The problem with distraction
Mental health nurses are encouraged to rely heavily upon distraction to help people manage anxiety, depression or the emotional consequences of past trauma. That’s OK so far as it goes but unfortunately it really doesn’t go very far.
Making sense of mental health
Mental health work needn’t drive you up the wall!
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.
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!
We all have good days and bad days. That’s part of being human. We call it normal mood fluctuation. Sometimes we feel great. Other times… not so much.
It’s important to understand what this normal mood fluctuation is about. And what it’s not. Feeling fed up or ‘a bit sad’ is NOT a depressive illness. If your mood has been low for a few days, or even less because of a personal tragedy, or even without a tragedy, that’s not depression.
Depression lasts weeks and months.
Depression is an illness with physiological symptoms.
Depressed people have trouble with sleep… With appetite… With concentration… With movement… It’s much more than just a low mood.
So when you feel a bit sad don’t assume you need antidepressants and run off to the the doctor to get some. It’s OK to have good days and bad days That’s part of the human condition It’s part of being who we are.
And when you meet someone who really is depressed, understand that they’re experiencing something far more profound than being ‘a bit sad’. They’re not about to pull themselves together, howeer much you tell them to. If they could have done that they would have done so already.
Complete the contact form below to arrange training for your staff.
The cognitive or psychological symptoms of depression (what we think about) are just as important as the physiological ones. Some people believe that psychological symptoms are more important but this is not necessarily true. After all there is no such thing as the ‘mind/body split’.
Depressed people tend to think in a particular way. They tell themselves the same sort of gloomy, pessimistic things over and over again. This is what psychologists call negative thinking. After a while this pattern of thinking becomes a habit. When that happens it is described as automatic negative thinking. This habit formation is one of the most damaging aspects of depression as it locks the sufferer into a downward spiral which drags them deeper and deeper into despair.
General thinking errors
There are three ‘general’ thinking errors that are important to understand not only for depression but many forms of mental ill health. The three ‘general thinking errors’ are…
Ignoring the positive
People seem much more likely to focus upon bad things that happen to them than they are upon the good.
Exaggerating the negative
Having focussed upon bad stuff many people then seem to blow it out of all proportion until it overwhelms them.
Overgeneralisation
One swallow doesn’t make a summer. One difficult conversation doesn’t mean it’s going to be one of those days and a couple of frustrations this week don’t mean you’ll never succeed at anything.
Let’s look at some more precise forms of depressed thinking.
Things will never get any better
If we believe this then we also believe that there’s no point in trying to improve things. This one thought stops depressed people from joining in with their treatment plans. These people become lethargic and apathetic. Not the most helpful start to recovery.
People would be better off without me
It’s not difficult to see where this thought pattern is leading. Many depressed people are so convinced of their own worthlessness that they come to see themselves as nothing more than a burden to others. This idea can lead to withdrawal, social isolation, shame and even self-harm or suicide. Once again this is not a helpful way to think about oneself.
I can’t help being depressed after what I’ve been through
This is a remarkably common depressive thought. It also seems quite reasonable at first glance. People who’ve been through difficult times are almost expected to become depressed. The problem is that such a belief system takes away the individual’s choices. If you believe depression is inevitable you won’t really struggle against it and so you won’t change it until you believe you’ve suffered enough. It’s often interesting to ask people how much suffering will be enough.
Some people ‘wear’ their depression like a badge. It’s as though they think they’ve earned it and no one’s going to take it away from them. Of course it’s true that they have a perfect right to feel as depressed as they like for as long as they like. The question is – why would they want to?
Depression runs in my family – it’s genetic
This attitude is called determinism. That’s the idea that people are helpless victims of fate. They believe that because their parents suffered from depression they also must. Of course it’s true that depressive illness does often run in families but that’s not always because of genetics. Sometimes it’s simply because of the coping skills we learn from our parents. Skills which can be unlearned or altered – often with surprisingly little effort. Even those people whose depression does appear to be genetic can be helped considerably once they let go of their deterministic attitudes. Any thought that implies helplessness is deterministic and extremely damaging.
What can depressed people do to help themselves?
Become an ‘inverse paranoid’. Expect good things to happen every day. This doesn’t necessarily mean the world will treat anyone better – but it does mean that people notice good things when they do happen and won’t waste time ruminating about or getting paranoid over the little inconveniences that happen to us all.
The simple truth is that if depressed people wait around for someone else to make things better for them it just won’t happen. However since one of the symptoms of depression is lack of motivation the big danger is that they will do just that. Your job as support worker is to motivate service users to take responsibility for their mood and circumstances while still giving assistance as needed.
This can be a difficult balance to strike. The general rule of thumb is to intervene less and less over time as the service user is encouraged to do more and more for themselves. But be careful. This isn’t an excuse to abandon people who really need our help – simply an awareness that they need to work toward greater independence as time goes on.
To arrange training for your staff please complete the contact form below…
If anxiety is a call to action that is there to help us solve a problem (how to be safe) depression is the opposite. Depression is a form of physiological de-arousal. This is about giving up. Very broadly speaking depressed people are no longer interested in finding a solution. They have decided that there is nothing to be done and so they give up. Of course there are degrees of this ‘giving up’ and it’s not really as ‘cut and dry’ as all that but none the less depression does have an element of giving up about it. That’s not to suggest that it’s a voluntary ‘submission’ to depression but it is fair to say that depressed people are generally less determined to sort out their problems than anxious people are.
This may seem strange but it actually links very well to the stress and vulnerability model we mentioned in an earlier episode. As people’s stress levels increase they become anxious and try to solve their problems. However if they are unable to solve their problems and the stress increases they give up trying to sort things out and so their anxiety (a call to action) subsides. At this point they move up the scale of mental disorder into depression.
Biological (physical) signs of depression include sleep disturbance (too much or too little), appetite disturbance, apathy and lethargy, tearfulness, slowing down of physical movement and passivity (the opposite of assertiveness).
The service user who never seems to cause any problems or demand anything from the staff might not be content – they are just as likely to be depressed. Be aware of the risk of suicide. According to the Beck Suicide Scale (BSS) the best indicators of impending suicide apart from past behaviour are ‘helplessness’ and ‘hopelessness’. Both of these things are features of depression.
Clinical depression is different from sadness. We all have bad days and the occasional low mood is just part and parcel of normal mood variation. Clinical depression includes the biological symptoms mentioned earlier and is thought to result from a reduction in the levels of various brain chemicals such as serotonin. However, as we noted in a previous episode on physiology there is a ‘chicken and egg’ situation here. Low serotonin levels can cause depression but inactivity (a major symptom of depression) also reduces serotonin levels still further. It’s not always terribly important to worry whether the depression came first or the inactivity was the cause. As is often the case dealing with current problems may well be far more important than trying to understand the history of the disorder. Sometimes ‘here and now’ is all we need to work on – at least in the beginning.
For example ensure that people’s current behaviour doesn’t undermine recovery. Many people turn to alcohol when they’re down but that simply makes things worse. Alcohol depletes serotonin levels which not only deepens depression it also prevents anti-depressant medication from working properly.
However as the depression begins to lift that sort of historical information can be extremely useful – but only if we know how to use it and what to do with it. That’s where diagnosis falls down – it’s only really interested in current symptoms. Formulation is more comprehensive and takes account of the many factors that led people into depression as well as the aspects of their thoughts and behaviours that kept them there. If diagnosis helps us to know what the problem is, formulation helps us to ensure people overcome it and then have at least a fighting chance of avoiding relapse in the future.
All that fancy stuff aside (we’ll get to it later) the basic trick with depression is positive action. Get people active again and give them a reason to continue to take an interest. This is more than mere distraction – it involves purpose. Clearly purpose can be difficult to achieve with some people but it’s worth working at none the less. Purpose and security also make it much less likely that people will present with challenging behaviours too. They have no reason to so long as their needs are being met.
There is, of course, much more to depression than we’ve covered in this little introduction. In particular we need to consider the specific thoughts and behaviours that both create and maintain the disorder. We’ll get to those as the series progresses. For now it’s enough to describe in broad terms what depression is. How it is assessed and what we do about it will come later.
To arrange training for your staff please complete the contact form below…
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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 