleep)

Motivational
(eg. loss of interest, inertia)

Cognitive
(poor concentration, indecisiveness)

Emotional
(eg. anxiety, guilt, embarrassment)

So, we avoid asking someone out. Look at what happened the last time, now even the thought of asking someone out sends us into a blind panic. However, there are costs to avoidance. The problem with avoiding things is that the relief avoidance may bring is only temporary. In practice, the things we avoid become harder and harder to do, and gradually we avoid more and more things. Exercise: List all the possible consequences in the above example: eg. Maintenance of negative beliefs about the self; not involved in couples-activities, leading to less positive reinforcers (positive results to behaviour which increase the likelihood of that behaviour occurring again)… ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Consequences of Avoidance

Poor self-concept Do less Less positive reinforcers (less incentive to do things) Cognitive distortions

Stressful Experiences Resulting in Avoidance

Do less Cognitive Distortions

Cognitive & Behavioural Changes

Negative Explanatory Style

Poorer self-concept Lowered selfesteem Lowered mood Cognitive Distortions

Depressed Mood Do less Lethargy (Don‟t want to do things) Apathy (Don‟t care) “Sadness”

When we avoid distressing-provoking situations we do less. Because we generally like consistency in our world (hence why we develop schemas to help us predict and see our world as constant and manageable), we feel more comfortable if our behaviours and our thoughts match. So, if we‟ve stopped doing something, we tend to change our thoughts and our self-concept to portray ourselves as someone who doesn‟t do that behaviour. Unfortunately, this can lead to lowered self-esteem and lowered mood, and we then interpret ambiguous and sometimes positive feedback from our world in a negative way, confirming our own lowered view of our self. This, of course is not pleasant and so our mood lowers further. We tend to become lethargic (we don‟t want to do things) and apathetic (we don‟t care if we do or don‟t do things!), and so we may find
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ourselves doing even less. The less we do, the less positive rewards we receive from our world, and so the less incentive we have to do things. We do less, have a poorer view of ourselves, and interpret our world more and more negatively to conform to our negative view, and so on. OK, so as we can see, avoidance of an anxiety provoking situation can lead to depression and some very unpleasant and depressionencouraging/maintaining consequences. Then what is the cure? If avoiding things you fear makes them harder to face, what would happen if you started to confront your fears? If the fear is reinforced by leaving the situation, what would happen if you stayed put? Actually, if you confronted for long enough the thing you feared, the fear would be less. However, most people don’t like to put this to the test, so they keep avoiding those situations. One good way to break the avoidance is to start with easy situations and slowly build up enough confidence to face the harder things. The other important strategy is to control the level of the anxiety using the breathing exercise, isometric relaxation, and staying in the situation until you have become calmer. But how do you organise such experiences? First, you make a list of all the situations you avoid. Make sure that you include things that might not be obvious at first, such as certain topics of conversations, missed opportunities, not accepting invitations, putting things off, and cutting activities short. Next, you rank those situations in terms of your need to avoid them, that it, from those situations in which you get anxious but never avoid, to those situations that you always avoid. Then, work your way up the hierarchy (which is the name for the list that you have constructed), confronting your fears at each level until they lose their power to evoke anxiety. Exercise: Planning Your Program of Exposure 1. Draw up a list of goals that you would like to be able to achieve. These should be specific goals that vary from being mildly to extremely difficult. For example;  To be able to have friends for dinner or a scary movie  To be able to watch the news or a scary movie  To be able to accept a promotion at work 2. If something is too hard, try to break it down into easier steps to enable you to work up to the goal a little at a time. 3. Many fears/anxieties need to be confronted frequently (i.e. 3 or 4 times a week) at first; otherwise your anxiety will rise again by the time you do it next.
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Once you have largely overcome the fear, you need only do it less frequently. The general rule is; the more anxious about something, the more frequently you need to confront it. 4. Carefully monitor your progress. Keep a diary of your goals, steps, and achievements, together with comments about how you felt and how you dealt with particular situations. This will help you to both structure your progress and give you feedback as to how you are doing. It will also provide you with the opportunity to collect information about how you have tackled situations, which will no doubt be of help in the future. Practicing the Steps: 1. If possible, use the relaxation exercise before you undertake the activity. Get yourself as calm as possible. 2. Perform all activities in a slow and relaxed manner. This means giving yourself plenty of time. 3. Mentally rehearse your activity. For example, if you will be talking with someone, practice what you will say to them. 4. When the circumstances allow it, stop your activity at the point which you become anxious. Find a place to sit down and rest and wait for the fear to pass, as it will within a few minutes. If circumstances prevent you from stopping an activity, then let yourself continue the activity with no pressure to perform. For example, if there are silences in a conversation, let them happen. It is not your responsibility to fill every gap. 5. Do not leave the situation until you feel yourself to be calming down. Never leave a situation out of fear – face it, accept it, let it fade away, and then either move on or return. If you do not do this, you will see it as a failure and lose confidence. 6. Try to remain in the situation as long as possible. If you observe the above directions, the longer you remain in the situation, the calmer you will become and the faster you will overcome your fears. 7. Congratulate yourself for successful achievements. Do not berate yourself if you‟re not quite so successful.

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Exposure Exercise: Make a list of all the situations that you avoid or that make you anxious.

1. ______________________________________________________________________________ 2. ______________________________________________________________________________ 3. ______________________________________________________________________________ 4. ______________________________________________________________________________ 5. ______________________________________________________________________________ 6. ______________________________________________________________________________ 7. ______________________________________________________________________________ 8. ______________________________________________________________________________ 9. ______________________________________________________________________________ 10. ______________________________________________________________________________
Order the situations in level of difficulty Pick the three you wish to work on first Write your goals below in very clear terms, together with the steps you intend to take in order to achieve them

1. GOAL________________________________________________________________________ Step: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 2. GOAL________________________________________________________________________ Step: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 3. GOAL________________________________________________________________________ Step: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 161

ANXIETY & DEPRESSION
CHAPTER 8 Overview
 Review last week  Check Progress on Relaxation  Coping  Bullying/Self Esteem  Power of Words  Revise SLEEP  Homework o Something FUN!!  Feedback o Loneliness/Isolation  Choices o Do not compare yourself with others o Life is what is happening while you‟re waiting for something else  Support Network  Relationships  Suicide
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Guidelines for helping a Friend/Partner/Family Member who is Talking About Suicide  Never assume they will not do it!  Talk openly and honestly; talking about suicide doesn‟t make someone commit suicide  Don‟t be shocked (or show shock); instead show them that you are concerned and want to help/support  Don‟t tell them that their ideas about suicide are silly or dumb; that will only make them sorry they told you in the first place  Don‟t say “Snap out of it”, “Pull yourself together”, or “Get over it”, someone who is depressed can‟t just “snap out of it” – if they do, that can be a serious suiciderisk warning sign  Show that you are willing to understand how they feel, but be careful of asking, “Why” questions because that may encourage them to be suspicious. Be supportive, not intrusive.  Say things like “I don‟t want you to do that”. “I‟d like to help somehow”, or “it would be awful for me if you killed yourself”  Encourage or, if necessary, insist that they talk with someone who can help (specialist)  Stick with the person through this difficult period, even though they may not be much fun to be with  Help them to stay away from drugs and alcohol; these only make things worse in the long run  Encourage but do not nag the person to eat well and get plenty of rest so that they will keep in good shape and feel good. Encourage them to do some exercise  DO NOT promise to keep the person‟s plans about suicide a secret, your first duty is to protect their life. Better to be an angry friend than a dead one

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 Ask a trusted specialist what to do. Do not try to handle this problem by yourself – if you do, you may feel responsible and guilty if the person does go ahead and commit suicide

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WHAT TO DO IF YOU FEEL SUICIDAL (A) Identify the specific problem by asking yourself the following questions: What is making me think about ending my life? Is it the loss of a relationship or a perceived failure in my career? What triggered my thoughts of suicide? (B) Investigate alternative solutions Investigate alternatives to suicide. What appears to be an insolvable problem may be looked at in new, more flexible way. Being flexible increases the probability of finding a solution to your problems. Ask yourself;  Is there another way of looking at this?  What can I do to improve the situation?  Is there anyone who could help me? (c) Identify your feelings Are intense feelings of anger, guilt or depression causing you to think of suicide? What can you do to change your feelings? Perhaps talking things through with a friend or therapist will help you to find a new perspective. Being able to express your anger verbally rather than in a self-destructive manner will help. (D) Identify your thoughts Severe self-critical and self-punitive thoughts create intense guilt. Poor self-esteem makes you vulnerable to suicide attempts as it causes you to be extremely sensitive to criticism, rejection or failure. By building self-esteem you can protect yourself from feelings of worthlessness than can lead to thoughts of suicide. Do not ever get caught up in thoughts like... they will soon get over it / no one will really miss me / they will be better off without me/ or no one cares Do Not Be Alone, even if you have to get hold of a stranger a paramedic or a police officer.....

Feeling down causes loneliness
Feeling depressed can in itself be a cause of loneliness. When people feel depressed, they place less importance on their health, their grooming and appearance. They lose interest in things and often believe that they have nothing to offer. This can lead to withdrawing from social contact or
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relationships because of the fear of being hurt or rejected. They assume that others see them as dull and uninteresting. Unfortunately, withdrawing from social contact gives more opportunity for brooding and self-pity and will make you even more depressed.

“Don‟t care...” and feeling helpless Your friends do not move away from you because they hate you or don‟t care. They simply feel helpless. They do not know what to do to fix your problem – this is where expert counselling comes in.
COMPARING YOURSELF WITH OTHERS…. LIFE IS WHAT HAPPENS WHILE YOU ARE WAITING FOR SOMETHING ELSE!!!!!! Assess your support networks…….. Assess your relationships…..

Life can change in a day; you are never as alone as you may think - at the end of the day you only have 2 choices,,,Give Up OR Keep going till you win! Giving Up was never really a choice though was it!

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