DBT

DBT is one of the most effective therapeutic treatment approaches for issues related to emotional dysregulation. Focusing on the psychosocial aspects of therapy and development of skills for dealing with highly charged emotional situations. These skills cover:

• Mindfulness
• Tolerating distress & getting through Crisis
• Regulating your emotions
• Improving relationships & assertiveness

It If you want to look at different options this article provides information about different websites with downloadable resources and information https://www.unk.com/blog/top-ten-sites-for-dbt-worksheets/

 

 

 

Developed for Young People but useful for Adults too   http://cwpcamhscentre.mymind.org.uk/4d-toolkit/

 

Crisis Survival

 

https://dialecticalbehavioraltherapy.wordpress.com/distress-tolerance-tipp-skills/

 

Temperature

Why it works  We can induce the dive reflex by putting our face in very cold water whole holding our breath, it starts to work after around 30-60 secs.  This reflex lowers our heart rate to below its normal resting rate. Caution: Never try this if you have any heart problems without your doctors permission.

How to do it. Hold your breath while putting your face under very cold  water, as far as your temples. Try and stay in the water for 30secs. 

Alternatively you can try holding an ice pack on your eyes and cheek area for 30 sec while holding your breath.  The effect is increased if you stand and bend your head over while doing this skill.   It’s an  unusual sensation give it a try to feel how it works before a crisis.  Keep ice packs in the freezer ready.

 

Intense exercise

Why it works  Anxiety decreases when our heart rate gets up to 70% of its maximum & positive emotions are increased after 20 to 30 mins intense exercise.

How to do it  Do intense aerobic activity for 20 mins.  E.g. running, jumping jacks, walking, cycling. 

 

Paced breathing

Why it works  Our bodies naturally relax when we breathe out, so if we can slow our breathing down & breathe out for longer than we breathe in then we start to relax.  This can be used at anytime.

How to do it   Breathe in deeply, using your diaphragm (abdomen).  Count the number of seconds for each breath in and each breath out.   Aim to breathe out for a longer count than you breathe in.  Count your breath,  so if you’re are counting 4 for the in breath, then count 5 or 6 when breathing out. 

 

Paired muscle relaxation

Why it works  When we create tension in a muscle then release the tension the muscle has to relax.

How to do it   The pairing comes from relaxing the muscles at the same time as breathing out.  Tense an area of the body, notice the tension and hold  the tension for 5 – 10 seconds.  Then release the tension and relax for 5 -10 seconds.  When relaxing the muscle, breathe out and say the word “Relax”. Continue with different areas of the body.  Notice how the body feels when it is tense, and when it is relaxed.  It takes practice to be able to do all these things at the same time.

 

If your mind is your worst critic

If you find your mind is constantly putting you down or repeating every nasty word you’ve had  directed at you finding ways to ‘unhook’ from everything your mind tells you or develop Self Compassion  can be helpful.

 

Self Compassion

We are often supportive, understanding and compassionate to others, but are much harsher and critical towards ourselves in the same situation. Learning to be more compassionate with ourselves leads to a calmer mind, better relationships, less anxiety and depression, and an increased sense of self worth.

   https://www.getselfhelp.co.uk/docs/Compassion.pdf

 

From Self-Criticism to Self-Kindness: This workbook is designed to provide you with some information and practical skills to help you be less critical and more compassionate towards yourself. It is organised into 7 modules that are designed to be worked through in sequence.  They recommend that you complete one module before going on to the next. Each module includes information, worksheets, and suggested exercises or activities.

https://www.cci.health.wa.gov.au/Resources/For-Clinicians/Self-Compassion

 

 

 

 

Unhooking or Defusing Techniques: Don't Believe Everything You Think!

https://www.getselfhelp.co.uk/defusion.htm

If You're Struggling and Making Your Own Safety Plan

If you’re struggling and you’re not sure if you want to live or die, can you,  just for now hold off making this decision and keep reading...

There are times in life when we might feel totally, hopeless, helpless, overwhelmed with emotional pain. It can seem like there is no other way out of our problems, we've run out of ideas, possible solutions. Our problems seem unfixable. The pain feels like it will never end. We believe  suicide is the only answer left.

You may feel like you do for good reasons and suicide might seem like a solution, perhaps a way to escape, but those feelings will change and fluctuate.   Suicidal thoughts are a sign to change something in your life - NOT to END your life.  The  Feelings will pass.   The ideas in  this pack will hopefully provide tools and strategies to cope  or help them  pass without doing things which might make it worse in the  long run.  

 

Making your  own safety plan

A safety plan is a personalised plan to support you step-by-step at times when you may be thinking about suicide.

https://www.stayingsafe.net/node/7

 

Making a Crisis (survival  or hope)  Box

You can call it whatever you like. The idea of a crisis box is that it is filled with items that make you feel better. You can use it when you feel anxious, stressed or suicidal.  Here are some ideas as to what to put in yours:

https://papyrus-uk.org/wp-content/uploads/2018/09/Hope-box.pdf

Or https://www.getselfhelp.co.uk/emergency.htm

 

People struggling with OCD might be finding that the current worry and uncertainty around the Coronavirus situation has really strengthened OCD and increased the demands it makes on  them.  OCD can claim  to offer a way to feel better, reduce the fear  or discomfort and gain some sense of control (very appealing at the moment). Unfortunately any relief it offers tends to be only brief and it often  ups its demands and requirements, leading people to be more and or trapped by it.

 

Resources for the OCD and related disorders community during the COVID-19 outbreak

The International OCD Foundation  have put together the following resources that you may find useful.

https://iocdf.org/covid19/#more-info

 

These links offer a starting point for challenging OCD within the corona virus context

https://www.wheretotalk.org/ocd-obsessive-compulsive-disorder-coronavirus-helpful-advice/

https://www.ocduk.org/ocd-and-coronavirus-survival-tips/

 

And  this suggests some self help resources

https://www.ocduk.org/overcoming-ocd/self-help/

 

This podcast with Russ Harris (ACT therapist) demonstrates several exercises, discusses the choice point, his book The Happiness Trap, living a value led life, applying ACT principals when feeling emotionally overwhelmed, and much much more. Hope it helps.

https://theocdstories.com/podcast/dr-russ-harris-the-happiness-trap/

Health Anxiety, or in ‘English’ – when you have an  obsessive preoccupation and anxiety that with being seriously ill

To worry about your health is a normal human experience, even more so within the context of coronavirus.  People affected by health anxiety have an obsessional preoccupation with the idea that they have (or will have) a physical illness. The person experiencing health anxiety may fixate on any type of illness and become convinced that harmless physical symptoms are indications of  severe medical conditions. For example, if a person experiencing health anxiety feels their chest is getting tight, they may believe that they are having a heart attack.

Health anxiety becomes a problem when it is excessive, out of proportion to the realistic chances of getting the condition, perseveres despite negative tests and reassurance from health professionals, leads to excessive unhelpful behaviours (such as body-checking and medical test-seeking) and causes someone  significant distress or impacts on their functioning.

Health anxiety can exist in people who are “healthy”, in people who are experiencing real yet unexplained medical symptoms and in people who have a diagnosed medical condition. In health anxiety the issue is not whether your physical symptoms are real, but whether you are responding to and coping with your symptoms in a helpful or unhelpful way.

People who have previously struggled with health anxiety or those who were not affected by this before may find they become preoccupied with any symptoms which might be indicators of coronavirus.

 

Self Help Resources for Health Anxiety

You may find the resources listed within the Managing the understandable Anxiety & Uncertainty   or OCD section helpful

 

In addition here are a range of self help tool packs for you to choose from:

A CBT based self help pack produced by Northumberland Tyne & Wear NHS

https://www.nhs.uk/conditions/hypochondria/documents/health%20anxiety%20a4%20%202010.pdf

 

This self help package brings together CBT & mindfulness approaches:

https://www.getselfhelp.co.uk/healthanxiety.htm

 

Overcoming Health Anxiety Workbooks:

This comprehensive information package is designed to provide you with some information about health anxiety, including how it develops, how it is maintained & how to decrease your health worries and concerns. It is organised into modules that are designed to be worked through in sequence. They recommend that you complete one module before going on to the next. Each module includes information, worksheets, and suggested exercises or activities.

https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Health-Anxiety

 

 

Anxiety UK

Have put together a range of information, resources and support for helping you understand how to deal with your anxiety during these difficult times while Coronavirus (COVID-19) is impacting on our lives.

https://www.anxietyuk.org.uk/coronanxiety-support-resources/

Many of the resources in the section above will be useful in managing the difficult feelings linked to trauma but for more specific information which provides psychoeducation about the impact of traumatic experiences.

 

All About Trauma

Trauma is Really Strange – This little book provides an easy to understand summary of the effects of trauma

https://student.londonmet.ac.uk/media/london-metropolitan-university/london-met-documents/professional-service-departments/student-services/counselling-service/trauma-is-really-strange.pdf

  

Carolyn Spring is a survivor of abuse and trauma who has developed a range of resources and training to help people who are struggling with the effects of complex, often childhood trauma or abuse and coping with dissociation of varying degrees.   She emphasises in a validating and compassionate way the importance of developing a sense of safety, understanding the effects of trauma and the things people can do to help themselves.

On her website she  has a fairly easy to listen to podcast   https://www.carolynspring.com/podcasts/

And an extensive Blog https://www.carolynspring.com/blog/

 

Trauma Stabilisation Pack

This is a range of self-help guides, produced by service users and the psychology team in Cwm Taf UHB, to help people who are experiencing reactions to trauma and provide advice on managing these symptoms.

https://cwmtafmorgannwg.wales/services/mental-health/stabilisation-pack/

 

 

Other Helpful Ways of Coping with trauma: 

Dropping Anchor is a really useful grounding technique developed by Russ Harris (ACT Made Simple 1^st Ed, 2009) https://www.actmindfully.com.au/  :  

You can use Dropping Anchor  for handling difficult thoughts, feelings, emotions, memories, urges and sensations more effectively; switching off auto-pilot and engaging in life; grounding and steadying yourself in difficult situations; disrupting rumination, obsessing and worrying; focusing your attention on the task or activity you are doing; developing more self-control; and as a ‘circuit-breaker’ for impulsive, compulsive, aggressive, addictive or other problematic behaviours.

 

What is involved?

Dropping anchor involves playing around with a simple formula: ACE

A: Acknowledge your thoughts and feelings

C: Come back into your body… slowly

Push your feet hard into the floor

Straighten your spine

Press your fingertips together

Stretch your arms & neck

E: Engage in what you’re doing

Notice 5 things you can see

3 things you can hear

Something you can smell or taste

Notice what you are doing

 

Download Dropping Anchor Handout for Clients PDF

Included with permission © 2019, Russ Harris www.TheHappinessTrap.com

 

Download Dropping Anchor - Ellie Caldwell PDF

Included with Permission - Thanks to Ellie Caldwell & Russ Harris

 

A Really Comprehensive discussion of Dropping Anchor is also provided by Russ  Harris in  this e-book:

https://www.actmindfully.com.au/upimages/The_Single_Most_Powerful_Technique_for_Extreme_Fusion_-_Russ_Harris_-_October_2016.pdf

 

If you prefer here are some audio versions

https://www.actmindfully.com.au/free-stuff/free-audio/

https://contextualconsulting.co.uk/insights/free-act-resources-from-russ-harris

 

PTSD Self help

A Four page self help guide for those struggling with PTSD      

https://www.getselfhelp.co.uk/docs/PTSDselfhelp.pdf

 

Specific Ideas for coping with flashbacks

A useful 2 page guide with simple strategies for coping with flash backs

https://www.getselfhelp.co.uk/docs/CopingwithFlashbacks.pdf  

Eleanor Longden's TED Talk

Eleanor Longden’s TED Talk illustrates the importance of offering Treatment choice to people both about treatments they are offered and the ways in which their experiences are understood.

Sometimes experiencing unusual experiences, hearing voices or having strong beliefs, such as ‘paranoia’ which others don’t agree with can be the result of trauma. If you think that applies to you might want to have a look at the above section on trauma too.

Many individuals who are having experiences that may be labelled as Psychosis will also be experiencing difficulties with anxiety, low mood, sleep difficulties, worry, stigma and low self esteem. These issues can be dealt with using standard protocols e.g. CBT, ACT, CFT

Different people may find different approaches helpful. It may be useful to encourage the individual to try out different approaches to see what works best for them.

• Cognitive Behavioural Therapy (CBT) can be very effective for reducing distress associated with difficulties such as hearing voices or experiencing unusual or suspicious beliefs.
• The Hearing voices network, Engaging with voices or Compassion for voices and ACT instead focus on finding ways to live more easily with these experiences.

Hearing Voices Resources 

Understanding Voices(UV)  https://understandingvoices.com/

Is a  website that aims to make it easier for people to find information about different approaches to voice-hearing and ways of supporting those who are struggling with the voices they hear.   It has been produced by Hearing the Voice (Durham University) in close collaboration with voice-hearers, their families and allies, and mental health professionals.

The website covers a wide variety of topics, ranging from what it is like to hear voices and what’s happening in the brain, through to the pros and cons of medication, cognitive behavioural therapy and peer support. It presents practical techniques for managing distressing voices, information for families & friends, & also sheds light on the links between voice-hearing & inner speech, trauma, creativity and spiritual or religious experience.

The Open minded online Website   https://openmindedonline.com/resources/

Provides a range of resources for living more easily with voices including a Self Help Guide to talking with voices

https://openmindedonline.files.wordpress.com/2019/09/self-help-guide-to-talking-with-voices-r.-may-and-e.-svanholmer-sep-2019.pdf

 

Strategies For Coping With Distressing Voices

 

Changing the Power Relationship with Your Voices

The more we can understand about voices we are hearing and the issues they represent the easier they will be to deal with. By finding out more about them we make them less mysterious and therefore less scary. This hand-out looks at how to get to know the voices, how to strengthen your awareness and how to understand and work with the deeper issues the voices are indicating.

http://rufusmay.com/2011/06/15/changing-the-power-relationship-with-your-voices/

 

Be good to yourself & Compassion for Voices

This is a resource from the Psychosis Research Unit which highlights the importance of being compassionate towards yourself in the face of mental health difficulties.

The leaflet offers helpful exercises aimed at increasing self-esteem and self-worth. In support of these exercises, the leaflet also provides information on other compassionate-focused resources which may be helpful.

To access a copy of the Be Good To Yourself Leaflet go to this link

http://www.psychosisresearch.com/wp-content/uploads/2019/07/Be-good-to-yourself.pdf

 

Open minded On line provides  a series of videos  on engaging with voices which are intended as inspiration and support for people interested in compassionate approaches to voices.    https://openmindedonline.com/portfolio/engaging-with-voices-videos/

This is another website to support and promote compassionate approaches to voices and other experiences.  It includes relevant resources, including the 5-minute film, 'Compassion for Voices: a tale of courage and hope.

http://compassionforvoices.com/websites/

 

Some people also find the Hearing Voices Network  a supportive and validating resource.

http://www.hearing-voices.org/

 

 

Fixed & Unusual or Paranoid Beliefs

How can we tell whether our suspicious thoughts are justified? It's not always easy. If you're struggling to decide whether your suspicious thoughts are justified, ask yourself the questions in this great one page handout which encourages more thoughtfulness about suspicious thoughts (paranoia)! 

https://recoveryfromschizophrenia.org/wp-content/uploads/2009/11/How-can-we-tell-whether-our-suspicious-thoughts-are-justified.doc 

If you want more information on this approach and paranoia go to http://www.paranoidthoughts.com/about.php

 

 

Cognitive Behaviour Therapy (CBT)

CBT can be very effective for reducing distress associated with difficulties such as hearing voices or experiencing unusual or suspicious beliefs. CBT looks at how thoughts, feelings and behaviours are connected and interact with each other. CBT works by looking at ways in which we can break some of the connections within this cycle, for example by examining whether our thoughts are based on facts or are actually being driven by our fears, or whether what we are doing might be inadvertently maintaining our distress. This work is completed alongside the development of strategies that can help to manage distress and increase resilience.

CBT also looks at the underlying factors which may be precipitating difficulties the individual is experiencing, for example, trauma.

This self help guide assumes that you are already receiving some support from an appropriate mental health professional.   https://www.getselfhelp.co.uk/psychosis.htm

These CBT resources can be used in multiple ways, for example tolerating unusual beliefs, voices or worry as well as considering alternative view points.

 

Tolerating Uncertainty

www.getselfhelp.co.uk/apple2.htm

 

 

Self Help Books & Reading for Psychosis

SELF HELP BOOKS

Think your crazy? Think again A resource Book for Cognitive therapy for psychosis. Morrison, Renton, French & Bentall (2008)

Overcoming suspicious and Paranoid Thoughts. Freeman, Freeman, Garety (2016)

How to Keep Calm and carry on. Freeman D, Freeman J (2013)

OTHER USEFUL READING:

Bipolar disorder: https://shop.bps.org.uk/understanding-bipolar-disorder.html

Psychosis: https://www.bps.org.uk/what-psychology/understanding-psychosis-and-schizophrenia

Power threat meaning framework: https://www.bps.org.uk/power-threat-meaning-framework

Download Supporting People with Dementia PDF

The outbreak of COVID-19 has resulted in a range of sudden changes to everyday life. This may be a particularly challenging time for carers supporting somebody with dementia.

This section  contains some general advice  & signposting to support the wellbeing of people with dementia & their carers.

 

KEEPING UP TO DATE

Keep up to date with government and NHS advice

Keep up to date with the most recent guidance by accessing reputable sources:

UK government

https://www.gov.uk/coronavirus

NHS

https://www.nhs.uk/conditions/coronavirus-covid-19/

https://111.nhs.uk/covid-19/

 

SUPPORTING SOMEONE WITH DEMENTIA

Supporting understanding

• Try not to overwhelm the person with too much information
• Consider using signs and prompts around the house
• Use distraction to help the person move on if they are confused or distressed

Try to keep yourself up to date with the most recent government rules and guidelines around hygiene and social distancing. However, it may be difficult for a person with dementia to understand (or remember) the complex information being given. Try to simplify the information as much as you can, giving just the key points.

If they are able to understand your explanation, then it may be helpful to make some prompts around the house to remind them. This could include signs to prompt hand washing and a sign on the door to remind them why they shouldn’t go out.

If the person you care for is not able to understand the information, or is very distressed, then it is better not to persevere with trying to explain. For example, if they are trying to leave the house, try to distract them with another activity. It may be necessary at times to weigh up the risks – for example, whether the level of distress they will experience if you try to stop them leaving outweighs the risks of being outside. These are difficult situations and you can only use your best judgement.

 

Routine and structure

• Create a new routine within the home
• Try to stay physically active
• Consider limiting news reports on TV and radio

People with dementia generally benefit from having a structured routine, with a good balance of activity & rest periods. Unfortunately, it may not be possible to access community resources, such as groups, cafes & day centres. It is helpful to create a new routine within the home in order to stay active & support wellbeing. Maintaining a good routine for eating & sleeping is also important. Consider limiting news reports, such as TV & radio, as this may be unsettling & cause additional anxiety. 

“Dementia UK” suggests the following strategies for managing without support groups & day centres:

• Try to both stay entertained and distracted
• If possible, set up different areas around your home so that you can move from activity to activity: watch favourite films and musicals in the living room. Listen to the radio in the kitchen. Do jigsaw puzzles at the table. If you can, take walks around the garden.
• Ask friends and relatives to bring you films, puzzles, music, games – anything you think the person with dementia might like to do. Again, they can leave these outside the front door for you.
• Staying physically active during this time will help to keep you mentally and physically well. If you feel well enough, and have access to countryside where you will not come into close contact with other people, then try and get outside for a walk. This can become part of a new routine for you, as well as give you both something to talk about when you get back home.
• If you have a garden, go outside when possible – especially now the weather is warming up. Finding things to do outside or simply sitting in whatever sunshine we may get over the next few weeks will help. Fresh air and green space will help lift the spirits and also provide some stimulation. If you can, plant up a few plant pots with seeds or flowers that can be placed near the windows. If you have a garden shed, there may be some projects in there you can try – like making a bird feeder.

https://www.dementiauk.org/dementia-uk-coronavirus-advice/

 

Social contact

• Maintain social contact using other means, such as telephone and video

Social contact is important for all of us and is likely to provide reassurance and a feeling of connection. Although face to face contact may be preferable, try to support the person you care for to stay in touch with people using other means. This might be via telephone, video chat, messaging, or sending letters.

 

Monitor wellbeing

• People with dementia can find it difficult to adapt to change
• Provide regular reassurance

People with dementia may experience anxiety, low mood, and difficulty adapting to changes. If they are able to talk about what is going on, listen to their concerns and demonstrate that you are taking them seriously. Provide reassurance and be aware that they may need you to repeat this reassurance often. It is important to be aware that if someone is not able to verbally communicate their feelings, you may see a change in their behaviour that indicates there is a problem. Increased distress, agitation and confusion can also be a sign of an underlying physical health problem, such as an infection.

You can learn more about dementia, mental health and wellbeing via the websites and phone numbers below. If you are concerned about changes in mood or behaviour, you should help the person you are caring for to access support from their GP.

 

Practical considerations

• Plan ahead for getting food and medication supplies
• Ask for help from people you know

There are lots of practical considerations around getting food supplies, accessing medication and getting help if you need it. It is helpful to plan ahead and talk to people who may be able to support you with grocery shopping and picking up prescriptions.

It is also helpful to consider what would happen in an emergency, if you were not able to provide the care that you usually provide. You can read more about putting contingency plans in place on the carer’s UK website:

https://www.carersuk.org/help-and-advice/health/looking-after-your-health/coronavirus-covid-19

 

Taking care of yourself

• Looking after your own needs is important
• This is an uncertain time - it is understandable to find it difficult

Looking after your own needs is important. We will all experience increased levels of stress and difficult emotions during this time. It might be helpful to consider actions you can take to support your own wellbeing, such as staying in contact with support networks, watching a television programme you enjoy, and getting a balance of activity and rest. Try to be kind to yourself and remember that feeling anxiety, stress, and loneliness during the COVID-19 outbreak is entirely understandable. Remember that this period will eventually pass.

 

SOURCES OF INFORMATION AND SUPPORT

Alzheimer’s society

www.alzheimers.org.uk

0333 150 3456

Dementia UK

www.dementiauk.org

0800 8886678

Age UK

www.ageuk.org.uk

0800 678 1602

Carer’s UK

https://www.carersuk.org/

The CWP My Mind Website    https://www.mymind.org.uk/

MyMind is a website for young people, parents, and professionals working with children & young people. Here you can find information on how to look after your mental health, how to access help and support, and details of support services in your local area.    It includes links to a range of resources to help you with mood, relationships or lifestyle factors.    https://www.mymind.org.uk/resources/

 

Cheshire & Wirral Starting Well: Provides a range of information on  health and wellbeing, guiding you to extra support if you need it.   https://www.startingwell.org.uk/

 

The 4D Toolkit is a fantastic resource developed to support young people currently or previously involved in a  DBT skills programme or receiving DBT.  It  might also be of interest to anybody that would like a short introduction to the ideas and practices of this therapeutic approach.

 http://cwpcamhscentre.mymind.org.uk/4d-toolkit/

 

ACT Resources For Supporting Children & Adolescents

https://thrivingadolescent.com/ provides a range of ACT (Acceptance & Commitment Therapy) resources for children & young people.  Resources might most usefully be selected a therapist/ clinician.

Stuff that Sucks by Ben Sedley is a great book for adolescents & adults  available as e-book/ on kindle

 

These are useful resources for parents or carers  of children aged under 12

https://thrivingadolescent.com/wp-content/uploads/2016/10/DNA-v-families-tip-sheets-HayesCiarrochi-2016.pdf

https://thrivingadolescent.com/wp-content/uploads/2016/09/DNAv-tips-for-families-social-view-at-home-1.pdf

https://thrivingadolescent.com/wp-content/uploads/2016/05/DNA-v-Self-view-tip-sheet-for-kids-and-parents.pdf 

 

Websites with a Library of Self-Help Resources

https://getselfhelp.co.uk/selfhelp.htm

https://www.moodjuice.scot.nhs.uk/

 

Eating Difficulties

CWP Eating Disorder Service http://www.creatinghopetogether.com/

 

For Children, young people & Families

The CWP CAMHS Website    https://www.mymind.org.uk