Improve your Mood
A guide to how you can manage low mood and depression
This guide is one of a series about wellbeing and mental health. This
booklet is about low mood and depression. Such problems are very common.
Manchester Public Health Development Service produces this series of
guides. Research backs up everything in the booklets. The tools and tips
have been shown to work for many people. It is about finding out which
ones will help you.
Other booklets in this series are:
mFrom Distress to De-stress
mSleep Well
mUnwind your Mind
mWork and Mental Health
The series also includes a set of relaxation audio tracks:
mDistress to De-Stress Relaxation Collection
You can download them free from the resource library at www.mhim.org.uk
We would like to know what you think about the booklet. We would
also like to know how useful it has been. Please e-mail your feedback to
[email protected]. Thank you.
Contents
Getting the most out of this booklet 1
Understanding anxiety2
See it8
Treat it9
Beat it31
This guide aims to:
mHelp you understand how mood can affect you
mGive you tools to help you overcome and manage low mood and
depression.
This guide has a number of tools for you to try. Find out what works best
for you. They are:
mThe vicious cycle of depression
mGet a routine
mActivity scheduling
mChallenging thoughts
mProblem solving
At the end of the book there are details about where to get more
information, help and treatment.
Getting the most out of the booklet
A big part of dealing with low mood and depression is finding out what
keeps it going. You then need to find out what can help you. Use this
booklet in this way.
The ‘Understanding low mood and depression’ section looks at how
low mood can impact on life. It explains how people can end up in a
vicious cycle of low mood and depression.
The ‘See it’ section will help you see how low mood affects your life.
The ‘Treat it’ section has a range of tips to help you deal with low mood
and depression.
The ‘Beat it’ section gives you more ideas on how to make progress. It
also lists where you can get further support.
There are spaces in the booklet for you to write things down. You may
find that this helps you think more clearly about how you feel.
What you’ll need:
p
A
pen and maybe a notebook for extra notes.
p
T
ime for reading and thinking about how you can help yourself.
p
S
omewhere quiet to read and think.
p
T
o keep going and pace yourself by taking one step at a time.
p
S
upport from a family member, friend or health professional if needed.
If you find it hard to work through this guide, you might be helped by
talking to someone. This could be a health worker such as your doctor
or practice nurse. Your focus, energy and motivation levels may be low
now; so there may be things it would be better to try first.
1
Understanding low mood
and depression
Everyone has changes in mood. Sometimes we feel sad, unhappy, fed up,
down or ‘have the blues’. With time, our mood usually changes and we
feel better.
If your low mood carries on or gets worse, you may have become
depressed. Long-term negative thoughts about yourself and your future
are common. Many symptoms can affect how you are able to function in
day to day life.
Depression is very common. It affects roughly 1 in 10 adults in the UK. It
can affect anyone: this includes children and teenagers.
2
Why do people get depressed?
There are many causes of depression. We do not know all the reasons why people
develop depression. This is what we do know so far:
mIt runs in families.
mIt can be due to how you were brought up.
mIt can be caused by stressful life events or changes. These include:
ldebt
lill-health
ldisability
lredundancy
l being a carer
l poor housing
ldiscrimination
l traumatic events
l being out of work
l the end of a relationship
l not having a lot of money
ldeath of a loved one (However, depression is not the same as grief
following the death of a loved one.)
Depression may happen just once, or may return again over time. Some people
may live with it throughout their lives.
3
What are the signs of depression?
Depression has a wide range of symptoms. They include thoughts,
emotions, changes to your body and the way you behave. Here is a list
of some symptoms of low mood and depression. Please tick any that you
often experience:
You feel…
mSad, upset, numb, guilty
mAngry and irritable about little things
mLess interested in things you once enjoyed
mLike things are out of your control
mLike you are not really there
mLike you are alone
You mind finds it is…
mForgetful
mGoing over and over things
mRacing/difficult to switch off
mDifficult to remember things
mImagining that the worst will happen
mDifficult to focus and jumps from one topic to another
Your thoughts might be…
m“I can’t cope”
m“I have no confidence”
m“Everything is hopeless”
m“Things are out of control”
m“The worst is going to happen”
m“I can’t be bothered”
m“I hate myself ”
4
You might behave by…
mNot doing everyday tasks
mFinding it hard to sit still/relax
mDoing things slower than usual
mBeing snappy and irritable
mPutting things off
mSelf harming
mAvoiding friends and family
mEating and sleeping more (or less)
mNot doing the things you used to enjoy
mDrinking/taking drugs and/or smoking more
Your body symptoms are…
mCan’t sleep / sleeping too much
mButterflies in the stomach
mNeed to go to the toilet
mFeeling sick
mHeadaches
mTired
mTearful
mTense muscles
mLower sex drive
mMore pains in the body
If you have ticked a number of these circles, you seem to be having
symptoms of low mood or depression. However, don’t be alarmed, this
is very common. There are things you can do to improve your situation.
You will find some useful tools in this booklet.
Sometimes these symptoms can be caused by medical problems. For
example: an under active thyroid, diabetes, a head injury, stroke, chronic
pain, or a lack of vitamins and minerals e.g. low vitamin D. You should see
your GP to be sure that your symptoms are not related to a medical problem.
5
The vicious cycle of depression
Depression changes the way you think, how your body feels, how you
feel emotionally and how you behave. These changes can have an
effect on each other. Depression can also affect other parts of your life.
Situations like: how you get on with other people, money, housing and
work.
These ‘five areas’ (thoughts, emotions, physical, behaviour and situation)
can all affect each other. This keeps the depression going. We call this a
vicious cycle. The arrows in the diagram over the page show how every
area can affect any other area to make a vicious cycle.
Here are some examples of things that can keep a vicious cycle going:
mPoor coping
Some people try to cope by using alcohol. Others might call in sick
to work. This can make the situation worse in the long term. For
example, people could become addicted to alcohol. It could lead to
financial or relationship problems. This makes the situation worse
and the depression stays.
mPoor motivation or low energy
People often stop doing things they used to enjoy. The vicious cycle
develops as they do less and less. This can make them withdraw
more and more.
mNegative beliefs or hopelessness
Some people do not seek help. This may be due to feelings of
worthlessness. For example, “Why should anyone help me ,
I’m rubbish”. It could be because they feel helplessness. For
example, “Nothing can change the way I feel”. Sometimes
people do not know that they have depression. If this is the case it
will not be treated.
6
Situation
Things in your life
Had an argument / Got a lot to do the next day
Hard to focus at work
Thoughts
Negative:
“I’m a bad person”
Blaming:
“It ’s my fault ”
Behaviour
Emotions
Sad
Hopeless
Empty
Lonely
Guilty
Stay in
Avoid people
Drink/eat more
Stop doing things
Physical
Can’t sleep
Tired
No energy
Body aches
Headaches
Sara is going through a stressful time at work. This is making her feel
down and empty. She can’t fall asleep at night because she keeps
thinking about what is going on. She feels very tired during the day and
does not want to talk to anyone. This makes her feel lonely and hopeless.
Sara starts to think that it is all her fault. Her body aches all the time,
so she stops looking after the house. Soon the house is a mess and as
she sits in the lounge she thinks that she must be a bad person to let
things get this bad. She goes to the kitchen and finds some wine and a
tub of ice cream. Sara sits down and starts to enjoy herself as she tucks
into her treats. Once she has finished them off, she starts to feel guilty.
This reinforces her thought that she is a bad person. She starts to avoid
people even more. And her vicious cycle of depression continues...
7
See it
Do you notice any vicious cycles in your life? Have a go at drawing your
own cycle on the blank diagram below. Use the symptom checklist from
page 4 and 5, or think of the last time you felt low. You can download a
free copy from www.mhim.org.uk.
Situation
Things in your life
Thoughts
Behaviour
Emotions
Physical
8
Treat it
To beat depression you need to break your vicious cycle. You can do this
by changing something in one of your ‘five areas’. So getting better can
mean making small changes in:
mwhat you do mhow you feel about things
mhow you think mwhat is going on in your life
myour physical health
The key is to take small steps, one at a time. A small positive change in
one area can have a positive effect on the other areas. So you can create
a positive cycle. Sara decides to talk to a friend. This is her positive cycle:
Situation
Stressful time at work
Things in your life
Thoughts
“I’m doing the best I can”
“My friends do like me”
Behaviour
Emotions
Talk to a friend
Ask for help
Hopeful
Positive
Physical
Sleeps better
Less tired
9
Working with physical symptoms
Depression can affect your body as well as your thoughts and emotions.
It can:
mchange your appetite (eating more or eating less)
mchange your sleep patterns (sleeping more or sleeping less)
mlead to a lack of energy and feeling tired.
Some people find they have more aches and pains. Others become more
aware of any physical pain that they have had before.
Many things will affect your body and your mood,
including what you do and what you put into your body.
These include:
mMedicines
mHow much you eat
mWhat sort of food you eat
mExercise and activity levels
mAlcohol and other drugs
mSleep and relaxation
mIllnesses
mPain
mEven the amount of sunlight you get
It is worth spending some time to think about each
of these things. Think about what changes you want
to make. You may want help and support to do this. In Manchester, the
Community Health Trainers are one such service. You can find out more
about them and other services at the end of this booklet.
The booklet ‘From Distress to De-stress’ has lots of tips about how
to reduce the physical impact of distress. You can download a free copy
from www.mhim.org.uk.
10
Working with behaviours
Often people with depression do less. They may stop doing some of
the things that they used to enjoy. Some people stop going out. They
become withdrawn and less sociable. It is common to put jobs off. Some
of the things people do to cope will end up being unhelpful. Some people
may drink more alcohol, stay in bed more or over-eat.
These changes in what people do can make their mood worse. They
often do less of what is helpful, eg less exercise. They do more of what is
unhelpful (but feels good in the short term), eg eat fattening food. This
feeds the vicious cycle.
The first thing to do is to look for what you are doing. Once you have
done this, you can look at doing less of the unhelpful ways of coping
that you use.
It also helps to make sure that you keep up with things that you need to
do. This stops you from feeling like things are out of control.
Next, look at what you can start doing. Choose things that will improve
your mood (even if you don’t feel like it!). Some examples include:
mBe more active.
mBuild relationships.
mGet out of the house.
mTalk to friends and family.
mKeep in contact with the outside world.
mDo enjoyable and pleasurable activities.
11
Complete each box to see how things are for you.
Things that I do now that are unhelpful:
Try to do less of these
Things that I need to do:
Try to fit these into your week
Things that I enjoy or would like to do:
Try to do more of these
12
When you’re feeling down, doing more can seem like a huge burden. This
may be for many reasons. Maybe you’re not sleeping well or you’re not
eating as well. This is common in depression. It can sap your energy
and make you feel tired and lethargic. Your thoughts may be telling
you ‘There’s no point ’ or ‘I’ll do it later ’. This makes it tougher
to be more active. It becomes harder to get into healthy and enjoyable
routines. There is some good news. There is proof that being more
active is a great way to beat depression.
But when you feel tired and your head’s telling you not to bother, it is hard
to get motivated. So how do you get going? Here are some ideas for you:
Motivation follows action.
When we feel down it is a real effort to get going. However, once we do
make a start then we often feel like we want to do a little bit more. This
is true no matter how small the start is. If we wait until we feel like doing
something before we start, then we may wait for a long time!
‘I’ll do it tomorrow’…
and tomorrow never comes!
13
Get a routine
A good routine can help you to look after yourself. It can improve your
sleep. It can also help you feel more in control of your life. The body
works better when its basic needs are met. The brain needs a lot of
energy to function. Without enough food, it won’t work well. Some
people need to take medicines at a regular time. It is important to plan
them into your day if you need to do this.
It
is important to have
ma regular bedtime and wakeup time
mperiods where you are active, and
mperiods where you rest and relax
mregular times to eat
You could plan a daily routine like this:
7-8am
1-2pm
5-7pm
10pm
11pm
Get up, shower and breakfast
Lunch
Dinner
Prepare for bed
Bed
The booklet ‘Sleep Well’ has lots of tips about how to get a better night’s
sleep. You can download a free copy from www.mhim.org.uk.
14
Activity scheduling
Another tip is to plan to do a range of things in your week. It can help
a lot to do things which give you pleasure. It is also good to do things
which give you a sense of achievement.
Symptoms of depression can be helped by being active. This can help
boost your self-esteem. Doing something social can also help. These are
what are called the ‘Fabulous Four’.
The activity schedule over the page can help you build more activity into
your day. You can download a free copy from www.mhim.org.uk.
Step 1
Think about activities that fit into the ‘Fabulous Four’ activity groups:
mPleasurable activities
mActivities which give you a sense of achievement
mActivities which are physically active
mSocial activities
Aim to do a balance of activities from each group. This is important. Try
to do a different type of activity each day.
Step 2
Plan what you are going to do:
mPrint or copy the diary over the page. Then fill in what you aim to do
for the next week. Include the time of day when you will do the activity.
mMark on the diary whether you managed to do the activity or not.
Write down how you felt about it, or what got in the way.
Step 3
Practice makes perfect:
It might take a lot of practice to find the combination that works for you.
Just remember to try to keep a good balance of activities from across the
‘Fabulous Four’. Also, keep it realistic – don’t try to do too much at once.
Once you get used to doing more, you can plan more activities each day.
15
Pleasurable
activity
Activity with
a sense of
achievement
Physical
activity
Social activity
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
16
To help keep on track, you could ask someone to remind you to do things.
It will help you to get going. It can also keep you on track. This is
important because depression can affect your memory.
To increase the chances of getting started, you could
give yourself a time limit. You could decide to go for
a walk for just 10 minutes. Then time yourself. Use a
clock to make sure you don’t go over the ten minutes
(unless you want to, after you begin!)
Small steps: one small step at a time
Don’t try to do everything all at once. You’re not going to feel better
overnight. Getting out of the depressive cycle takes time. It is best to
tackle the things that need doing, in small stages.
Doing a task may seem like a huge effort. Thinking about all the things
you have to do can be daunting. Breaking things down into smaller stages
can help. It can make it seem less scary.
For example: Sara decides to see more of her friends. She decides
to text them first and then to phone them. She feels that she can cope
with that. This builds Sara’s confidence. She then decides to ask them
to come round to see her at home. Once she feels okay doing that, she
plans to go out somewhere with them.
But don’t take anyone’s word for this, try it yourself. Think of a small
job that you have been putting off. If you can, break it down into even
smaller parts. Then take the smallest bit first. Just start to have a go at
it and see what happens. The problem solving tool on page 25 can help
you to do this.
17
Working with your thoughts
Negative automatic thoughts
With depression your thinking tends to become more negative. You might
have what are called ‘negative automatic thoughts’. These just pop into
your mind and make you feel more depressed. Some examples include:
‘I’m no good’; ‘They don’t like me’; and ‘Nothing will help’.
This type of thinking can make you see things in negative ways. When
you are down, these thoughts seem true and reasonable. But really they
are unrealistic and untrue. They are just plain unhelpful. So it can help
to question your thoughts. You need to make sure that you aren’t making
yourself feel worse.
For example: Sara’s friend, Yasmin, walks past her in the street and ignores
her. Sara’s first reaction is to think that Yasmin has fallen out with her. She
thinks that Yasmin is ignoring her. She starts to feel angry and upset.
Unhelpful thinking styles
There are many types of unhelpful thinking styles. They are very
common. We all do them. Try to keep an eye out for when you are
using any of them. There are some examples over the page.
When you spot them, you can label them. Once you have recognised an
unhelpful thought, you can start to do something about it. You can learn
to demand evidence (coming up next). You can then dismiss the thought
because you will know it is not true.
Sometimes your thoughts might be linked to long term beliefs. These
could be about you, about other people or about the world. They may
hold you back in your recovery. If so, you may need to talk to someone
like your GP, a counsellor or therapist.
18
19
Blaming Yourself
You think things are your fault.
You do this even if it has little
or nothing to do with you.
“I have done something to
make Yasmin ignore me .”
Over-Generalise
You do not see a bad event as
just a one-off event. Instead it
just proves that everything is bad.
“If my friend Yasmin
doesn’t like me , no one
else will either.”
Expecting the Worst
You expect things to go wrong,
no matter what. You expect
the worst will happen.
“Yasmin is never going to
speak to me again .”
Living by Fixed Rules
You think you need to live by
rules like ‘should’, ‘ought’ and
‘must’.
“Every time I see people I
know, they should say ‘Hello’.”
Jump to conclusions:
You think things without any
proof. You guess what people
think (mind reading) and predict
the future (fortune telling).
“Yasmin hates me. That is
why she didn’t say ‘Hello’.”
Negative Focus
You only see the bad things.
You see your weaknesses but
not strengths.’
“Yasmin did not say
‘Hello’ to me .”
(Sara ignores all the times
Yasmin has said ‘Hello’.)
Demand evidence
One way to question the thoughts or ideas that bother you is to ‘demand
evidence’. Do not just accept a negative thought that pops into your
head. Instead, take another look at it. See if it is backed up by reality.
Check whether it is helpful.
If Sara had challenged her first reaction she would not have got upset.
She would see that all she really knows is that Yasmin did not say ‘Hello’.
There are many reasons why this might have happened.
When Sara next sees Yasmin she asks her why she ignored her. Yasmin
is shocked. She had been late going to pick her kids up from school that
day. In her rush she had not noticed Sara walking up the road.
Sara realised that she had spent two days feeling upset about nothing.
She wished she had spoken to Yasmin earlier. Then she realised that
what she really needed to do was ignore her thought. It had not been
true. She was glad that she spoke to Yasmin. She promised herself that
she would not just accept her thoughts in future.
20
This might sound too simple. When you feel down, your head might say
things like ‘I can’t do that ’ or ‘It sounds like rubbish’, but if you
give it a go you may notice a small change.
Here are some questions that you can ask yourself. Use them to
challenge your unhelpful thoughts. The table below shows how Sara
could have challenged her thoughts.
Unhelpful thought?
“Yasmin hates me”
What evidence do I have for this?
She walked past me today and did not say ‘Hello’.
Is my thought opinion or fact?
Opinion
What type of unhelpful thinking am I doing?
I am jumping to conclusions: mind reading.
Is there another way of seeing this?
She might not have seen me. She did look busy.
What would I say to a friend who thought this?
“That doesn’t sound like her. You are both really good friends.
Maybe she had other things on her mind and just didn’t see you.”
What are the chances of this being true?
Low
What is a more realistic thought?
“I get on really well with Yasmin . She probably didn’t see me.”
You can download a blank copy from www.mhim.org.uk.
21
By challenging her thought, Sara could have changed how she felt. Her
negative automatic thought made her feel upset. If she took time to
assess the thought she could see it was not true. Her more realistic
thought would make her feel calm and relieved.
Negative automatic
thought
“Yasmin hates
me”
Emotions
Alternative thought
New emotions
Down
Angry
Upset
“I get on
really well
with Yasmin .
She probably
didn’t see
me .”
Relieved
Calm
When you are feeling down, unhelpful thoughts can get in the way of
making change. The table below shows how changing your thoughts can
make you feel like doing a bit more.
Negative automatic
thought
“These ideas
will never
work”
Emotions
Down
Hopeless
Demoralised
Alternative thought
New emotions
“I’ve got
nothing to
Curious
lose by trying.
A bit more hopeful
It might take
A little motivated
my mind off
my problems.”
The booklet ‘Unwind your Mind’ has more tools to help you deal with
unhelpful thoughts. You can download it free from www.mhim.org.uk.
22
Working with our environment
or situation
‘No man (or woman) is an island’, as the saying goes. Each of us is
connected to the world and the people around us. We all affect and are
affected by our surroundings.
Your environment or situation includes things other than your thoughts,
emotions, body and behaviour. Here are some examples:
mrelationships
mpeople you know
mmoney and debt
morganisations
mhousing
mwork
msupport
mthings that have happened to you
The things that go on in your life can have a big effect on your mood
and vice versa. Often people get depressed because of the things that
happen to them.
When people are depressed, they find it hard to do normal, everyday
things. This can have a knock-on effect on other parts of their lives. It
can also have an effect on the people around them. It could have an
impact on their caring roles. It could affect their work. They may find it
harder to keep the house going.
It is important to keep these things in mind when tackling depression.
23
Ask yourself these questions:
What has helped me in the past?
Could you try them again?
What may help this time?
Plan to do these
24
Problem solving
When you feel low, it can feel like there is too much to deal with. You may have
some ideas about how to sort things out. But, it is hard to work out what is best.
You may feel stuck and not know what to do.
Problem solving can help you to work out what to do. It helps to work through a
problem in a structured way. Once you have a plan to deal with a problem, you
can try it out.
What is the problem? Identify a problem you want to
tackle. You may need to break down a big problem into
small, bite-sized manageable pieces to tackle one-by-one.
What could work? Come up with as many ideas as you
possibly can.
Work out what is good about each solution and then
what is bad about each solution.
Choose one of your solutions – the one that seems to
be the best. Look at the things that are good or bad about
each solution to help you decide.
Make a step-by-step plan. Include what you are going
to do and when you plan to do it. It is a good idea to try to
think about anything that might get in the way of your plan.
You can then think of a mini-plan to overcome any obstacles.
Review what happened and see how well it worked. If it
hasn’t, then you can go back to another solution and try that.
25
What happened?
What could work?
What is the problem?
What is good?
What is bad?
10
9
8
7
6
5
4
3
2
1
What will you do?
What will you try?
mchoose a problem
mcome up with lots of solutions
mwork out what is good and bad
about each one
mchoose one solution
mcreate a step-by-step plan to
follow - then do it!
mevaluate how it went
Problem Solving
This table can be used to problem solve a worry or problem you have. You
can download a blank version from www.mhim.org.uk
26
You may need to seek the right kind of extra support and advice to deal
with any problems.
What do you think could help?
Plan to do these
Here are some people who may be able to help:
Manchester Community Health Trainers support people with making
small changes that benefit their health, e.g. better diet or more exercise.
Tel: 0161 861 2548
Citizens Advice Bureau for advice on money, housing etc.
Tel: 08444 111 222
Shelter for help with housing problems
Tel: 0844 515 1640
Lifeline for advice about drugs
Tel: 0161 272 8844
Manchester Carer’s Forum for support for carers
Tel: 0161 819 2226
27
Treatments and support for depression
Antidepressant medication
This is a common way to treat depression. Antidepressants do not cure
depression. They do reduce the symptoms. This can help you feel more able to
deal with the depression in other ways.
Antidepressants can improve:
mMood
mSleep
mAppetite
mEnergy levels
mConcentration
You can take them while you try other things to tackle your low mood. This
includes the tips and tools in this booklet. It also includes going to counselling or
other therapies. You can talk to your doctor about what your options are.
It can take some time for antidepressants to start working. It may take two to
six weeks before you start to feel the benefits. You need to take them every day
for them to work.
You may feel some mild side effects when you start taking them. They can
include headaches, dry mouth and blurry vision. Some people feel sweaty, dizzy
and/or sleepy. These effects often go in seven to ten days. The side effects of
different antidepressants vary. It is a good idea to ask your doctor about what to
expect. They can tell you what to do if you have a problem. If the side effects
stay, your doctor may ask you to lower your dose. You may need to change to
another antidepressant.
You do not get addicted to antidepressants. This is because you do not need to
take more and more over time for them to work. If you just stop taking them
you can feel some effects. These are called withdrawal symptoms. Headaches,
worrying and not being able to sleep are common. They can also include feeling
sick and being sick.
If you are thinking of stopping your medicine you should speak to your doctor
first. This is because you may need to slowly reduce how much you are taking.
This will give your body time to adjust.
28
Talking treatments or therapies
You may want to access a service that can help you improve your mental
health. Your doctor can suggest services that can help. In Manchester
you can also ask to see a therapist yourself. The Gateway Service is
the single-point of access to such NHS services. You will go through a
referral form so they can find out what you want and need. They will
then suggest which form of service will suit you best.
There are other mental health services in Manchester. More information
about the range of these services can be found at www.mhim.org.uk. A
few are listed below and at the end of the booklet.
When you attend a service they will listen to how you are feeling. They
will help you to see what impacts on your mental health. They will
support you to make changes to improve your mental health. Some
therapies may be quite brief. Others continue for longer periods.
NHS mental health services
Manchester Mental Health and Social Care Trust
Gateway Service
Website:www.mhsc.nhs.uk
Tel (9am-7pm): 3 0161 882 2400 (citywide)
Tel (7pm-9pm):3 0161 720 2045 (North)
32323 0161 276 5368 (Central)
32323 0161 277 1224 (South)
Tel (9pm-9am):3 0161 922 3801 (citywide)
African & Caribbean Mental Health Service
Offer a range of services to African and Caribbean people with mental
health problems aged 16 and over.
Tel:
0161 226 9562
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Voluntary sector services
Self Help Services
They offer a range of mental health services. These include:
mPsychological Wellbeing Practitioner Service.
mComputerised Cognitive Behavioural Therapy (cCBT) with support.
Website:www.selfhelpservices.org.uk
Tel:
0161 226 3871
Especially for young people
Emerge 16/17
They offer a mental health service only for 16 and 17 year olds.
Website:www.cmft.nhs.uk
Tel:
0161 226 7457
42nd Street
42nd Street offer services for young people aged 13 to 25. These include
counselling, individual support, group work and volunteering.
Website:42ndstreet.org.uk
Tel:
0161 228 1888 (Mon, Thu & Fri 2pm-5pm)
YASP
They offer services for young people aged 13 to 25, who find themselves
under stress. These include internet cafe, counselling, mentoring,
befriending, advice drop-in and volunteering.
Website:www.harp-project.org/projects/project_yasp_index.php
Tel:
0161 221 3054
For older people
Age Concern Counselling Service
This is a counselling service for Manchester residents aged 60 and over
and their carers.
Website:silverservice.org.uk/info-advice/counselling.html
Tel:
0800 027 57 87
30
Beat it
Practise, practise, practise…
Things are not going to change overnight. It can be a challenge to
change the way you have been doing things for so long. But, with
practice it will become easier and easier. In the end, the changes will feel
like second nature as you get used to them.
There is a lot of information in this booklet. It might be useful to read it
more than once. Try each technique a few times and keep practising the
ones that you find useful.
Do not expect too much too soon. It may take some time for you to
change the way you think and feel. It is a bit like learning to walk as a
toddler. We all fall over at first. You might even bang your head or graze
your knee. You keep going despite these setbacks. Eventually you learn
to walk. It doesn’t happen overnight. It takes time and practice. It is the
same for overcoming low mood and depression. It is not going to happen
straight away. But, it will be worth it in the end.
After a while, it is useful to go back and check your depression checklists.
You will be able to see if there have been any changes.
31
Coping with setbacks
Everyone has setbacks. Life is like that! The trick is to find ways to cope
with them. When they do occur, remember that it happens to everyone. It
does not mean that you have failed. It is important not to give yourself a
hard time. If you do start to think things like ‘I’m a failure’, you can use
the Demand Evidence section of this booklet to challenge your thoughts.
When you have a setback, try to remember that you are not back to
square one. It can be easy to forget about all the progress you have
already made. Try to learn from it. We often learn more from things
when they don’t go quite right compared to when they go smoothly. Take
some time to reflect on what has happened. Try to understand why it
has happened and what you can learn from it. You may be able to find a
pattern to what is going on.
You may be able to tell when a setback is more likely. Start to learn your
warning signs. Such signs might include:
mlots of things going on in your life
mfeeling like everything is too much
mchanges in your mood: feeling low, angry, upset, wound up etc
mchanges in your thinking: negative thinking, unhelpful thinking
styles, giving yourself a hard time
mgetting more irritable: having arguments with others
mchanges in your body: feeling more tired, headaches, aching muscles
mchanges in what you do: doing fewer enjoyable things, avoiding
people and places, being less active.
32
Once you can see your warning signs, you can do something to deal with
them. This can stop things from getting worse. You could even come up
with your own survival guide with a plan to deal with each warning sign.
Finally – don’t give up! Dealing with low mood and depression can
take time and practice. It may take a while to notice an improvement.
Remember to take some time each month to look at the progress you
have made.
33
Looking after yourself
You can look after yourself in many ways. The skill of ‘looking after you’
is important. You need to pay attention to your needs. Some people
might feel guilty and view it as being selfish. However, taking care of you
is a good thing. It does not mean that you need to ignore other people’s
needs. It means that you value yourself enough to take care of you.
Only by looking after yourself will you be ready to deal with the ups and
downs that life will throw at you. You will also be more able to support
others when you feel strong and well rested.
Eat well: Your brain uses up more than 50% of the energy
in the food you eat. That is why it is important to eat starchy
food. This includes rice, pasta, bread and potatoes. When
you do not eat well, your brain cannot work properly. Eating
your 5-a-day helps improve physical and mental health. It
includes fresh, frozen, canned or dried fruit and vegetables.
It is also important to eat protein. This includes meat, fish,
beans, tofu and quorn. Omega3 oils found in oily fish and
dark green vegetables are also needed for a healthy brain.
You also need to have enough liquid each day. This includes
what you drink. It also includes the liquid found in your food.
Read the booklet ‘Food and Mood’ for more information.
You can download it free from www.mhim.org.uk.
Vitamin D: There is very little Vitamin D in the food we eat.
Our skin makes Vitamin D from sunlight. However, this only
happens between the months of March and October. You only
need to spend 20 minutes in the sun each day, if you have
pale skin. The darker you are, the longer you will need to
spend in the sun. Many breakfast cereals and all margarines
(but not low fat spreads) have Vitamin D added to them. Just
check out the label. You can also buy Vitamin D tablets to
take once a day.
34
Get active: This is a great stress reliever. It can make
you feel fitter and more confident. Choose something that
you enjoy and can fit into your lifestyle. Aim toward 30
minutes of activity at least five times a week. Walking,
gardening and doing the housework are all examples of
physical activity. To find out what is on in Manchester, visit
www.gettingmanchestermoving.org. The booklet ‘Physical
Activity and Mood’ has even more tips about getting
started. You can download it free from www.mhim.org.uk.
Sleep well: This lets the body and mind recuperate and rest.
When you don’t sleep well, your brain does not work properly.
You can use breathing techniques in bed to help you to fall
asleep. The muscle relaxation can also help. Read the booklet
‘Sleep Well’ to find out more. You can download it free from
www.mhim.org.uk.
Relax: This helps the body and mind recover and rest. You
can relax in many ways. Some people read. Others paint and
draw. Some people knit and others spend time with animals.
Try to find a way that works for you. Breathing techniques
can reduce the affect of stress on the body. Read the booklet
‘From Distress to De-stress’ to find out more. You can
download it free from www.mhim.org.uk.
35
Connect: Build bonds with people. It can help you feel
supported. It can also allow you to feel closer to others. We
have always lived together in groups. Having a good set of
friends and family can improve your wellbeing.
Give: This is about doing something nice for others. Helping
people can make you feel good about yourself. It will make
others feel good too. It could be as simple as smiling at a
stranger. Even holding a door open for someone can make
their day. You could help a neighbour or friend or do random
acts of kindness. It can feel good to help at a local community
group or charity. You could meet new people, learn new skills
and gain great experience.
Keep learning: Learn or rediscover skills. It builds
confidence and esteem. You will feel more able to cope with
life. There are a number of life skills courses available across
Manchester. One such course is called BOOST. Contact Self
Help Services to find out more. Their details are at the back
of this booklet. There are also free computerised Cognitive
Behavioural Therapy courses online. These include:
mwww.llttf.com
mmoodgym.anu.edu.au
mecouch.anu.edu.au
Take notice: Notice the world around you. It can put things
in perspective. It can also brighten your day. Often we can
go around in autopilot and miss the little things that could
improve our mood. Keep an eye out for rainbows, architecture
and nature!
36
Things to do in a crisis or emergency
Sometimes things can feel like they are too much to handle. If you feel
like this, it is very important to get some help as soon as possible.
If you need help and support urgently:
mContact your GP. Write down your doctor’s name and number here:
mGo to the nearest A&E if your mental health worsens to crisis point.
Write in the address of your nearest A&E here:
mCall 999 and ask for an ambulance
If you need to talk to someone contact:
The Sanctuary
This is an overnight service for adults. They must live in Manchester. It is
for people who feel that they are at crisis point. They offer support with
issues such as anxiety, panic attacks, depression or suicidal thoughts.
0161 637 0808 (11pm-9am every night)
Samaritans
They provide confidential emotional support for people who are having
feelings of distress, despair or suicidal thoughts.
08457 90 90 90 (24 hour Helpline)
0161 236 8000 (Manchester)
Saneline 0845 767 8000 (6pm to 11pm daily)
Crisis Point 0161 225 9500
37
If you are already using Manchester Mental Health & Social Care
Trust services:
Check your care plan for your crisis plan contact details.
MMHSCT Crisis Line: 0161 922 3801
(Mon-Thurs 5pm - 9am, Friday 5pm - Monday 9am & Bank Holidays)
It is important to remember that many people feel like this at times.
There are people out there who can and want to help you.
Suicide is forever, your problems are not.
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Other sources of help
Books
Anxiety and depression: a practical guide to recovery, by Robert Priest
Dealing with depression, by Kathy Nairne and Gerrilyn Smith
Depression: the way out of your prison, by Dorothy Rowe
Depressive Illness: The Curse of the Strong, by Dr. Tim Cantopher
Feeling good: the new mood therapy, by David Burns
Mind Over Mood, by Christine Padesky
Overcoming depression, by Paul Gilbert
Overcoming depression and low mood: a five areas approach, by Dr Chris Williams
Organisations
Alzheimer’s Society
Website:www.alzheimers.org.uk
Helpline: 0300 222 1122 (Mon-Fri 9am-5pm, Sat-Sun 10am-4pm)
Tel:
0161 342 0797 (Mon-Fri 9.30am-5pm)
Association for Post-Natal Illness
They provide information and support about a range of issues to do with postnatal depression.
Website:apni.org
Helpline: 020 7386 0868 (Mon-Fri 10am-2pm)
Depression Alliance
They provide information and support for people living with depression.
Website:www.depressionalliance.org
Depression UK
This is a national self-help organisation that helps people cope with their depression.
Website: www.depressionuk.org
Info line: 0870 7744320
National Debt Line
They offer help for anyone in debt or worried about falling into debt.
Website: www.nationaldebtline.co.uk
Helpline: 0808 808 4000 (Mon-Fri 9am-9pm, Sat 9.30am-1pm)
Relate
They offer advice, counselling, workshops, mediation and support around relationship issues.
Website:anxietyuk.org.uk
Helpline: 0300 100 1234 (Mon-Thurs 8am-10pm, Fri 8am-6pm, Sat 9am-5pm)
39
Rethink
They offer advice and information about mental health and issues that can impact on it.
Website:www.rethink.org
Helpline: 0300 5000 927 (Mon-Fri 10am-2pm)
Sane
They work to improve quality of life for anyone affected by mental illness.
Website:www.sane.org.uk
Helpline: 0845 767 8000 (6pm-11pm every day)
Shelter
They offer free, advice and information on housing issues.
Website:england.shelter.org.uk
Tel:
0808 800 4444 (Mon-Fri 8am-8pm, Sat-Sun 8am-5pm)
Step Change Debt Charity
They offer support to manage debt problems.
Website:www.stepchange.org
Helpline: 0800 138 1111 (Mon-Fri 8am-8pm, Sat 8am-4pm)
The Samaritans
The helpline provides confidential emotional support for people who are
experiencing feelings of distress, despair or suicidal thoughts.
Helpline: 08457 909090 (24 hours a day, every day)
Manchester: 0161 236 8000
The Silver Line
They provide a free confidential helpline providing advice and befriending to older people.
Website:www.thesilverline.org.uk
Helpline: 0800 4 70 80 90 (24 hours a day, every day)
The Stroke Association
Website:www.stroke.org.uk
Helpline: 0303 3033 100 (Mon-Fri 9am-5pm)
Tel: 0161 742 7482
Young Minds
They work to improve the emotional wellbeing and mental health of children and
young people.
Website:www.youngminds.org.uk
Parent helpline:0808 802 5544 (Mon-Fri 9.30am-4pm)
40
Websites
www.mhim.org.uk
This is the ‘Mental Health in Manchester’ website. It has information about
mental health issues. There are details of local services. It also includes
information in a range of languages.
www.gettingmanchestermoving.org
There are links to health advice. There are also details about where you
can be active in Manchester.
www.llttf.com
This is the ‘Living Life to the Full’ website. It is a free online life skills
course. It covers a range of skills that help deal with everyday stresses.
moodgym.anu.edu.au
Mood Gym is a free self-help website. It covers a range of skills to help
prevent and deal with depression.
ecouch.anu.edu.au
E-couch is a free self-help interactive website. It covers a range of topics.
These include modules for depression, anxiety and worry.
www.cci.health.wa.gov.au
This website features free online self-help modules and resources.
www.getselfhelp.co.uk
This website offers free Cognitive Behavioural Therapy self-help
information, resources and including therapy worksheets.
rcpsych.ac.uk
This is the Royal College of Psychiatrists website. It is an online mental
health resource.
41
Local services
Active Lifestyles
You need to be a member to attend sessions. This is free to do. You can
join at your first session. There is a huge range of activities to try for only
£1 per session.
Website:www.manchester.gov.uk/activelifestyles
E-mail:[email protected]
Tel:
0161 232 3100
Community Health Trainers
They offer support to make healthy changes. This includes help to sleep
more soundly.
Website:www.mphds.org/mphds/health-trainers/health-trainers
E-mail:[email protected]
Tel:
0161 861 2548
Manchester Citizens Advice Bureau
They offer free, confidential, impartial and independent advice and
information on a wide range of subjects.
Website:www.manchestercab.org.uk
Tel:
08444 111 222
Manchester Carers Forum
They offer a range of support for carers.
Website:www.manchestercarersforum.org.uk
Tel:
0161 819 2226
Manchester Mind
Manchester Mind offers a range of services including:
mAdvice, information & counselling services
mYoung Adult Advice & Support Project (YASP)
Website:harp-project.org
Tel:
0161 226 9907
42
South Manchester Healthy Living Network (SMHLN)
SMHLN covers areas of south Manchester. It offers a range of
wellbeing services.
Website:www.mhsc.nhs.uk/services/wellbeing-services/southmanchester-healthy-living-network
Tel:
0161 217 3667
Stop Smoking Service (Manchester)
This service helps people to stop smoking. It offers free NHS support
and advice.
Website:www.stopsmokingmanchester.co.uk
Tel:
0161 205 5998
The Roby
The Roby offers a range of services. It specialises in services for people
from South Asian cultures.
mCounselling in a range of community languages
mSouth Asian Women’s group
mParent and Toddlers group
mEvolve (Drop-In)
Website:www.theroby.org.uk
Tel:
0161 257 2653
ZEST
Zest covers areas of north and east Manchester. It offers a range of
wellbeing services.
Website:zestactivities.blogspot.co.uk
E-mail:[email protected]
Tel:
0161 234 3715
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© Manchester Mental Health & Social Care Trust, Public Health Development Service.
All rights reserved, not to be reproduced in whole or in part without the permission of the
copyright owner. December 2013, Version 3