The Wellbeing Course Resource: Mental Skills The Wellbeing Course was written by Professor Nick Titov and Dr Blake Dear
About Mental Skills This resource introduces three mental skills which people find helpful. We discussed in Lesson 2 how stress, anxiety, low mood and depression can affect our brains and how we think and approach things they can bias us to think in certain ways and to do certain things. We also discussed how it is important to try to recognise these biases and to try to challenge them. The skills in this resource are mental skills, which many people find helpful for challenging some of the changes caused by stress, anxiety, low mood and depression. These skills can be used in lots of different situations and are easy to learn. 1. The Risk Calculator: This skill helps to work out just how likely it is that something bad will really happen. This is helpful for situations where we think we may be overestimating the risk of something bad happening. 2. The Coping Calculator: This skill helps to work out just how likely it is we would be able to cope in a challenging situation or if something bad did happen. This is particularly helpful when we think we may be underestimating how well we can cope with things. 3. Shifting Attention: This is a skill we can use when we are experiencing strong Physical Symptoms as a result of medical conditions or strong worries and unhelpful thoughts, which are difficult to challenge. When practiced regularly and developed as a skill, we can effectively shift our attention away from unhelpful symptoms affecting our emotional wellbeing. Let s look at each of these skills in depth 2
The Risk Calculator When we are stressed, worried and anxious, our brain and the way we think changes. We become much more likely to over-estimate the risk of bad things happening. Specifically, research shows that stress, anxiety and worry can bias our thinking so that we see things as more risky than they are. Over-estimating risk is a problem because it can lead us to experience lots of additional unhelpful symptoms, which further affect our emotional wellbeing. Because of this it is important that we manage the tendency of stress to bias our thinking by keeping our thinking accurate. The Risk Calculator is a simple skill to help keep our sense of risk accurate. It involves 3 steps: 1. Think of something bad you are worried about happening and estimate how likely you think this event is to occur (e.g., a 1 in 2 chance? A 1 in 10 chance?). 2. Think about all the smaller events that would need to happen for the feared event to occur and then estimate how likely each of these individual events is to occur. 3. Multiply all of the probabilities together and mathematically calculate the actual likelihood of the feared event, and re-evaluate your estimate. Importantly, in most cases, exact statistics about certain events happening are not available. So, just give your best guess it s usually accurate enough. Let's look at some examples... 3
The Risk Calculator Step 1: Think of an event that you are fearful of happening and estimate how likely you think it is to occur I worry about having a panic attack while I am out and far away from home. And, getting stuck in a public place unable to really move or get any help to get home safely. I ve had some panic attacks in the past. 1 I believe this will happen 1 in every 10 to 20 times. Step 2: Think about all the smaller events that would need to happen for the feared event to occur and then estimate how likely each of these individual events is to occur. I have to have a major panic attack (I get 1 every month or so) 1 in 12 2 I have to be out of the house and in public 1 in 40 3 I d have to be far away from home 1 in 50 4 I d have to not be near my car 1 in 10 5 I d have to be alone (without any family or friends) 1 in 80 6 There has to be no one around to help or willing to help 1 in 500 7 I have to have no mobile reception (to call for help) 1 in 1000 8 9 10 11 12 13 14 It has to be a long lasting panic attack (if brief, I could just rest a bit) 1 in 300 Step 3: Multiply all of the probabilities together and mathematically calculate the actual likelihood of the feared event, and re-evaluate your estimate. Multiply Event Probabilities: 12 x 40 x 50 x 10 x 80 x 500 x 1000 x 300 Actual Probability: 1 in 2,880,000,000,000,000 By using the Risk Calculator I could see and convince myself that my worst fear of having a panic attack and being stuck in public with no help or way to get home was VERY unlikely to say the least. I have to remind myself that, in an absolute worst-case scenario, I just have to call or get someone else to call a friend for me 4
The Risk Calculator Step 1: Think of an event that you are fearful of happening and estimate how likely you think it is to occur I often worry about losing my job sometimes my mood is pretty bad and it affects my ability to concentrate and work as fast or well as I like. Sometimes I also have to take sick days out of the blue. I haven t told my boss about my issues yet and don t know how she d react. I believe this will happen 80% Step 2: Think about all the smaller events that would need to happen for the feared event to occur and then estimate how likely each of these individual events is to occur. 1 I have to have a major deterioration (most are pretty minor) 1 in 50 2 It would have to affect my performance for a long time rather than couple of days 1 in 80 3 It would have to affect my performance in a major way 1 in 40 4 I d have to not be able to get a doctors certificate 1 in 500 5 My boss would have to ignore all my previous good work 1 in 70 6 My boss would have to be completely unsympathetic 1 in 100 7 My boss would have to ignore my rights as a worker 1 in 1000 8 9 10 11 12 13 14 Step 3: Multiply all of the probabilities together and mathematically calculate the actual likelihood of the feared event, and re-evaluate your estimate. Multiply Event Probabilities: 50 x 80 x 40 x 500 x 70 x 100 x 1000 Actual Probability: 1 in 560,000,000,000,000 My chances of having a major deterioration in my mood and then losing my job was pretty unlikely although, sometimes it seems really likely, especially at the most difficult times at the moment. My depression could get worse over time and the likelihood may increase. But, then, that s in the future and just worrying about it now isn t helpful in the end, most of us get to the point where we can t work anymore. 5
The Coping Skills Calculator When people struggle with stress, anxiety, low mood and depression, the brain and the way we think often also changes in that it makes us think we cannot cope with difficult situations. Specifically, our thinking can be biased in such a way that we underestimate our ability to cope with challenging situations. Because of this people often struggle with thoughts and we often hear phrases like I won t cope, I ll fall apart, I ll have a melt down and I ll have a break down in response to difficult situations. We all define coping in different ways and have different ideas about what coping looks like. However, the truth is that in reality most of us cope well in very difficult situations especially when others are relying on us. This isn t to say these situations do not have an impact on us or do not cause us any symptoms just that we manage our way through them. The Coping Calculator is a simple skill to help keep our sense of our ability to cope accurate. It involves 3 steps: 1. Think about something you are worried might happen and estimate how likely you think you are to cope with this event. 2. Think about all the things that would need to happen in order for you not to cope, and estimate how likely each of these individual events is to occur. 3. Multiply all the probabilities together to calculate the actual likelihood of you not coping, and then review your initial estimate. Let's look at some examples... 6
The Coping Calculator Step 1: Think about something you are worried might happen and estimate how likely you think you are to cope with this event. I get so worried that if my car was stolen, it would end up with me having a meltdown. I sometimes get so distracted by worrying about this I would rate it as probably a 1 in 5 chance. Step 2: Think about all the things that would need to happen in order for you not to cope, and estimate how likely each of these individual events is to occur. 1 2 3 4 5 6 7 8 9 10 11 12 I would need to lose my phone and not be able to call anyone to pick me up (but I always carry my phone so this isn t likely!) There would have to be no public transport (if this was the case then it means there would be some sort of national emergency) My insurance company would have to reject my claim (but I have never made a claim before, and if they did, I would complain) I would have a meltdown in the carpark and be sobbing uncontrollably (even when I ve had really bad news before, I have always held it together even if I was upset) 1 in 50 1 in 1000 1 in 100 1 in 100 Step 3: Multiply all the probabilities together to calculate the actual likelihood of you not coping, and then review your initial estimate. Multiply Event Probabilities: 50 x1000 x 100 x 100 Actual Probability: 1 in 500,000,000 When I look at the maths I know I would cope. It wouldn t be good and I don t want it to happen. But, in reality I d cope. 7
As you can see, the Coping Calculator is a really powerful and systematic way of reminding yourself of how well you really can cope. It is often helpful to reflect on the difficult times you have had to deal with. The reality is that most people are much more resilient and resourceful than they give themselves credit for, especially in really difficult situations. The Coping Calculator is a good way to remind yourself of this. Shifting Your Attention Research tells us that stress, anxiety, low mood and depression all affect our attention and what we focus on. When we are stressed and anxious we tend to focus on potential threats and dangers. When we are low and depressed we tend to focus on the losses and other negative aspects of our situation. We can think of attention as a bit like a torch in a dark room. The torch allows us to see a portion of the room in very great detail while the rest is left in the dark. Attention is also designed to help us focus on what is important. However, when we are dealing with a lot or have poor emotional wellbeing, it can be biased to focus on things that are actually unhelpful. Research tells us that the more anxious or depressed we are the more likely our attention is to be biased towards threatening and negative things. Why does our attention get biased? It isn t a coincidence. By focussing our attention on threatening and negative things our brain is trying to let us know that something may be wrong and that we may need to take action. However, if we do not take action, then our attention can be drawn to more threatening and negative things over long periods of time. This can make our emotional wellbeing much worse. Shifting your attention as a skill Many people find learning to shift their attention away from negative or threatening things can be a helpful skill to develop. However, it does take time to develop and there is no right, wrong or standard way to practice this skill. Instead there are lots of individual preferences for the way people distract or shift their attention. However, there are some general guides and principles people find useful for developing this skill. 8
The 3 steps are: 1. Briefly challenge any unhelpful thoughts or worries 2. Briefly practice the 3 3 3 Controlled Breathing, if tense or stressed 3. Then, shift your attention to something different and more helpful. You may decide to shift your attention onto: 1. A specific task: Challenge yourself by concentrating on each of the individual steps required to complete the task. Describe each step and what you need to do to achieve it, and then pat yourself on the back after you have done each step. 2. A specific memory: Remind yourself of when you did something well, or did something that you enjoyed. Be realistic about recognising your own achievements, especially when times have been tough. 3. Time, object and place: Focus on an object around you pay attention to its shape, texture, colour, weight, position, shadow, size. Describe it to yourself. You can also concentrate on time and place. Remind yourself of the time, date, month, and year. Think about where you are, its specific location including street number, street, town, city, country, even planet. Think about what the ground feels like under your feet, how the air smells, the temperature, etc. Let your attention shift to things that are more helpful and positive. Most people find that their attention keeps going back to the thing they do not want to focus on and that they need to shift their attention repeatedly, especially early on. However, over time people find they get better at shifting their attention and keeping their attention more focussed on helpful things. Shifting Attention does not aim to control, fix or ignore our problems. The aim is to learn to acknowledge if things are distressing, try to do something constructive, and then focus attention onto neutral or positive things so that the mind does not dwell on unhelpful things. Shifting Attention is a way to train yourself to begin to automatically shift your attention away from distressing things. 9
Let s look at some examples from Jo and Glenn My unhelpful thoughts are like a broken record, even after thought challenging, I still find it difficult to stop them from playing through my mind I started to practice shifting my attention after challenging my thoughts. If I still had the thoughts, I d focus my attention on where I was and what was happening around me. It was difficult at first, because my attention wanted to go back to whatever it was I was worrying about. But, it became really helpful with practice. I now find that I can choose to focus my attention on different things depending on the situation. For example, if something needs to get done, I d focus my attention on completing that task. I realised that, whenever I feel self-conscious, my attention shifts to my physical symptoms and I then get a mental image of myself looking like a complete fool. It was difficult shifting my attention at first because my physical symptoms were so strong. I thought I d first practice controlling my attention in non-social situations, such as focusing on where I was, kind of like grounding myself and making myself calmer, when I was listening to music. Then I decided to practice shifting my attention when doing things like talking to people on the phone. This helped me to build up my confidence and I found it much easier to do it in more challenging situations. We have summarised some important key points made by our previous participants. Attention shifting is a skill that takes practice: Think of your attention as a muscle. The more you train the better you become at shifting your attention. It is completely normal for your attention to drift back to the thing you do not want to focus on. The trick is to acknowledge this and gently bring your mind back to what you have decided to focus your attention on. Start small and build on your progress: Many people have difficulty shifting their attention at first and this is normal. It may help to start with smaller, easier tasks, and gradually build on your progress. Use your senses: As you try to shift your attention onto something, try to absorb yourself in the experience by using all of your senses. For example, instead of focusing on painful feelings, try to direct your attention on your other senses. This can involve sight (e.g., visualising a pleasant scene or focussing on the details of an image), smell (e.g., lighting a scented candle), touch (e.g., focusing on the breath), taste (e.g., mindfully eating something) and sound (e.g., listening to calming music). Most people find it important to shift their attention to something important or engaging for them. Shifting your attention is not denying or blocking your emotions: Emotions are a normal part of life and it is unhelpful to block them out. The aim of shifting your attention is to learn to focus on the here and now so that things don t get in the way of what you need to do. 10
Summary The three mental skills described in this resource are helpful for managing a couple of important changes to the way we think and what we do, which are caused by stress, anxiety, low mood and depression. All of the mental skills can be learned relatively quickly and many people find them helpful for managing their symptoms and improving their emotional wellbeing. Good Luck, The Mind Spot Clinic Team Copyright 2015 The MindSpot Clinic All rights reserved. You may use and/or copy this information for personal reference only. The MindSpot Clinic endeavours to ensure all information contained in this material is correct at the time of inclusion. However, the accuracy of the material cannot be guaranteed and people using the information do so entirely at their own risk. The information may not be reproduced or published in any other way or by any means without the prior written consent of The MindSpot Clinic. 11
Worksheet: The Risk Calculator The Risk Calculator Step 1: Think of an event that you are fearful of happening and estimate how likely you think it is to occur Step 2: Think about all the smaller events that would need to happen for the feared event to occur and then estimate how likely each of these individual events is to occur. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Step 3: Multiply all of the probabilities together and mathematically calculate the actual likelihood of the feared event, and re-evaluate your estimate. 12
Worksheet: The Coping Calculator The Coping Calculator Step 1: Think about something you are worried might happen and estimate how likely you think you are to cope with this event. Step 2: Think about all the things that would need to happen in order for you not to cope, and estimate how likely each of these individual events is to occur. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Step 3: Multiply all the probabilities together to calculate the actual likelihood of you not coping, and then review your initial estimate. 13