Mental health work can seem so complicated… and not just for beginners. Many seasoned practitioners go on for years without a clear idea of how the different diagnoses, conditions and coping strategies fit together. It’s like trying to make sense of a 1,000 piece jigsaw without any real idea of what the overall picture is supposed to look like.
The confusion that arises can lead to workplace stress, unclear aims and difficulties in following care plans with different workers pulling in different directions whilst the service-user or client gets stuck in the middle of a whirlpool of confusion.
It’s always better when you can see the whole picture
This course is intended to provide the ‘picture on the box’. It shows clearly and simply exactly how the different types of diagnosis and conditions fit together and even maintain and exacerbate each other. Delivered either online or face to face (with appropriate distancing, of course) it’s available to staff teams anywhere in the world, just so long as they speak English and have a working internet connection.
The course involves…
Session 1
Anxiety (the gateway to mental disorder)
Freeze, flight and fight
Session 2
Depression (when you’re tired of trying)The opposite of the FIVE ‘F’S
Psychosis (The Devil makes work for idle hands)
Session 3
Personality disorder (9 statements of vulnerability)
The symptom groups – are the same as the 3 clusters… are the same as the vulnerabilities
3 models – All roads lead to the same destination
Session 4
Dependence and self-reliance
Therapeutic optimism Expressed emotion
Get in touch to book this training for your own staff. Go on, you know you want to!
“Rehearse death. To say this is to tell a person to rehearse his freedom. A person who has learned how to die has unlearned how to be a slave.”
(Seneca)
In the previous post I suggested that there’s no point in becoming distressed today because we think something might distress us later. That just increases the misfortune. Indeed, once we realise that most of the things people worry about never actually happen it becomes clear that it’s possible to ruin the quality of an entire life with pointless and unnecessary anxiety. If we expect next Friday afternoon to be distressing that’s one thing. But let’s not destroy today as well.
In the Christian tradition this seems to be what Jesus meant when he said
“….. do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.”
(Matthew 6:34)
I have long believed that Jesus (or whoever wrote the Gospels after his death) must have been familiar with the earlier works of stoic philosophers, there are just too many such coincidences for it to be otherwise in my opinion.
But it’s important to be clear. Freedom from distress by avoiding the emotional content of anticipation (avoiding worry, in other words) isn’t the same as avoiding anticipation altogether. On the contrary, we must anticipate. In fact the stoics advised us to go further than most worriers do in our anticipation – but we do so without distress. We do it as an intellectual exercise. We visualise loss and misfortune and we imagine how we might cope with the worst. On the one hand his can prepare us for what tragedies may befall us. On the other it helps us to understand and appreciate what we already have.
“Take full account of what Excellencies you possess, and in gratitude remember how you would hanker after them, if you had them not.”
(Marcus Aurelius, meditations)
This is one of the ways that stoics are able to maintain emotional equilibrium when things go wrong for them. They understand that all things in life are transient and they prepare for the changes in advance – they are always prepared to ‘give back’, to ‘return’.
Never say of anything, “I have lost it”; but “I have returned it”…….
“But he who took it away is a bad man.” What difference is it to you who the giver assigns to take it back? While he gives it to you to possess, take care of it; but don’t view it as your own, just as travellers view a hotel.
If you want to improve, reject such reasonings as these: “If I neglect my affairs, I’ll have no income; if I don’t correct my servant, he will be bad.” For it is better to die with hunger, exempt from grief and fear, than to live in affluence with perturbation; and it is better your servant should be bad, than you unhappy.
Begin therefore from little things. Is a little oil spilt? A little wine stolen? Say to yourself, “This is the price paid for apathy, for tranquility, and nothing is to be had for nothing.” When you call your servant, it is possible that he may not come; or, if he does, he may not do what you want. But he is by no means of such importance that it should be in his power to give you any disturbance.
(Epictetus, The Enchiridion)
Stoics visualise the loss of the things they hold dear. They make a point of contemplating death, material losses, homelessness, hunger, injury and illness, unemployment, grief – all the unfortunate things that might happen for them. And then they imagine how they might deal with them. There are several advantages to this:
Increased contentment with the things we have;
Increased awareness of the things we need to od to maintain and improve our circumstances;
Significant reduction in distress if the worst does happen because we’re prepared;
Clear direction to deal with misfortune if it does occur;
Freedom from anticipatory anxiety (worrying about what might happen).
Of course that doesn’t mean stoics need to go around reflecting upon miserable possibilities all the time. That wouldn’t do at all. But every so often, once or twice a week perhaps it’s a good idea to stop and think about what we have (health, possessions, abilities, relationships, status etc) and how it might be taken away. I promise you – make this a habit and you’ll enjoy life a great deal more. You’ll also be much more resourceful and better prepared to deal with tragedy.
In a different, less obviously philosophical context I talk to anxious, worried people about the ‘three stage plan’ for dealing with anxiety. I’ve used it for years with good effect. Once again it’s an idea stolen from the stoics. This is how I described it in one of my mental health Ebooks:
“We can also help people to plan, both should the worst happen and also how to prevent it. This becomes a fairly straightforward three-point process:
What’s the worst that could happen?
If it does happen how can you survive it?
Now we know you can survive the worst what can you (or we) do to make sure it doesn’t happen?
Whatever else we do we must be honest, rational and realistic. Only then can we understand whether or not the anxiety, the perception of threat is justified. If it is then we can begin to work on making the situation safe with all the facts that we need. If it isn’t justified (if it’s what Freud called inappropriate anxiety) then we can have the confidence to work on activities designed to help the person to face the thing they fear.”
(Stuart Sorensen – Mental health and social care p.20)
When we take gratitude, negative visualisation and awareness of the eternal now (see yesterday’s post) together we have a powerful blueprint for dealing with anxiety and enhancing enjoyment of life as a whole. But don’t just take my word for it. Give it a go and see what happens.
Dealing with anxiety – the 3 stage process
What’s the worst that could happen?
If it happened how would you/we cope with it?
How can you/we prevent it from happening?
“If you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment.”
Last night I had an interesting conversation with a stranger in the car park of my local supermarket. We’d exchanged a few pleasantries in the queue for the checkout – like me he refuses to use automated checkouts because, also like me, he’d much prefer that people keep their jobs.
We happened to have parked our cars next to each other on the way in and so the conversation continued in the car park, this time the subject was cars, driving and the rather nasty bump he’d had to the front of his vehicle. That conversation reminded me of today’s topic on anxiety.
Some time ago, one dark winter morning I found myself driving to work down unlit country roads in the rain. Visibility was poor and so I wasn’t going particularly fast which turned out to be a really good idea.
Also on the road on that dark, wet morning was a cyclist. A cyclist who was dressed in dark clothing with no lights and no helmet. To be honest I don’t even know how this guy might possibly have seen where he was going without lights – it really was that dark. However, presumably he could. I couldn’t see him though.
As I approached this invisible cyclist he pulled out into the middle of the road intending to turn right. You can guess what happened next. That’s why it’s such a good job I wasn’t going very fast. If I’d been driving at the legal speed limit instead of to the actual conditions I’d probably have killed him.
Fortunately, amazingly even he was OK apart from a few bruises. The ambulance came and took him to hospital where he was checked over. The police arrived and took my details, including my negative breath/alcohol test and I called in to work to explain that I wouldn’t be in that day. What happened next was revealing, especially about anxiety, phobias, avoidance and the ease with which normal freeze, flight or fight responses can become pathologies if we’re not careful.
My plan had been to return to work the following day. However within an hour or two of getting back to my accommodation I’d started to think. I actually believe that it would have been much easier to deal with the anxiety that followed if the accident had been my fault. If I’d done something wrong I could just decide to correct the flaw in my driving and make sure that nothing like this happened again. But that’s not what happened.
No matter how hard I tried I couldn’t think of any aspect of my driving that morning that I can change for the better. I hadn’t been drinking, I wasn’t going particularly fast, I was awake and alert, I was certainly concentrating due to the poor conditions, my car was in good condition and roadworthy and I was correctly positioned on the road. There was nothing I could think of to do that might prevent something like this happening again and if it does the next one might be fatal. That’s a really scary prospect.
It’s interesting that even though this is the first such accident I’ve had in over 30 years of driving all across UK, all that evidence of safe driving paled into insignificance against this one event. That’s because of a particular mental shortcut, an heuristic we know as the availability heuristic. I mentioned heuristics in an earlier video as part of my evolutionary psychology series. Click the link at the top of the screen for more information.
The availability heuristic is an evolved mental strategy that gives precedence to recent events. In a changing environment it’s useful – it allowed our ancestors to recall and give weight to the location of food, of predators and a whole host of other, changing environmental and behavioural artefacts. In the modern world it’s still extremely valuable but it has its drawbacks. One such drawback is the over-emphasis we give recent events. Here’s how it can turn useful anxiety into pathological disorders.
My emphasis on this single, recent memory caused me to work hard to find a way to avoid similar problems in the future. So far so good – we can all see the benefit of that. Unfortunately, the only thing I could come up with to avoid a repetition of this awful event is to stop driving. That’s rather less positive – especially in the light of the odds, bearing in mind my years, even decades of driving without hitting anyone, cyclist or not. But recent memories are the thing and that’s why I seriously considered not driving, giving up my job because I’d have no way to get to work without my car and I even spent time trying to rework my finances to allow me to retire early, all because I didn’t want to drive.
Now think about this. If I’d actually stopped driving that day what would my most recent driving memory be? Obviously it would be the traumatic memory of hitting, and initially thinking I’d seriously injured or even killed a cyclist. If that’s the result of the availability heuristic, the result of my most recent memory then my anxiety about driving will never dissipate. Not only that, the sense of fear I’d feel when contemplating driving, coupled with the relief I feel when deciding not to constantly reinforces the heuristic every time I think about getting back into the car.
Even though I know all this it took me three more days to pluck up the courage to drive my car again. I chose a quiet, sunny afternoon in broad daylight and drove around quiet country roads and literally had to force myself to turn the key and start the engine. That gave me a new memory but not enough to overcome the power of the traumatic heuristic. Powerful, traumatic memories take a lot of subsequent memories to take away the fear they generate. And the longer we avoid the issue the harder the trauma is to overcome. And that’s the point of this little video.
If you have an anxiety state that doesn’t seem rational, regardless of the emotion you feel, it’s important to ignore the emotion. Do this as soon as you can to build up new memories that can take advantage of the availability heuristic. That’s what people mean when they tell people to get back on the horse. Don’t let anxiety overcome rationality or you might find that your life choices become governed by fear to such an extent that avoidance shrinks your world, your opportunities and your options over time until there’s almost nothing left.
And it all begins when we give in to traumatic memories because of the availability heuristic.
In keeping with that tradition I posted a story about courageous ants from France whose bravery hormone was the basis of a new anxiolytic drug. I want to be clear this morning…
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In this video I discuss the evolutionary roots of anxiety, its purpose as a call to action and the way to manage it in the modern world. Beginning with broad principles of freeze, flight and fight we consider the role of the brain’s primitive limbic system (reprile brain) in anxiety, the Freudian concept of appropriate and inappropriate anxiety and ways to help people to overcome it. We consider the basics of relaxation, of anxiety management and the ‘3 stage test’ to help people regain perspective.
We consider reassurance and the folly of offering reassurances we can’t back up with facts – that just demonstrates us to be untrustworthy or ill-informed, causing the anxious person to reject our attempts to help them altogether.
Finally we consider the role of gradual desensitisation (exposure therapy) as opposed to ‘flooding’ in a quest to help people to build up positive memories of facing the thing they fear.
To arrange training for your staff please complete the contact form below…
If you enjoyed this tutorial please subscribe to my youtube channel. Lots more videos on mental health and social care to come. You can subscribe to the website and Facebook too. Just click on the left of the screen or scroll down if you’re viewing this via mobile.
This video tutorial outlines the stress and vulnerability model as a tool for mental health recovery. It’s intended for anyone with an interest in mental health and recovery as well as workers at all levels in mental health and social care.
We begin with an overview of the 3 main symptom groups of mental disorder before outlining the model itself and the progressive role of anxiety, depression and psychosis.
Next we consider categories of vulnerability and stressors before defining recovery and providing a brief overview of how it might be achieved.
Finally a collection of slides are included for download. Screenshot the images and save them in a word document to make handouts for reference.
To arrange training for your staff please complete the contact form below…
I often get to take student mental health nurses around in my day to day practice. It’s part of their training to spend time ‘in the field’ so to speak and learn their craft. We don’t just drag them around and let them watch what we do though. We try to help them understand what seems at first to be a very complicated world of diagnoses and disorders, mindsets and medications.
This short video is intended to reassure new students and others that mental disorders don’t need to be complicated. It’s true that we can (and often do) make the world of mental health as complex and convoluted as we like. But there are still some basic principles that can help guide us all through the maze.
This is how I explain the basics of diagnosis and disorder to those students unfortunate enough to cross my path. We should always begin with simple principles and then build upon those foundations. That way, when things start to get complicated there’s something straightforward to rely upon as we go.
To arrange training for your staff please complete the contact form below…
Mind The Care Training 