PATIENT SKILLS
PROGRAMME
Facilitator Manual
Module C
1
About this Manual
This manual contains materials to support the delivery of the Patient Skills Programme. It
includes:
 overview of the Programme
 standard programme for each session
 materials for the delivery of all Module C activities
 explanation of the icons and charts used in the materials
Additional materials to support the programme are
 materials for the delivery of all Module A activities
 materials for the delivery of all Module B activities
 participant Workbook and Handouts
 guide for Facilitators
 guide to Facilitator Training, Skills and Assessment
 guide to Quality Assurance
 guide for Programme Leads
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Overview of the programme
2.1
The purpose of the Patient Skills Programme
The core focus of the programme is to enable people to better manage their own health,
through increasing their self confidence, increasing their skills and supporting positive
changes in health related behaviour, leading to activated patients who feel in control of their
health choices.
2.2
How this programme relates to wider health services
The Patient Skills Programme does not, and should not; exist in isolation from the wider
health services that people use. The Health Foundation, through its Co-Creating Health
programme, believes that people with long term conditions are best able to manage their
own condition when:
 they have the necessary skills, knowledge and confidence
 they are being supported by clinicians proactively using self management support skills
and techniques
 the systems and processes of the healthcare service are designed to support self
management
2.3
Course structure
The Patient Skills Programme is normally run over six weeks, with a workshop a week. Each
workshop consists of a series of activities, each lasting 20 minutes, which are put together to
create a single session lasting 2 hours 40 minutes.
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However, the programme is designed to be adaptable, and may, for example, be spread over
longer by running (particularly the last two or three sessions) at fortnightly, rather than
weekly, intervals, or by creating new workshops.
2.4
Course delivery: co-facilitation
What makes the programme unique is that it is co-delivered by a health professional and a
person with experience of living with a long term condition working in partnership. This
collaboration between the professional and lay tutors is a model for the collaborative
relationship the programme is promoting between health professionals and patients.
Feedback from previous participants has shown that they find the different perspectives,
experience, knowledge and skills that the tutors from different backgrounds bring extremely
valuable.
2.5
Course content
The programme is made up of three sets (Modules) of activities, containing a range of
different components and activities:
 Module A: Core Repeated Activities: Goal-setting, Goal Follow-up and Problem solving
– These activities are core to health related behaviour change and should be included
and repeated in every workshop.
 Module B: Core Generic Self-management skills
– These activities are also considered core self management activities or core to the
group process. Each activity should be covered at least once in the course of Patient
Skills Programme.
 Module C: Optional Self-management skills and topics
– These activities are optional and may be included as needed. Additional module 3
activities may be created for specific diseases and communities.
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3
Standard programme
All the modules are designed to be delivered flexibly, in the order and at the pace that best
suits the group, however, we have set out below a standard programme for each of the six
workshops.
Programme for workshop 1
Module
Activity
B
B
B
A
A
B1
B2
B3
A1
A2
Getting to know one another
Understanding self-management
Recognising and accepting change
Introducing goal-setting
Setting the agenda and close
Programme for workshop 2
Module
Activity
A
B
C
A
A
A
A3
B4
C1
A4
A5
A2
Welcome
Follow-up
Challenging unhelpful beliefs
Helpful breathing (optional)
Sharing and agreeing agenda
Working on a self-management goal
Setting the agenda and Close
Programme for workshop 3
Module
Activity
A
B
A
C
A
A
A3
B5
A6
C2
A7
A2
Welcome
Follow-up
Working together in partnership
Problem-solving
Eating Well (optional)
Weekly goal setting
Setting the agenda and close
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Time
(minutes)
40
20
20
40
Time
(minutes)
5
30
20
20
20
30
10
Time
(minutes)
30
20
20
20
30
10
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Programme for workshop 4
Module
Activity
A
B
B
C
A
A
A3
B6
B7
C3
A7
A2
Welcome
Follow-up
What happens next? Follow-up options
Anxiety, relaxation and your health condition
Managing fatigue, helpful rest and sleep(optional)
Weekly goal setting
Setting the agenda and close
Programme for workshop 5
Module
Activity
A
B
B
C
A
A
A3
B8
B9
C4
A7
A2
Welcome
Follow-up
Planning
Communicating our needs and feelings
Being thankful for what’s going well (optional)
Weekly goal setting
Setting the agenda and close
Programme for workshop 6
Module
Activity
A
B
B
C
A3
B10
B11
C10
A
A8
Welcome
Follow-up
Becoming a resourceful self-manager
Recognising and managing set-backs
Accepting and asking for support from others
(optional)
Setting Longer term goals
Close and evaluation
Error! No text of specified style in document.
Time
(minutes)
30
20
20
20
30
10
Time
(minutes)
30
20
20
20
30
10
Time
(minutes)
30
20
20
20
30
10
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4
Using the Module C Activities
Module C contains a library of optional activities which may be generic or condition-specific.
There is time allocated in each workshop, with the exception of Workshop 1, for one or two of
these activities to be included. At the end of workshops 1-5 there is an opportunity for the
participants and facilitators to negotiate the agenda for the next workshop. Further conditionspecific activities may be developed by individual organisations delivering the programme.
These can be added to the Module Three library.
This list of the Module Three options and a brief description can be used by facilitators to
help them during this Agenda-setting process.
Module C Options
Activity Name
Fatigue, rest and sleep
Activity Description
Helps us to recognise and identify ways that fatigue can be
managed by effective planning, rest, relaxation and sleep.
Eating well-making
choices, making changes
Allows us to identify some small changes in the food and drink
choices we make and to consider and find solutions to the
barriers to making these changes.
Helpful breathing
Introduces and practices helpful breathing and explains how it
may help to regain control of symptoms and reduce anxiety.
Mixed feelings about
Explore our own ideas about the importance and benefits to us
being active
of becoming more active and allows us to consider our own
mixed feelings about it.
Acknowledging and
Recognises and acknowledges that negative emotions (fear,
managing unhelpful
anxiety, worry, and guilt) frequently accompany a health
emotions
condition, reflects on your experience and to consider ways
that these emotions can be handled positively.
Making a self-care plan in Introduce the Care-planning process which can be done with a
partnership
member of the health care team and considers how it is being
introduced locally.
NB check local relevance.
Making and sharing plans Considers the subject of planning for future, when we may be
for future health care
more unwell and unable to make our own decisions, and how
to communicate these plans with family, friends and the health
care team.
Using our minds as a
Introduce the concept of the mind as a self-management tool,
self-management tool
the mind body connection and some helpful techniques to
manage symptoms leading to more optimal self-management.
Being Thankful for what’s Enables us to feel less anxious and more relaxed by allowing
going well
us the opportunity to show gratitude for, and share with others
simple events and experiences which have made us feel
good.
Accepting and asking for Explores reasons why asking for help can be difficult and
help and support from
considers ways to access varying types of support from family,
others
friends and colleagues.
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5
Layout of the materials
Scripted and Unscripted Facilitator Instructions
There are two pages which cover exactly the same workshop content:
 Upper page provides structured but unscripted notes which an experienced facilitator
can use to deliver the programme content. The clouds which can provide suggestions
for free-thinks and discussions can be completed by facilitator beforehand
 Lower page provides structured and scripted text which an inexperienced facilitator can
use to deliver the programme content. The clouds which offer suggestions for free-thinks
and discussions are provided.
It is expected that, over time and with greater experience, facilitators will confidently move
from a scripted to an unscripted delivery style. When a facilitator uses the unscripted notes
they should take care to ensure that the materials are delivered in a suitably non-directive
style with careful attention to the use of language which supports self-determination.
Fonts
 The activities for each workshop use Arial 11 black, this is chosen as it is clear and easy
on the eyes.

Comic Sans 13 Blue is used to identify discussions as it denotes a more informal
tone.
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6
Guide to Icons
Icons are used throughout this manual as a visual reminder to facilitators and to back-up the Facilitator Instructions
Icon Name
Icon
What it means
Self-Management Circles
When the Optimal Self-management circles are shown, the facilitator
should refer to the fact that self-management requires attention to all three
areas of the Bio-psychosocial model of health.
Small Group Discussion
This should be for groups of three or four individuals. The facilitators can
and should circulate amongst the small groups to offer support and
clarification.
Whole Group Discussion
This is an opportunity to discuss issues as a whole group. There are open
questions in the notes which can be used to stimulate the discussion.
However these may or may not be required. There are also ideas in the
clouds which may be helpful to guide the discussion. If any discussion
becomes negatively focussed the facilitator should initiate a problemsolving approach and ensure that solutions are identified before the
discussion ends.
Opportunities for problem-solving occur throughout the workshops; during
Goal-setting, Goal Follow-up and during individual activities. Any
opportunity to problem-solve should be seized when time allows. Problemsolving can use either a formal process where ideas are captured on a flipchart, or an informal process where the facilitator verbally collects ideas
from the group and offers them back to the participant who voiced the
problem to enable them to choose a solution which is helpful to them.
This is an opportunity for individuals to briefly ‘pair-up’ with another
participant, so they can share their experiences safely. Should there be an
uneven number of participants, it works best if one of the facilitators makes
up a pair. Do not allow these ‘pair and share’ conversations to last more
than 2 or 3 minutes.
Problem Solving
PS
Pair and Share
Freethinking
Role Modelling Box
It can be helpful to head the Group free-think chart beforehand. Both
facilitators are involved in a free-think, one acts as a scribe whilst the other
generates and manages the ideas from the group and feeds them to the
scribe at a pace they can write. Ask the questions and allow the group time
to come up with their ideas. Be prepared to rephrase the question if you
feel this will help the group to generate more ideas. The clouds provide
other ideas. With permission from the group you could add a few of these if
they are finding it difficult. Scribe the ideas from the group, using the words
of the participant. If the idea is rather long-winded, ask “How would you like
me to write this down?”
There are many opportunities to role-model your own experience of selfmanagement. Prepare these beforehand and identify examples which will
be relevant and helpful to the group, and which you feel comfortable to
share. When talking about your own experience you should be brief,
approximately 30 seconds, and always finish by describing the solution
which worked for you.
Role Play
During a role-play, both facilitators act out a short interaction between two
people. Briefly explain beforehand that this is what you are doing. It can be
useful to tell the group when you are starting the role-play and again when
the role-play has stopped.
Refer to / complete
Workbook
In many activities reference is made to completion of materials which is in
the work book that accompanies the workshops. Some of these, like Goalsetting, are for completion during the session; others are for use at home,
like Guided Imagery, whilst others are for reference only.
7
Guide to charts
These Charts are used through the workshops.
Self-management circles
Group Ground-rules
We agree to:
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treat each other with respect
arrive in good time and aim to attend every session
let everyone’s viewpoint be heard
maintain confidentiality
identify achievable goals and work towards them
help others find solutions to problems they encounter
join in discussions
gather and share information and resources with
others
 be open-minded about new ideas and give them a try
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Questions to help you set your Goals
What is your Goal?
How important is your Goal to you? What makes it important?
What do you need to achieve it?
Which bits will you do this week?
How much? How often? When?
If you visualise yourself doing this bit of your Goal this week,
how confident do you feel, on a scale of 0-10?
Agenda Setting Questions
What am I going to this meeting for and what do I hope to get
from it?
How have I been feeling since my last visit?
What have I been finding difficult?
What else in my life might be affecting my health?
What have I been doing to look after my health?
Is there anything I might find difficult to talk about?
What is my goal?
What do I need to know about treatments?
Our Goal Needs To:
be our choice
be important to us
be a little difficult to achieve
allow us to feel more confident once we have
achieved it
 let us show other people and ourselves that we can
overcome problems
 let us feel in control
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Problem Solving
identify the problem
explore it
think of some ideas
choose one to try
try the idea out in a real life situation
Specific
Measurable
Achievable
Realistic
Time based
SMART Goals
What you will do?
How much...how often?
How confident are you that you can do it?
How confident are you that you will do it?
When will you do it?
Accept problem isn’t
solvable now
Identify the real
problem
Get more
ideas
Explore the
problem
Choose
another
idea
Problem Solve
Suggest
Ideas
Try the
idea out
Questions to help you with Goal Follow-Up
 What was your goal for the past week?
How much? How often? When?
 Was it the whole goal or a step towards your goal you
wanted to reach?
 Tell us how you did with that goal?
Choose an idea
Questions Chart
 What am I going to this meeting for and what do I hope
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to get from it?
How have I been feeling since my last visit?
What have I been finding difficult?
What else in my life might be affecting my health?
What have I been doing to look after my health?
Is there anything I might find difficult to talk about?
What is my goal?
What do I need to know about treatments?
The Journey towards Optimal Self-Management
My role in
I am
I can
managing my
confident
identify and
health
that I know
solve
condition is
how to
problems
important
manage my
when they
health
arise
condition
Beginning
x
x
x
the journey
Finding the

x
x
Route
Travelling


x
Staying on



Track
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Why is it helpful to have a setback plan?
Tips for Preparing an Active Declaration
 Plan a meeting with doctor to discuss what you might
 you feel you are doing something to manage the
want to happen
 Choose the best person to act for you and talk about it
with them
 Decide what you would want to happen
 Prepare any documents, with professional advice (e.g.
GP, CAB)
 Sign the documents and get them witnessed
 Make sure right people know you have the documents
 Have several copies in useful places (e.g. medical notes,
with medicines)
Becoming Resourceful
How else might I get what I need?
Who else has information that might help me?
What is something very similar which might also
work?
Who else has expertise in this field?
What is another thing I can try?
What would I suggest someone else could do in a
similar situation?
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change
you feel more in control
to speed up recovery
helps to regain lost function
can give other people a helpful role
provides a sense of direction
provides small goals to work towards
The 3 Circles
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medical
social
emotional
Questions to help us plan
How long it will take?
When is the best time to do it?
What help do I need to do it?
Can I break it down into chunks?
What do I need to do to prepare for it?
What do I need to do to recover afterwards?
Materials to support activities
Module C
Activity C1: Helpful breathing
Activity: Helpful breathing
Time: 20 minutes
Requirements: Prepare with co-facilitator modelling of breathing
Number of Pages: 10
Aim:
 To introduce and practice helpful breathing and how it may help to regain control of symptoms and reduce anxiety.
Objectives:
 identify times when they are aware that their breathing is affected by anxiety
 observe a demonstration of pursed-lip breathing and diaphragmatic breathing
 practise pursed-lip breathing and diaphragmatic breathing
 consider times when they will find a breathing technique helpful
Module C
Activity C1: Helpful breathing

Introduce Helpful Breathing, by explaining that although we often take breathing for granted, it is a
very helpful tool to assist us at times when we feel stressed, anxious or in pain

Invite the group to briefly discuss:
Unscripted Instructions
The prompt question is
there as a guide. You can
use this, or any other
appropriate questions, to
stimulate the discussion.
What have you noticed happens in your chest when you feel anxious or are in pain?

Explain that we will be demonstrating and practising two different breathing techniques in this
workshop:
–
Diaphragmatic (belly) breathing
–
Pursed lip breathing

Introduce pursed lip breathing as a simple, quick technique we can use at any time when we want
to control our thoughts, get our breath back or receive a burst of relaxation

Explain that pursed lip breathing creates gentle back pressure in the air passages and keeps
them open for longer
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Module C
Scripted Instructions
The prompt question is
there as a guide. You can
use this, or any other
appropriate questions, to
stimulate the discussion.
Activity C1: Helpful breathing
Unless we live with on-going breathlessness, we usually take our breathing for granted. One of the most
interesting things about breathing is its dual nature. On the one hand it's something that the body does
automatically and on the other hand it's something that we can control. Over time we may notice our
breathing pattern has changed. The muscles we use for breathing may have become out of condition
and we breathe more and more from the top of our chest and lungs.
Breathing well isn’t only helpful when we have breathing difficulties, it can also be a powerful tool which
can help us to manage stress, anxiety, tense muscles and even pain.
What have you noticed happens in your chest when you feel anxious or are in pain?
In this workshop we will show you two different breathing techniques which you might find helpful,
diaphragmatic or belly breathing and pursed-lip breathing. First we are going to show you pursed-lip
breathing - a simple way to manage anxiety and breathlessness.
For some people pursed lip breathing, if practised regularly, can become a good way to give a sense of
being able to take control of thoughts and breathing and provide a quick burst of relaxation whenever we
need it. So how does it work and how do we do it?
It works by creating a back pressure in our breathing passages when we breathe out and so keeps our
airways open for longer. This also slows down our breathing and lets us focus on our breath.
Module C
Activity C1: Helpful breathing

Describe the process of pursing the lips, as follows:
Unscripted Instructions
Make sure you feel
confident to use the
techniques before you
attempt to describe them
to other people.
Read all breathing
instructions slowly.
One facilitator models the
technique as the other
describes it.
Gently press the centre of the lips together, and as you breathe out allow the air to escape through both
sides of the lips. To do this more effectively, the cheeks should be relaxed. Breathe out long and slowly. If
you are struggling with this, pucker your lips as if you are about to whistle (or kiss someone’s cheek) and
blow through these pursed lips as if gently flickering the flame of a candle.

explain that the longer you take to exhale the more used air you expel

Invite the group to follow the instructions below:
Relax your neck and shoulder muscles by pulling your shoulders down and then releasing
them.........allow your hands to rest gently on your thighs........breathe in and out regularly and smoothly.
Now breathe in slowly through your nose, if you can, for two counts, keeping your mouth closed. It
doesn’t need to be a deep breath; a normal breath will do. It may help to count to yourself: In...one… two.
As you breathe out, purse your lips together gently so they are just touching… and breathe out slowly
and gently through your pursed lips.........Carry on breathing like this, just trying to make the out breath a
little longer than the in breath.
In, one…two…
Out, one…two...three...four…
Be aware of allowing a space between the out breath and the in breath. Continue for a few more breaths
and then breathe normally.
Module C
Activity C1: Helpful breathing
Scripted Instructions
Make sure you feel
confident to use the
techniques before you
attempt to describe them
to other people.
Read all breathing
instructions slowly.
One facilitator models the
technique as the other
describes it.
So how do we do it? Gently press the centre of the lips together, and as you breathe out allow the air to
escape through both sides of the lips. To do this more effectively, the cheeks should be relaxed. Breathe
out long and slowly. If you are struggling with this, pucker your lips as if you are about to whistle (or kiss
someone’s cheek) and blow through these pursed lips as if gently flickering the flame of a candle.
Either of these ways creates a slight obstruction to the air leaving your lungs. The longer you can exhale
the more of the trapped air is released.
Let’s now have a practice of this breathing technique.
Relax your neck and shoulder muscles by pulling your shoulders down and then releasing
them.........allow your hands to rest gently on your thighs........breathe in and out regularly and smoothly.
Now breathe in slowly through your nose, if you can, for two counts, keeping your mouth closed. It
doesn’t need to be a deep breath; a normal breath will do. It may help to count to yourself: In...one…
two.
As you breathe out, purse your lips together gently so they are just touching… and breathe out slowly
and gently through your pursed lips.........Carry on breathing like this, just trying to make the out breath a
little longer than the in breath.
In, one…two…
Out, one…two...three...four…
Be aware of allowing a space between the out breath and the in breath.
Continue for a few more breaths and then breathe normally.
Module C
Activity C1: Helpful breathing
Unscripted Instructions
Other facilitator
demonstrates by placing
a hand on their abdomen
with the little finger in the
belly button.
Allow a few seconds for
group to find their
diaphragms and get
prepared.
When might this type of breathing be helpful to you?

Introduce diaphragmatic or belly breathing, by explaining that if we regularly live with pain,
tension and anxiety the diaphragmatic muscle can become de-conditioned over time.

invite the group to participate in the breathing exercise below
First find the diaphragm by putting one hand on your abdomen with your little finger in your belly button.
Where your hand is now – this is your diaphragm. Once you have found it, put your other hand on your
upper chest.
Uncross your legs; make sure you feel supported by your chair. Lift your shoulders towards your ears for
a few seconds…then drop them to release any tension there. If you want to, close your eyes.
Module C
Activity C1: Helpful breathing
Scripted Instructions
When might this type of breathing be helpful to you?
The second technique we want to show you is diaphragmatic or belly breathing.
The stresses of modern life can lead to the diaphragm - the muscle which supports this type of deep
breathing from lower down in the chest - becoming less fit. This tends to make us breathe from higher
up in the chest which is a less efficient type of breathing. By practising diaphragmatic breathing, we can
strengthen the breathing muscles, make our breathing more efficient and use less energy.
Other facilitator
demonstrates by placing
a hand on their abdomen
with the little finger in the
belly button.
Allow a few seconds for
group to find their
diaphragms and get
prepared.
Now, we can all practice some diaphragmatic breathing.
First find the diaphragm by putting one hand on your abdomen with your little finger in your belly button.
Where your hand is now – this is your diaphragm. Once you have found it, put your other hand on your
upper chest.
Uncross your legs; make sure you feel supported by your chair. Lift your shoulders towards your ears for
a few seconds…then drop them to release any tension there. If you want to, close your eyes.
Module C
Unscripted Instructions
Read all breathing
instructions slowly
Activity C1: Helpful breathing
Allow your breath to come in and out naturally, in and out...... in and out.......notice how you are
breathing...… with your in-breath, just notice how your diaphragm rises under your hand and your
abdomen expands outwards.......as you breath in again, imagine your lungs filling with fresh air........your
hand on your chest should barely move......let your diaphragm help you......imagine it slowly pulling the
air in and then slowly pushing it out.....continue like this..... just be aware of allowing a space between
the out breath and the in breath....let your body decide when it is ready to breathe in again........imagine
your breath coming from lower and lower down in your body..... gently breathe like this.....allow the
breath to come naturally and evenly............. ............now we are going to bring an end to this....... just
when you’re ready to.....open your eyes and focus for a moment on how you feel.
When might this type of breathing be helpful to you?
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explain that new ways of breathing takes practice
suggest that they begin slowly and not worry about getting it right straight away
Module C
Scripted Instructions
Read all breathing
instructions slowly
Activity C1: Helpful breathing
Allow your breath to come in and out naturally, in and out...... in and out.......notice how you are
breathing...… with your in-breath, just notice how your diaphragm rises under your hand and your
abdomen expands outwards.......as you breath in again, imagine your lungs filling with fresh air........your
hand on your chest should barely move......let your diaphragm help you......imagine it slowly pulling the
air in and then slowly pushing it out.....continue like this..... just be aware of allowing a space between
the out breath and the in breath....let your body decide when it is ready to breathe in again........imagine
your breath coming from lower and lower down in your body..... gently breathe like this.....allow the
breath to come naturally and evenly............. ............now we are going to bring an end to this....... just
when you’re ready to.....open your eyes and focus for a moment on how you feel.
When might this type of breathing be helpful to you?
Breathing well takes practice. If you didn’t quite get it this time, it might be easier to practise when you
are lying down. Start slowly and simply. You don't want to increase any stress or anxiety you feel by
worrying if you're doing a breathing exercise properly!
Module C
Appendix, References and Notes
Activity C1: Helpful breathing
Module C
Activity C2: Eating well
Activity: Eating Well-making choices, making changes
Time: 20 minutes
Requirements: Flipchart. Problem Solve chart.
Pages: 10
Aim:
 To assist the group to identify some small changes in the food and drink choices they make.
 Enable the group to consider and find solutions to the barriers to making these changes.
Objectives:
 Consider and recognise that making healthy food choices is not just about knowing about what and how much we should eat
and drink but also about how our feelings and thoughts influence what and how much we eat and drink.
 Identify some simple healthy eating and drinking guidance and some helpful sources of further information.
 Discuss how to deal with situations where, our social life and healthy eating don’t necessarily fit together.
 Identify and consider some small changes which they could make and maintain.
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Module C
Activity C2: Eating well

Unscripted Instructions
Introduce eating and drinking as something most of us enjoy and an important part of our daily
lives
Do we eat the same food every day or do we sometimes eat special foods? Why do
we sometimes want to eat different foods? What feelings or emotions affect our
eating and drinking habits? Do we sometimes eat and drink even though we might
not be hungry or thirsty?




Summarise the discussion by explaining that eating does not just mean satisfying hunger but is
also a social and emotional experience too.
Explain that healthy eating does not mean following a rigid diet but is about making small
changes and healthy choices.
Explain that there isn’t time in these workshops to tell you everything there is to know about
eating well but that information is available in the resource pack.
Invite the group to consider other sources of information about healthy eating and drinking.
Where else might you find useful information about healthy eating and drinking?
Module C
Scripted Instructions
The prompt questions are
there as a guide. You can
use these, or any other
appropriate questions, to
stimulate the discussion.
Activity C2: Eating well
For most of us drinking and eating is an important part of our daily lives. We like to choose what to eat
and drink, and enjoy them at times and in the amounts which suits us.
Do we eat the same food every day or do we sometimes eat special foods? Why
do we sometimes want to eat different foods? What feelings or emotions affect
our eating and drinking habits? Do we sometimes eat and drink even though we
might not be hungry or thirsty?
Eating isn’t just about satisfying our hunger and giving our bodies the nourishment it needs to remain
well. Eating and drinking is also about our mood, our habits and can be a social experience too.
Eating well is important for everybody, but it is especially important for people living with a health
condition though this does not necessarily mean we need to be following a rigid diet. But with many
health conditions making small changes can make quite a difference and allows us to find a helpful
balance in the foods we choose to eat.
There isn’t time in these workshops to give you everything that is available about healthy eating but if
you decide that making some changes would be a useful goal there is plenty of information available. In
fact there is information in your resource pack.
Where else might you find useful information about healthy eating and drinking?
Module C
Unscripted Instructions
Activity C2: Eating well



explain that these workshops give you the opportunity to consider what eating healthily might
look like for you
Explain that eating well for any health condition is similar to healthy eating for the general
population:
–
low in fat, sugar and salt
–
some protein foods, which don’t have to be meat
–
plenty of fruit and vegetables
–
some starchy, carbohydrate foods, like bread, potatoes, cereals, pasta and rice
Acknowledge that even if we know about eating healthy we might still find choosing to eat in a
healthy way difficult. Suggest there are ways which can help us to be more successful.
Module C
Scripted Instructions
Activity C2: Eating well
These workshops give you the opportunity to think about what, when and how much we eat and drink
and what eating healthily might look like for you.
Eating well for any health condition involves much the same as is recommended for the general
population, which is:




low in fat, sugar and salt
some protein foods, which don’t have to be meat
plenty of fruit and vegetables
some starchy, carbohydrate foods, like bread, potatoes, cereals, pasta and rice
Perhaps we already know what healthy eating looks like and yet we still find making helpful choices,
about the types of food and the size of portions, difficult. If we choose to make some changes, there are
things we can do to help us to be successful.
Module C
Activity C2: Eating well

Suggest that knowing what foods to eat or to avoid is helpful but that it is also helpful to be able
to:
–
recognise the social and emotional factors which effect what, how and when we eat
–
identify and plan for situations where healthy eating is difficult

Explain that eating healthily does not mean never eating our favourite foods in the future or
involve ‘special’ diet food.
Unscripted Instructions
Allow group time to come
up with their ideas.
Be prepared to rephrase
question if you feel this
will help the group to
generate more ideas.
With permission from
group you could add a
few ideas if they are
finding it difficult.
What are some small changes we could make in our eating and drinking?
Module C
Scripted Instructions
Allow group time to come
up with their ideas.
Be prepared to rephrase
question if you feel this
will help the group to
generate more ideas.
With permission from
group you could add a
few ideas from this list if
they are finding it difficult.
Activity C2: Eating well
It can help if we know about the foods which are good for us to eat and also which foods it is helpful to
avoid. It is also just as helpful to be able to recognise what we are feeling and thinking influences what,
when and how much we eat. We can also plan for those times and situations when everyday life and
eating healthily don’t match up.
Making healthy choices doesn’t mean we’ll never eat our favourite foods again or that we
need to eat ‘special’ foods. It does mean making small changes we can stick to, which, in
the long run, is so much better than completely changing what and how we eat and then not sticking to it
at all.
What are some small changes we could make in our eating and drinking?
Eat two portions of fish each week,
Reduce sugary foods, Cut down on sweetened
drinks, salt, fat, Eat three regular meals, Eat
more fruit, vegetables, beans, peas and lentils,
Drink less alcohol, Reduce portion size, Read
food labels.
Module C
Unscripted Instructions
Activity C2: Eating well

Allow group time to come
up with their ideas.
acknowledge that even if we know about eating well, making changes is still really hard
Why do we find making healthy food and drink choices difficult?
Be prepared to rephrase
question if you feel this
will help the group to
generate more ideas.
With permission from
group you could add a
few ideas if they are
finding it difficult.
Ask group to select one of
these problems and come
up with some solutions as
a group.
Write solutions down and
then ask person who
identified the problem to
choose most helpful
solution.
Guide them to the food
diary in resource
booklet/pack.

problem Solve one of the problems identified

suggest that keeping a food diary may be helpful to allow us to identify our eating habits

suggest that they may wish to consider setting a goal to make a small change to their eating or
drinking behaviour over the next week
Module C
Scripted Instructions
Allow group time to come
up with their ideas.
Be prepared to rephrase
question if you feel this
will help the group to
generate more ideas.
With permission from
group you could add a
few ideas from this list if
they are finding it difficult.
Ask group to select one of
these problems and come
up with some solutions as
a group.
Write solutions down and
then ask person who
identified the problem to
choose most helpful
solution.
Activity C2: Eating well
Most of us have a pretty good idea about what we need to do to eat well but even so, we still find making
the healthy choices is quite difficult.
Why do we find making healthy food and drink choices difficult?
We enjoy food, Pressure from other
people, Habits and routines’; eating is
comforting, social situations, Cravings.
Problem Solve one of the problems identified.
You might find it helpful to keep a record of what and when you eat for a couple days, to see if, how and
why you’re eating habits change throughout the week. With this information we are better able to make
the small changes which we are most likely to be able to continue with.
Is anyone perhaps considering setting a goal involving eating or drinking more healthily?
Guide them to food diary
in resource booklet/pack.
Module C
Appendix, References and Notes
Activity C2: Eating well
Module C
Activity C3: Becoming more active
Activity: Fatigue, rest and sleep
Time: 20 minutes
Requirements: Flipchart headed “How could we manage fatigue?”
Number of Pages: 8
Aim:
 To enable participants to recognise that fatigue can be managed by effective planning, rest, relaxation and sleep.
Objectives:
 reflected on their experiences of fatigue
 considered some of the causes of fatigue apart from their health condition
 identified some solutions to managing fatigue
 explored their beliefs about rest
 Identified some solutions to poor sleep.
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Module C
Unscripted Instructions
Use the self-management
circles chart to remind the
group that optimal selfmanagement is about
looking after all areas of
our health while carrying
on with everyday life.
Activity C3: Becoming more active



introduce fatigue as a symptom associated with many different health conditions
explain that fatigue is different to tiredness and it may be hard to explain to other people
acknowledge that self-managing a health condition requires determination and effort, and feeling
fatigued makes it even more difficult to manage
What are your experiences of feeling fatigued?
These prompt questions
are there as a guide. You
can use these, or any
other appropriate
questions, to stimulate
the discussions.
Apart from our health condition, what else causes us to feel fatigued?
Module C
Scripted Instructions
Use the self-management
circles chart to remind the
group that optimal selfmanagement is about
looking after all areas of
our health while carrying
on with everyday life.
Activity C3: Becoming more active
Feelings of fatigue are really difficult for us to explain to other people. Fatigue is an overwhelming and
long-lasting tiredness and it may be associated with all sorts of different health conditions. There are,
however, other causes of fatigue.
Self-managing our life with a health condition takes determination and effort. Feeling fatigued can make
juggling a health condition with everyday life very difficult; achieving optimal Self-Management can be
harder than ever. Constantly being fatigued can make us depressed and feel negative about the future.
What are your experiences of feeling fatigued?
These prompt questions
are there as a guide. You
can use these, or any
other appropriate
questions, to stimulate
the discussions.
Other people’s reactions, Hard to
explain to others, Makes doing simple
things difficult, The less you do, less
you want to do.
Apart from our health condition, what else causes us to feel fatigued?
Doing too much, Not planning, Loss of
fitness, Doing too little, Poor sleep,
Medication, Not enough rest, Pain,
Demands of others, Worry, Not
saying ‘no’.
Module C
Activity C3: Becoming more active

Unscripted Instructions
Allow group time to come
up with their ideas.
Be prepared to rephrase
question if you feel this
will help the group to
generate more ideas.
Explain that as individuals we alone know the causes of our fatigue and different causes require
different management.
How could we manage fatigue?
With permission from
group you could add a
few ideas if they are
finding it difficult.
Ask group to come up
with some solutions as a
group.
Write solutions down and
then ask person who
identified the problem to
choose most helpful
solution.
Summarise by saying that living with a health condition requires us to do things differently; this might
include taking more rest in the day or breaking activity down in to chunks. Acknowledge that some people
feel guilty about resting or not pushing themselves to finish a job.
Does anyone experience this?

If so, invite group to problem-solve
Module C
Scripted Instructions
Allow group time to come
up with their ideas.
Be prepared to rephrase
question if you feel this
will help the group to
generate more ideas.
With permission from
group you could add a
few ideas from this list if
they are finding it difficult.
Activity C3: Becoming more active
Only we know the main reasons why we feel fatigue so we need to identify these reasons in order to
take action to make changes. If we think about the causes of fatigue from our discussion:
How could we manage fatigue?
Planning, Exercise, Learning to say no,
Keeping socially active, Fresh air,
Laughter, Relaxation, Rest, Improving
our sleep, Eating well, Taking
medication as prescribed.
Ask group to come up
with some solutions as a
group.
Write solutions down and
then ask person who
identified the problem to
choose most helpful
solution.
Life with a health condition often requires us to do things differently. One of the changes we can make is
to take more breaks and rests. Breaking our day into alternate periods of being busy and resting helps
us to feel less fatigued and we achieve more in the long run.
Many people feel guilty about doing this and find it hard to rest during the day.
Does anyone experience this?
If so, invite the group to problem-solve.
Module C
Unscripted Instructions
Activity C3: Becoming more active



The prompt questions are
there as a guide. You can
use these, or any other
appropriate questions, to
stimulate the discussion.
Allow group time to come
up with their ideas.
Be prepared to rephrase
question if you feel this
will help the group to
generate more ideas.
With permission from
group you could add a
few ideas from this list if
they are finding it difficult.
introduce poor sleep as another possible cause of fatigue
talk about some of the reasons sleep is disturbed by a health condition
explain the importance of not getting into a battle with ourselves if we wake up in the night and
cannot get back to sleep again
What experience do you have of this? How does it feel?

suggest that although we feel we are the only people experiencing poor sleep, it is actually quite
common
What can we do to help ourselves get a better night’s sleep?


explain about the importance of routine in getting to sleep perhaps reminding them of importance
of routine for children’s bedtimes
suggest they experiment and try new things to find what works best for them
Module C
Scripted Instructions
The prompt questions are
there as a guide. You can
use these, or any other
appropriate questions, to
stimulate the discussion.
Allow group time to come
up with their ideas.
Be prepared to rephrase
question if you feel this
will help the group to
generate more ideas.
With permission from
group you could add a
few ideas from this list if
they are finding it difficult.
Activity C3: Becoming more active
Another cause of fatigue is poor sleep and you might have found that your sleep is disturbed by your
health condition. Perhaps you are unable to get into your comfortable sleep position, or you wake up to
use the toilet frequently. Once awake we often find getting back to sleep a problem. We begin to feel
frustrated with ourselves and we worry about not getting back to sleep. We might find we are getting into
a battle with ourselves.
What experience do you have of this? How does it feel?
Often we feel we are the only people experiencing this but we can see that these problems are quite
common.
What can we do to help ourselves get a better night’s sleep?
Medication to re-establish sleep pattern,
Accept the existing pattern, Establish
routine, Don’t just lie there do something,
Make a note of nagging worries, Reduce
caffeine (including chocolate), Mindfulness,
Relaxation, Relaxing music or Radio (with a
timer), Aromatherapy, Warm bath, Milky
drink, Distraction techniques.
It may be helpful to establish a routine, both for bed-time or if we are lying awake. Perhaps you
remember using one when you put your children to bed. Much as a good bed-time routine is important
for children, so is it for an adult. The key is to experiment to find out what works for you.
Module C
Appendix, References and Notes
Activity C3: Becoming more active
Module C
Activity C4: Being thankful for what’s going well
Activity: Being thankful for what’s going well
Time: 20 minutes
Requirements: Flipchart
Number of Pages: 8
Aim:
 To enable participants to feel less anxious and more relaxed by allowing them the opportunity to show gratitude for and share
simple events and experiences.
Objectives:
 reflected on how easy it is to become focussed on negative events
 considered some of the benefits of being thankful for positive events and actions of others
 identified and shared up to three events or actions they are thankful for
 considered how they may use this in the future
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Activity C4: Being thankful for what’s going well
Module C

introduce activity by asking them to imagine walking into a kitchen which smells of newly baked
bread and Invite them to share how it feels

mention that if they stayed in the kitchen for 10 minutes, they would stop noticing the lovely smell

Suggest that it is easy to stop noticing the things in our life which are going well and notice the
things which aren’t going so well and we may even keep reminding ourselves about the things
which are going badly

explain that this focus on negative events may lead to anxiety and depression

suggest that by getting better at thinking about and savouring what went well can lift the mood
and allow us to relax

introduce a simple technique which stops us from focussing on negative things by bringing to
mind the positive things in our lives

explain that this is sometimes called ‘counting blessings’ or ‘being grateful’, and that
research has shown that people who regularly spend some time thinking about what has been
going well in their lives feel happier, more energetic and less depressed

invite the group to have a go at this, and suggest they may want to continue with this over the
week

invite them to think about, and then write down, three things in life that they are thankful for
Unscripted Instructions
Module C
Activity C4: Being thankful for what’s going well
Scripted Instructions
Have you ever walked into a kitchen that smelled of freshly baked bread? How did it feel?
If you stayed in the room for ten minutes though, sadly you would stop smelling the fresh bread.
It is easy to stop noticing the things in our life which we enjoy and are going well; we ignore them and
perhaps notice more the things we don’t like or which are not going so well. Sometimes we keep
reminding ourselves about the things in life which are going badly.
Focusing on negative events may set us up for anxiety and depression. One way to keep this from
happening is to get better at thinking about and savouring what went well. Being thankful for things feels
good, it lifts our mood and allows us to relax.
We have a simple technique to share with you which stops us from dwelling on these negative things and
instead brings to mind the positive things in our lives. Some people call this ‘counting blessings’ or
‘being grateful’.
This is a tried and tested method which has shown that people who regularly spend some time thinking
about what has been going well in their lives feel happier, more energetic and less depressed.
Let’s have a go at this, and then perhaps you may want to continue with this over the next week.
You can do this by thinking about, and then writing down, three things in your life that you are thankful
for.
Activity C4: Being thankful for what’s going well
Module C
Unscripted Instructions

Suggest their list can be of quite small or of very big things and that in the past, people have
come up with:
–
listening to my favourite music
–
a colourful sunset
–
a beautiful bird singing
–
meeting an old friend at the supermarket
–
having a loving family
–
receiving a letter or card from a friend
–
looking forward to my birthday
–
neighbour’s lovely garden


invite group to work in threes for about 3 minutes
explain it doesn’t matter if they can’t think of 3 things and remind them
that this is because we are more used to focusing on negative things
write down up to 3 things they are thankful for and then share these within the small group
reconvene the group
ask for a volunteer to start. Ask each participant to choose one thing from their list to add to the
chart
One facilitator shares
their lists and then writes
on the flip chart-other
facilitator contributes as
group goes round.
If a participant is unable
to think of anything, ask
them to listen to what
others have described.
Invite them to add their
input at the end of
activity.



Activity C4: Being thankful for what’s going well
Module C
Your list can be of quite small or of very big things. In the past, people have come up with:
Scripted Instructions
One facilitator shares
their lists and then writes
on the flip chart-other
facilitator contributes as
group goes round.
If a participant is unable
to think of anything, ask
them to listen to what
others have described.
Invite them to add their
input at the end of
activity.







listening to my favourite music
a colourful sunset
a beautiful bird singing
meeting an old friend at the supermarket
having a loving family
receiving a letter or card from a friend
neighbour’s lovely garden
We’d now like to work in groups of threes for about 3 minutes and come up
with at least 3 blessings. If you can’t think of 3, it doesn’t matter. We are far
more used to focusing on negative things than positive ones and this new way
of thinking can take a little time to get used to.
Please write down the 3 things you are thankful for and then share them within
your group.
What things did you come up with? Can we have a volunteer to start? If you were to choose one thing
from your list to add to the chart, what would it be?
Module C
Activity C4: Being thankful for what’s going well
Unscripted Instructions
What do you notice about the things which people have shared or have chosen to
When all participants
have fed back and list has
been read out, facilitate
discussion.
The prompt questions are
there as a guide. You can
use these, or any other
appropriate questions, to
stimulate the discussion.
go on this list? How did sharing your ‘thankful list’ feel? How did it feel to hear
other people sharing their lists? If you found it helpful, how might you be able to
use this in the future?
Remark that it was interesting to notice that many of the things shared were simple events and
actions-most cost little or no money, many were about nature, friendships and simple acts of
kindness by others.
Remind group that being thankful for what’s going well is not about ignoring difficulties and
challenges and that we have tools, like problem-solving which can help us, but is more about not
allowing ourselves to dwell on problems indefinitely.
Suggest that as a new technique it may take time for it to feel comfortable, but that people who
continue to do this occasionally will feel happier in the long run than people who do not.
Suggest it also appears that thanking other people for their simple acts of kindness also leads to us
feeling happier.
Remind the group they could set this as a goal and could keep a diary of the ‘blessings’ counted over the
course of these workshops and bring it in to one workshop to share.
Module C
Scripted Instructions
When all participants
have fed back and list has
been read out, facilitate
discussion.
The prompt questions are
there as a guide. You can
use these, or any other
appropriate questions, to
stimulate the discussion.
Activity C4: Being thankful for what’s going well
What do you notice about the things which people have shared or have chosen
to go on this list? How did sharing your ‘thankful list’ feel? How did it feel to
hear other people sharing their lists? If you found it helpful, how might you be
able to use this in the future?
It was interesting to notice that many of the things we shared were simple events and actions-most cost
little or no money, many were about nature, friendships and simple acts of kindness by others.
Being thankful for what’s going well is not about ignoring the difficulties and challenges we meet - when
these do occur we have tools like problem-solving which can help us. Being thankful is more about not
allowing ourselves to dwell on these problems indefinitely.
If this is new to you it may take time for it to feel comfortable, but we do know that people who continue
to do this from time to time will feel happier in the long run than people who do not. It may be that you
are also able to thank other people for their simple acts of kindness, which in turn helps you to feel even
happier.
Perhaps you want to set this as a goal and you could keep a diary of the ‘blessings’ you counted over the
course of these workshops. You could bring it in to one workshop to share with us.
Module C
Appendix, References and Notes
Activity C4: Being thankful for what’s going well
Module C
Activity C5: Becoming more active
Activity: Mixed Feelings about Being Active
Time: 20 minutes
Requirements: Prepared modelling boxes
Number of Pages: 8
Aim:
 For participants to explore their own ideas about the importance and benefits to them of becoming more active and consider
their own mixed feelings about this.
Objectives:
 consider the importance of exercise in the management of a health condition
 reflect on why people may be reluctant to increase their physical activity
 identify why exercise may be helpful for them
 consider their ambivalence about exercise
37/101
Module C
Activity C5: Becoming more active

Unscripted Instructions



Here we are thinking
about the negative
feelings people generally
have about exercise.
Some people in the group
may really like exercise.
Acknowledge that.
even though being fit is widely recognised as a good thing many people are ambivalent about
exercise
getting started can be difficult
ambivalence is normal
read the following scenario
Lesley lives with a health condition; s/he goes to visit the GP who says “You really should do more
exercise if you want to manage your condition better. You really ought to be doing at least half an hour
every day.”
How might Lesley be feeling right now? How else might Lesley be feeling? How
might you have felt if this was said to you?
Module C
Scripted Instructions
Here we are thinking
about the negative
feelings people generally
have about exercise.
Some people in the group
may really like exercise.
Acknowledge that.
Activity C5: Becoming more active
Even without a health condition keeping physically fit and active is an important part of taking care of our
health. However when we live with a health condition, getting and staying fit can really help to keep our
bodies in the best possible condition and help us to overcome some of the difficulties which challenge us.
Now, although we may agree with this in theory, in reality we may feel quite differently. Some people
really enjoy exercise, once they get started, but still find it hard to get going. Other people have never
enjoyed exercise even when well and enjoy it even less now they live with a health condition. These
feelings are not at all unusual. Think about the following scenario:
Lesley lives with a health condition; s/he goes to visit the GP who says “You really should do more
exercise if you want to manage your condition better. You really ought to be doing at least half an hour
every day.”
How might Lesley be feeling right now? How else might Lesley be feeling? How
might you have felt if this was said to you?
30 minutes! Exercise hurts. I don’t like it.
I can’t even do 5 minutes so no point
starting. I’m too fat. I feel embarrassed.
It’s a waste of time. I don’t like being
sweaty. It’s for young fit people.
Module C
Activity C5: Becoming more active

exercise helps with all three areas of Self-Management, but often we choose NOT to exercise
Unscripted Instructions
What would some of the benefits of doing more exercise be for
you?
Facilitator models own
ambivalence around
exercise

mixed feelings can make us feel uncomfortable
Regular exercise is good because…
But I find it hard to do regularly because…
Many of us will have experienced some of these feelings about physical activity at times.
Module C
Activity C5: Becoming more active
Many of us will have experienced some of these feelings about physical activity at times.
Scripted Instructions
Although we don’t want to exercise, it does help us in all three areas of selfmanagement. It can keep us socially active and more independent, it lifts the mood and
we feel good about ourselves and it improves our physical fitness and the management
of our condition and can help to regain movement and skills we have lost.
What would some of the benefits of doing more exercise be for you?
Facilitator models their
ambivalence around
exercise.
We can see there are many benefits from exercising and we can also see that there are many reasons
we don’t DO it. Many of us feel ambivalent, or have mixed feelings, about exercise.
We might find it hard to admit to having these mixed feelings, they might make us feel uncomfortable so
we try to ignore them.
Regular exercise is good because…
But I find it hard to do regularly because…
Module C
Unscripted Instructions
Activity C5: Becoming more active

Invite the group to work as small groups to explore their own ambivalence
You could share with the people in your group:
– one reason you know why exercise is good for you
– one reason or feeling why you don’t do it
You may want to write
these on a flip chart.
Allow 5 minutes for this
exercise. Facilitators
circulate around all
groups supporting any
who seem stuck.
Would anyone like to share something they perhaps learnt from this exercise?


summarise this activity and suggest that starting to do some exercise might be a good goal
see resource table/workbook
Module C
Scripted Instructions
You may want to write
these on a flip chart.
Allow 5 minutes for this
exercise. Facilitators
circulate around all
groups supporting any
who seem stuck.
Activity C5: Becoming more active
You could spend some time now exploring in a small group how these some of these mixed feelings
about exercise might work with you.
You could share with the people in your group:
– one reason you know why exercise is good for you,
– one reason or feeling why you don’t do it.
Would anyone like to share something they perhaps learnt from this exercise?
It may be that now you have had a chance to think about both the benefits for you of being more active
and also about the reasons why you choose not to exercise that you want to begin to add some regular
exercise into your everyday life. Some activity is better than none at all. People who have been inactive
get more immediate health benefits from becoming active again than people who are already fit.
Perhaps you have decided that becoming more active is a goal you want to set yourself. There is
information on the resource table and in your work book about different types of exercise and how much
exercise to begin with.
Module C
Appendix, References and Notes
Activity C5: Becoming more active
Module C
Activity C6: Dealing with emotional impact
Activity: Acknowledging and managing Unhelpful emotions.
Time: 20 minutes
Requirements: Self-management circles chart, Prepared Modelling Boxes, Flipchart.
Number of Pages: 8
Aim:
 To acknowledge that negative emotions frequently accompany a health condition, to reflect on their experience and to consider
ways that these emotions can be handled positively.
Objectives:
 consider the range of unhelpful emotions which accompany a health condition
 reflect on how these affect their self-management
 have the opportunity to share their experiences
 identify some helpful ways to manage these emotions
•
45/101
Module C
Unscripted Instructions
Activity C6: Dealing with emotional impact



acknowledge that life with a health condition can be challenging at times
adjusting to change is not easy
the health condition impacts on the way we feel and vice versa

person with a health condition models to the group a time when this has been the case for you

normalise feelings of anger, fear, frustration and guilt
Make reference to the SM
circles chart
Use the modelling box.
Describe a time when
your condition has
impacted on your
emotions.
Would anyone be willing to share a time when they experienced one of these
feelings? And what was it led you to feel this way?
Module C
Scripted Instructions
Make reference to the SM
circles chart.
Use the modelling box.
Describe a time when
your condition has
impacted on your
emotions. This needs to
be a person with a health
condition.
Activity C6: Dealing with emotional impact
Life with a health condition brings challenges and changes. Often we are able to use our experience and
ability to problem-solve to adapt to and meet these challenges.
Sometimes the problems we face seem to overwhelm us. We begin to feel that all the
effort we put in makes no difference. Our life, as we knew it, may feel as though it is
over.
In the introductory session we talked about the three areas of self-management. We saw that a good
self-manager is aware of the impact their health condition has on the way they feel. They also know that
the way they feel can sometimes impact on the health condition.
These feelings might be of sadness, anger, fear, frustration or guilt. They are very common and most
people with a health condition have felt at least one of these at one time or another.
Would anyone be willing to share a time when they experienced one of these
feelings? And what was it led you to feel this way?
Module C
Unscripted Instructions
Make sure the group are
clear about what they are
sharing. You could write
it on a flipchart.
Allow about 9 minutes for
this sharing. Circulate
around the groups.
Bring the group back
together for a discussion.
Activity C6: Dealing with emotional impact

feelings like these may upset the balance, and optimal self-management difficult
to achieve

this can lead to us becoming depressed

these feelings of low mood and depression can become a downward spiral
 ask the group to form small groups of three
 In small groups share their experiences of:
– Times you have felt frustrated, fearful or perhaps depressed
– What it was that lead you to feel that way as well as how you felt

this is about listening and sharing, not solving problems. If somebody does not feel comfortable
sharing this is OK. But please listen to somebody else

explain we are now going to have a whole group discussing about the positive ways we can
manage
Module C
Scripted Instructions
Make sure the group are
clear about what they are
sharing. You could write
it on a flipchart
Allow about 9 minutes for
this sharing. Circulate
around the groups.
Bring the group back
together for a discussion.
Activity C6: Dealing with emotional impact
When we experience feeling this way it can really affect our ability to self-manage. Juggling life with a
health condition can begin to feel impossible and optimal self-management is difficult
to achieve. The circles are not overlapping and everything can feel a bit ‘out of kilter.’
If we experience these emotions over a long period and we also have all the other
challenges of life with a health condition to deal with, things like pain, medication and
limited mobility it is not surprising that some people begin to feel a loss of hope which
can in turn make us feel depressed.
Feeling low and depressed makes managing our lives and our health condition even more difficult, this
makes us feel even more depressed. This can become a downward spiral.
We would like you now to share your experiences in small groups of three. We would like you to think
about:
 times you have felt frustrated, fearful or perhaps depressed
 think about what it was that lead you to feel that way as well as how you
felt.
If you prefer, you can do this as a pair. We would like the other people in your group or pair to simply
listen for a little while rather than offering you advice or trying to solve the problem.
If you prefer not to share your own experience, that is fine, you may still be willing to listen to the
experience of someone else.
Sometimes sharing experiences like this can make us feel uncomfortable for a while. However, most
people find it helpful to share how they are feeling with someone who listens and tries to understand.
Thinking about the things you have just been sharing in your small groups we now want to focus as a
whole group on some positive, helpful ways to manage.
Module C
Activity C6: Dealing with emotional impact
Thinking about those feelings and the situation you have just shared - is there
anything you can think of which would have helped you to manage those unhelpful
feelings?
Unscripted Instructions
Write these ideas down
on a flipchart.

suggest writing down feelings can also be helpful

recognising and managing unhelpful emotions is important for achieving optimal selfmanagement
Module C
Scripted Instructions
Write these ideas down
on a flipchart.
Activity C6: Dealing with emotional impact
Thinking about those feelings and the situation you have just shared - is there
anything you can think of which would have helped you to manage those unhelpful
feelings?
Physical activity/exercise
Mindfulness/relaxation
Call a friend/Talk to someone/socialise
Focus on your abilities not your
disability
Volunteer. Give yourself a treat
Being thankful
Some people find sharing how they feel with someone else really helpful - other people find it hard or
even impossible to open up about how they feel in front of someone else. Many people have found it
helpful to write down their thoughts and feelings about living with a health condition; you may find this
helpful as well.
Recognising and managing unhelpful emotions can help us to become more effective optimal selfmanagers. It is another way to help us feel in control and to feel that we can juggle our lives with a health
condition.
Module C
Appendix, References and Notes
Activity C6: Dealing with emotional impact
Module C
Activity C7: Using our minds as a self-management tool
Activity: Using our minds as a self-management tool
Time: 20 minutes
Requirements: Self-management circles chart
Number of Pages: 8
Aim:
 To introduce the mind as a self-management tool and the mind body connection and some helpful techniques to manage
symptoms leading to improved self-management.
Objectives:




appreciate the significance of link between mind and body
consider some ways in which we can use our minds to manage symptoms
reflect on how some of these techniques could assist optimal self-management
select a technique to try
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Module C
Activity C7: Using our minds as a self-management tool

talk about the mind body connection referring to the power the mind has on the body
Unscripted Instructions

guide the group through the visualisation below followed by a discussion
Make reference to the SM
circles chart.
Read the script slowly.
Allow a little time for
people to readjust.
These discussion
questions are there to
guide you.
Make reference to the SM
circles chart.
Close your eyes for a moment –
Now imagine a blackboard… (PAUSE)… watch as someone walks towards the blackboard...
(PAUSE)… .they reach out to the blackboard and slowly run their nails down it.... (PAUSE)… imagine the
sound it is making.
What did you notice happened to your body during this visualisation? When would
it be helpful to use the power of the mind in the everyday management of your
health condition?
Module C
Scripted Instructions
Make reference to the SM
circles chart.
Activity C7: Using our minds as a self-management tool
There is a strong link between our thoughts and feelings and our emotional and physical
health.
Perhaps, you have heard the phrase ‘its mind over matter’. This doesn’t mean we need
to ignore or forget our health condition, but it does mean that we can use the power of
our minds to manage the impact our health condition has on our daily lives.
Read the script slowly.
Allow a little time for
people to readjust.
Many of us will have had the experience of walking down a high street and catching the smell of newly
baked bread or fish and chips and then feeling hungry even though we weren’t hungry only a moment
before.
Just imagining an event happening can cause our bodies to react.
Close your eyes for a moment –
These discussion
questions are there to
guide you.
Make reference to the SM
circles chart.
Now imagine a blackboard… (PAUSE)… watch as someone walks towards the blackboard... (PAUSE)…
they reach out to the blackboard and slowly run their nails down it.... (PAUSE)… imagine the sound it is
making.
What did you notice happened to your body during this visualisation? When would
it be helpful to use the power of the mind in the everyday management of your
health condition?
To aid relaxation, Aid Sleep, Reduce
pain, Reduce worry, Relieve
breathlessness.
Module C
Activity C7: Using our minds as a self-management tool
Unscripted Instructions



mention that the mind can also make things feel worse if we concentrate on negative things
however the mind can only think of one thing at a time
demonstrate this with the following:
Think about a beautiful beach, the sun shining, waves lapping on the shore... (PAUSE)… Now, holding
that image in your mind.....identify the contents of your sitting room at home... (PAUSE)… Try to hold
both thoughts in your mind at the same time. You simply can't. What you can do is, alternate back and
forth between the thoughts, or just hold one thought but not the other.

the more we dwell on things the stronger they become
When have you found yourself dwelling on a symptom? What did you notice?


two techniques that use the mind are visualisation and distraction
distraction can be ‘doing’ they probably already do this
Module C
Scripted Instructions
Activity C7: Using our minds as a self-management tool
The power of our mind can also work against us for example when we start to experience pain or
something which can cause distress. Our powerful minds begin to focus on this pain or distress.
Niggling thoughts keep going back to whatever it is, that’s bothering us rather like a ‘dog with a bone’.
The human mind is an amazing thing. It can solve complex problems and analyse millions of bits of
information. However one thing the mind can’t do is focus on more than one thing at any one time.
We can try this now.
Think about a beautiful beach, the sun shining, waves lapping on the shore... (PAUSE)… Now, holding
that image in your mind.....identify the contents of your sitting room at home... (PAUSE)… Try to hold
both thoughts in your mind at the same time. You simply can't. What you can do is, alternate back and
forth between the thoughts, or just hold one thought but not the other.
The golden rule here is that whatever we focus on will get bigger or stronger. If we focus on our pain,
sadness or breathlessness, the symptom becomes greater. If we make a decision to focus on something
else the symptom will feel less. This is the same with our thoughts and feelings, the more we dwell on
them the stronger they become.
When have you found yourself dwelling on a symptom? What did you notice?
There are a couple of techniques which can help us in these situations, these are visualisation and
distraction, both can take time and practice to get right.
You might already be using distraction, by doing ‘things’ which keep you busy and take your mind off the
pain or distress you are experiencing....things like doing a jigsaw, making a cake or planting some seeds.
Module C
Activity C7: Using our minds as a self-management tool
Unscripted Instructions

talk about ‘thinking’ distraction, give examples
Can anyone suggest a ‘thinking-type’ distraction you have used?
Think of your own
distractions to put in the
cloud.

talk about visualisation, distinguishing it from thinking type distraction

people find these techniques useful once they find a good one for them and practise using it
Module C
Scripted Instructions
Activity C7: Using our minds as a self-management tool
There is another type of distraction which involves thinking. This type of distraction deliberately focuses
our thoughts on something other than a troubling symptom we are experiencing. Things like, naming
garden flowers or capital cities or by reciting your ‘times tables’.
Can anyone suggest a ‘thinking-type’ distraction you have used?
Naming blue flowers, thinking of
boys/girls names for each letter of
the alphabet, looking at patterns.
Visualisation is a little different. This technique uses mental images that we have already created or
selected to help us to manage symptoms. Like distraction these can be used in different ways.
We can create a still image in our minds eye, perhaps a flower or beautiful view, and we can snap this
into position whenever a painful thought or feeling arrives. Or we can visualise ourselves successfully
completing a task we have set ourselves. This is very helpful when working on goals we have set
ourselves.
When using both distraction and visualisation we need to be conscious that we are using the power of
our minds by focussing our attention away from the symptom, or the situation, which is troubling us.
People who try these techniques are often surprised by how well and quickly distraction and visualisation
work and will find ways different ways and situations to use them.
Module C
Appendix, References and Notes
Activity C7: Using our minds as a self-management tool
Module C
Activity C8: Making and sharing plans for future healthcare
Activity: Making and sharing plans for future healthcare
Time: 20 minutes
Requirements: Tips for Preparing an Active Declaration chart, suitable information on the
resource base
Number of Pages: 8
Aim:
 To introduce subject of planning for the future and how to communicate these plans with family, friends and health care team.
Objectives:




consider the option of preparing documents in advance
consider how we can broach the subject with other people
discuss the issues raised by these documents
identify some useful points which will help when preparing a living will or lasting power of attorney
61/101
Module C
Activity C8: Making and sharing plans for future healthcare

many people who live with health conditions have anxieties about the future
Unscripted Instructions
–
–
–

What if I have to spend a long time in hospital- who will manage my
affairs?
What if I am in a situation where I’m not able to voice what I want to
happen?
What will happen if the treatment I need stops working?
these are issues are often difficult to raise with family, friends or the health care team
How have you found discussing these issues with friends or family? Is this
something you have already done? Or do you avoid it?
Module C
Scripted Instructions
The purpose of this
activity is to allow people
to freely discuss the
issues. Technical aspects
are less important and
can be read about in
detail in the book or in
materials produced by
other organisations
Allow time for the
discussion to run. If it
becomes difficult or
emotional, use problem
solving to re-focus the
group on solutions
Activity C8: Making and sharing plans for future healthcare
When we live with a health condition it may mean that we are fearful about what the future may hold.
Questions like ‘what if?’ pop up in our minds. Things like:



What if I have to spend a long time in hospital- who will manage my affairs?
What if I am in a situation where I’m not able to voice what I want to happen?
What will happen if the treatment I need stops working?
These are issues many of us think about but perhaps we don’t want or feel able to raise them with family
or friends or the health care team.
How have you found discussing these issues with friends or family? Is this
something you have already done? Or do you avoid it?
They aren’t prepared to listen
You feel uncomfortable
Hard to find the right words
Fear you might get emotional
Module C
Activity C8: Making and sharing plans for future healthcare
What thoughts have you had about these things? What issues does it raise for
you?
Unscripted Instructions



explain that everyone feels differently about this subject and there is no ‘right’ way
acknowledge that one person faced with the same situation may want every possible action
taken whilst someone else would prefer not
Suggest that we can help the medical team by making our wishes clear
–
“The last time I was very unwell I felt I may not recover, I felt rather afraid, I would like to
be able to talk about my care should I become so ill again”
–
“I realise I have been very poorly and might be again but I don’t want to talk about it. I just
want you to care for me in the best way you feel”
Module C
Activity C8: Making and sharing plans for future healthcare
What thoughts have you had about these things? What issues does it raise for
you?
Scripted Instructions
You prefer to die at home/in
hospital. You want to be cared for
by other people/people you know.
You want every effort to be taken
to prolong your life.
Everyone feels a little differently about this subject, perhaps we feel that if we know what might happen it
would help us to prepare, or we may feel that we simply don’t want to know and would rather leave it in
the hands of the medical team at the time.
We can help the medical team to help us by making our wishes clear about what and how much we want
to know. Finding the words to do this can be quite difficult and awkward.
We might say something like,
“The last time I was very unwell I felt I may not recover, I felt rather afraid, I would like to be able to talk
about my care should I become so ill again”
Or perhaps,
“I realise I have been very poorly and might be again, but I don’t want to talk about it, I just want you to
care for me the best way you feel”.
Module C
Unscripted Instructions
Activity C8: Making and sharing plans for future healthcare

Suggest that fear is often the common factor in this difficulty we have in talking about these
emotional situations:
–
–
–
The legal/technical
aspects of these are not
relevant to this activity so
if legal/technical
questions are asked,
don’t be drawn into
discussion. Clear and
sound technical
information is available
from organisations like
Age UK.
Make sure there is
information on the
resource base.
fear of loss of control
fear of upsetting close family or friends
fear of handing too much responsibility onto other people


acknowledge that these are difficult situations and it is understandable that we find it worrying
explain that there are two types of document which can help us, by both making our wishes clear
when necessary and also to help us to initiate difficult conversations about the subject

Describe these two different types of document:
–
–
–

lasting Power of Attorney:
one involves appointing another person to take decisions which affect your health or
welfare
or appoint another person to take decisions on your property/financial affairs
Living Will:
–
–
–
–
–
makes a record of your wishes about the choices you make in the healthcare you would
want
and also about where you would wish to receive this care, if you become too unwell to
make your wishes known at the time; this might be because of an accident or because of
worsening health
can be used as a guide to the medical team and to family or close friends; the people who
may
be asked to make decisions about your treatment and care, It will help them greatly, at a
difficult
and often very emotional moment, if they know what it is that you want to happen
Module C
Scripted Instructions
The legal/technical
aspects of these are not
relevant to this activity so
if legal/technical
questions are asked,
don’t be drawn into
discussion. Clear and
sound technical
information is available
from organisations like
Age UK.
Make sure there is
information on the
resource base.
Activity C8: Making and sharing plans for future healthcare
A common factor in all of this is fear- fear of not being in control, fear of upsetting the people who are
close to us, fear of having to hand over responsibility to other people. These are difficult, emotional
situations to consider and discuss so it is understandable that we may feel fearful.
There are two quite different documents: a ‘lasting power of attorney’ and a ‘Living will’ which can help us
to manage these issues and they can also provide a really helpful way to start talking about, what can
otherwise be, rather an awkward conversation. You might hear these documents called ‘active
declarations’.
There are two kinds of Lasting Power of Attorney:


one involves appointing another person to take decisions which affect your health or welfare
the other involves appointing another person (not necessarily the same person) to take decisions
on your property/financial affairs
A Living Will makes a record of your wishes about the choices you make in the healthcare you would
want, and also about where you would wish to receive this care, if you become too unwell to make your
wishes known at the time; this might be because of an accident or because of worsening health.
A Living Will can be used as a guide to the medical team and to family or close friends; the people who
may be asked to make decisions about your treatment and care. It will help them greatly, at a difficult
and often very emotional moment, if they know what it is that you want to happen.
Module C
Activity C8: Making and sharing plans for future healthcare
Unscripted Instructions

chose the chart to suggest some helpful tips for Preparing an Active Declaration
Go through Tips for
Preparing an Active
Declaration chart.







Tutors check briefly how
group is, in particular
anyone who may have
been upset. Mention
there is information in
resource base about
support groups.
Tips for Preparing an Active Declaration
Plan a meeting with doctor to discuss what you might want to happen
Choose the best person to act for you and talk about it with them
Decide what you would want to happen
Prepare any documents, with professional advice (e.g. GP, CAB)
Sign the documents and get them witnessed
Make sure right people know you have the documents
Have several copies in useful places (e.g. medical notes, with medicines)
OPTIONAL
If mood in group is low, lift
mood with a brief ’Being
Thankful’ exercise.
Allow one minute to
identify three things you
are thankful for and one
minute to share these
with the people either
side of you.

explain that there is more information on the resource base
Module C
Activity C8: Making and sharing plans for future healthcare
Scripted Instructions
If you feel that having one or both of these documents may be useful in your situation, here are some
tips.
Go through Tips for
Preparing an Active
Declaration chart
Tutors check briefly how
group is, in particular
anyone who may have
been upset. Mention
there is information in
resource base about
support groups.







Tips for Preparing an Active Declaration
Plan a meeting with doctor to discuss what you might want to happen
Choose the best person to act for you and talk about it with them
Decide what you would want to happen
Prepare any documents, with professional advice (e.g. GP, CAB)
Sign the documents and get them witnessed
Make sure right people know you have the documents
Have several copies in useful places (e.g. medical notes, with medicines)
OPTIONAL
If mood in group is low, lift
mood with a brief ’Being
Thankful’ exercise.
Allow one minute to
identify three things you
are thankful for and one
minute to share these
with the people either
side of you.
These are the steps we need to take in drawing up these documents. There is much more detailed
information on these in the book and in the resource base.
Module C
Appendix, References and Notes
Activity C8: Making and sharing plans for future healthcare
Module C
Activity C9: Making a self care plan in partnership
Activity: Making a self - care plan in partnership
Time: 20 minutes
Requirements: Self-management circles chart, Information on local Care-planning
Number of Pages: 8
Aim:
 To introduce the Care-planning process and consider how it is being introduced locally.
Objectives:




understand what is meant by care planning
consider the relevance of care planning in their self-management
discuss their individual experience of care-planning
share any concerns they have about the process
71/101
Module C
Activity C9: Making a self-care plan in partnership

talk to the group about the difference between care planning meetings and the times we see the
doctor when we are unwell

mention goal-setting as an important part of care planning

ask the group about their experiences
Unscripted Instructions
These discussion
questions are there to
guide you.
Make reference to the SM
circles chart.
Perhaps you have already been given the opportunity to do this. If so how did
you find it? Was it a helpful experience?

talk about optimal self-management being more than just the medical management of our
condition

we are the experts of our life with the condition
Module C
Scripted Instructions
Activity C9: Making a self-care plan in partnership
Setting goals is an important aspect of these workshops. Most of us have found it a helpful experience
which allows us to manage the complex job of living well with our health condition. Goal-setting isn’t just
useful whilst we are attending these workshops.
Within this local area people living with a health condition are being offered the opportunity to work in
partnership with a member of their medical team to plan the management of their condition and produce
a Care Plan. Goal-setting is important to this plan.
The meetings we have with a doctor or other member of the team are usually arranged because we are
experiencing a health problem, or we feel more unwell than normal. So the focus of these meetings is on
things which are not going well.
These discussion
questions are there to
guide you.
Make reference to the SM
circles chart.
A Care-planning meeting is a little different because in it we can find out more about how to self-manage
our condition. We can share some of our experiences of life with the condition and we can think about
and make shared-decisions of its future management. Someone once described it as the doctor or other
member of the medical team ‘looking with, rather than looking at, the patient.’
Perhaps you have already been given the opportunity to do this. If so how did you
find it? Was it a helpful experience?
Self-management isn’t just about medical management - it is about all three areas in the circles and the
way these fit into our everyday lives.
A member of the medical team might have more knowledge and be experts in the medical aspects of the
health condition, but we are the experts in our own lives.
Module C
Activity C9: Making a self-care plan in partnership

Unscripted Instructions
–
–
–
–
–
Briefly describe the
process and any
materials which will be
used locally for Careplanning.
Make sure any locally
used forms are on the
resource table. Invite
people to have a look at
the forms in pairs.
Facilitators circulate
around the group. After
about 5 minutes, bring the
group back together for
the discussion.
Care planning meetings usually happen once a year, here you can discuss things like:
changes in the health condition
anything we have been doing, trying different foods/ activities/ medications
what support we need
any goals we have achieved
New goals

ask the group to look at locally produced materials in pairs

whole group discuss their thoughts/worries and how they might use these
What thoughts do you have about these? How well would they help you to select
goals you want to set? What worries might you have about making a health plan
like this?
Module C
Scripted Instructions
Briefly describe the
process and any
materials which will be
used locally for Careplanning.
Make sure any locally
used forms are on the
resource table. Invite
people to have a look at
the forms in pairs.
Activity C9: Making a self-care plan in partnership
With Care-planning, we are able to have annual meetings to discuss the management of our health
condition. At these meetings we can look at the progress of our health condition, the impact of the way
we choose to self-manage, and perhaps in the food we eat or the medication we take.
We can also look at the impact the condition has on our lives and whether there are actions either we or
the health care team can take to lessen this impact. If we feel that other support would be useful help us
to manage our health, we can also agree and arrange this.
During the meeting we will be invited to identify goals to work on. These goals should be our goals, so
they could be something like, “I want to be able to ride my bike again” or “I want to stay out of hospital”.
There are forms/ booklets/ leaflets which help you to think about your goals which are being used locally.
You may want to have a look at these now in pairs.
Facilitators circulate
around the group. After
about 5 minutes, bring the
group back together for
the discussion.
What thoughts do you have about these? How well would they help you to select
goals you want to set? What worries might you have about making a health plan like
this?
Module C
Activity C9: Making a self-care plan in partnership
Unscripted Instructions
Make sure you know
beforehand what the
process is locally.

acknowledge the group’s achievements when setting goals

remind them of the importance of problem solving and goal follow up
Briefly describe the
process which will be
used locally for followingup on goals.

explain the importance of being an equal partner when deciding on a care plan and setting goals

the goals need to be their own goals and fit into their lives
Module C
Scripted Instructions
Make sure you know
beforehand what the
process is locally.
Briefly describe the
process which will be
used locally for followingup on goals.
Activity C9: Making a self-care plan in partnership
Your experience of setting goals in these workshops will really help when the time comes to make your
Care plan.
Some of you will already have a long-term self-management goal you are working towards. Perhaps you
have had to adapt your goal over recent weeks.
You might also have had done some problem-solving either within these workshops, or with family or
friends. Just as important as setting a goal is following-up on the goal, so when you make your care plan
you will also be asked when and how you would like to follow-up on your goal.
Care planning in this way is relatively new. Not all health care team members are fully confident to
support people to set achievable and realistic goals which fit with the rest of their lives and truly support
self-management.
If you find this to be the case and that you are being directed to set a goal which is medically-directed,
you could share with those members your experience of attending this series of workshops and offer
them some help and guidance about what you want.
Module C
Appendix, References and Notes
Activity C9: Making a self-care plan in partnership
Module C
Activity C10: Accepting and asking for help and support from others
Activity: Accepting and asking for help and support from others
Time: 20 minutes
Requirements: Prepare modelling boxes.
Number of Pages: 8
Aim:
 To explore reasons why asking for help can be difficult and consider ways to access varying support from family, friends and
colleagues.
Objectives:
 recognise that they may need help and support, now or in the future, and that asking for this help can be difficult
 reflect on helping other people can be a positive experience
 consider why they find asking for help difficult
 identify ways in which they can communicate needs with other people
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Module C
Activity C10: Accepting and asking for help and support from others

Unscripted Instructions
Allow 5 minutes for this
small group discussion.
share with the group that accepting help from other people is sometimes a necessary part of life
with a long term condition

recognise that although most of us find accepting help difficult, offering help to other people is
rewarding
Make sure everyone has
an opportunity to share
their experience.
When were you able to offer help and support to someone else? How did
helping someone out make you feel?
Tutors circulate around
tables.

ask for feedback and then summarise the discussion
Module C
Scripted Instructions
Activity C10: Accepting and asking for help and support from others
Living with a health condition has its ups and downs. Often we can get by without needing support from
other people but at other times, when things get tough, we would all benefit from a bit of support.
Accepting help can feel awkward and difficult for some of us, yet giving help to other people can make us
feel happy.
Allow 5 minutes for this
small group discussion.
Let’s think about this. Share with your table or group a time when you were able to help someone and
how that made you feel.
Make sure everyone has
an opportunity to share
their experience.
Tutors circulate around
tables.
When were you able to offer help and support to someone else? How did
helping someone out make you feel?
Helping out other people with perhaps a kind gesture can often be a very positive experience for us. We
feel good about ourselves.
Module C
Activity C10: Accepting and asking for help and support from others

Unscripted Instructions
Invite the whole group to
identify and share
situations where they
might need help. Invite
them to think about times
when their condition is
having a greater impact.
Invite the group to consider times when they may need to ask for help, this could be with:
–
family
–
colleagues
–
friends
–
strangers
In what sorts of situation might we need help or assistance from someone else?
This discussion is firstly
about how we may feel
about asking for help and
secondly what it is that
makes us feel that way.
We need to make sure
that a range of different
feelings are shared within
the group.
We need to give space
and opportunity for
people to reflect on their
past experience.
How do we feel when we need to ask for help? What makes us feel that way?
Module C
Scripted Instructions
Activity C10: Accepting and asking for help and support from others
Let’s think, now, about times when we might need help and support from someone else. It could be a
friend, a family member, a colleague or even from someone we don’t know well.
In what sorts of situation might we need help or assistance from someone else?
Invite the whole group to
identify and share
situations where they
might need help. Invite
them to think about times
when their condition is
having a greater impact.
The ideas in the bubbles
are there as prompts.
This discussion is firstly
about how we may feel
about asking for help and
secondly what it is that
makes us feel that way.
Hospital visit, Travel,
Feeling lower than usual,
Celebrations and festivals.
So we have seen that the situations when we need help are many and varied. Sometimes it is about
asking family and friends… perhaps when we are preparing a meal or going to a social event. At others
we may need to accept the help of strangers, perhaps if we are struggling with a suitcase or shopping.
How do we feel when we need to ask for help? What makes us feel that way?
We need to make sure
that a range of different
feelings are shared within
the group.
We need to give space
and opportunity for
people to reflect on their
past experience.
.
Embarrassed, Stupid,
Helpless, Guilty,
Inadequate, Loss of independence,
Other people will judge me,
People will stare at me.
Module C
Unscripted Instructions
Allow time here for people
to consider their
ambivalence.
Make this case-study
scenario relevant to the
group where possible.
Activity C10: Accepting and asking for help and support from others



remind people that earlier they had seen giving help as a positive experience and yet it is still
hard to accept.
giving help feels good, but asking for help feels bad
suggest that having ready-made phrases can be helpful
Introduce this case-study: Pat, who uses crutches for walking, is in a supermarket. At the checkout
he/she is struggling with unloading the trolley. The person behind in the queue offers to help. Rather than
accepting this help, Pat says in an embarrassed way “No, it’s alright, I’m fine”.
What could Pat say differently which would allow him to receive the help in a way
which would be acceptable to them both?
You could chart helpful
phrases or you could
suggest the group may
want to write these down.

invite the group to identify some helpful phrases which could be used by the person in the case
study
Summarise the discussions, emphasising that accepting useful help and support from other
people allows us to maintain our independence and acknowledge that changing the way we
communicate can be difficult at first but becomes easier with practice.

invite the group to consider accepting appropriate help the next time it is offered
Module C
Scripted Instructions
Pause....
Allow group to consider
this for a moment.
Activity C10: Accepting and asking for help and support from others
We talked earlier about how being able to help other people can be a positive experience and yet we
find accepting and asking for help difficult. So why do we find asking for or accepting help so difficult?
Let us think now about how we communicate our need for help to other people, sometimes it is about
the words we use, sometimes it is about being specific in the sort of help we need.
It can be helpful for us to have phrases ready for times when we know we will find it difficult.
Make this scenario
relevant to the group
where possible.
Only use the suggested
phrases in the bubble if
the group find it difficult to
come up with ideas.
Invite the group to write
helpful phrases on a chart
or you could suggest they
may want to write these
down.
Listen to this situation: Pat, who uses crutches for walking, is in a supermarket. At the checkout he/she
is struggling with unloading the trolley. The person behind in the queue offers to help. Rather than
accepting this help, Pat says in an embarrassed way “No, it’s alright, I’m fine”.
What could Pat say differently which would allow him to receive the help in a way
which would be acceptable to them both?

“Oh, thank you, it is a bit of a struggle.”
“Yes, please, that would be really
helpful.” “That is so kind of you, and
could you put the shopping in the trolley
for me?”
Accepting help is not about us losing independence; it may even be that by accepting useful help and
support from other people it allows us to maintain our independence.
Changing the way we communicate with other people can feel hard. Change often feels this way, but if
we choose to practise this, even in a small way at first, we will find it becomes easier. Give it a go, make
someone’s day, accept and welcome their help.
Module C
Appendix, References and Notes
For further information:
Tel: 0207 257 800
www.health.org.uk
Activity C10: Accepting and asking for help and support from others