Controlling your actions

If you want to catch up you can find the pre-session, week one, week two and week three posts in the links

Anakin Skywalker is out, Peep Show is back!  This week at StressControl was focused on being able to control our actions and understand how the things we'd covered in previous weeks (effects on our body and controlling our mind) link together.  

Before we started, we re-did the wellbeing questionnaire from week one.  I think I'd slightly improved more scores but only by one point each.  Interestingly I still scored higher for low mood than for stress/anxiety so there's something to think about in that!

We had the trusty Theory - Coffee - Practice triumvirate to guide us through the session.  I scribbled quite a lot down this time, rather than solely relying on the printed materials as my reference for afterwards.

Theory

As with last week, the most simplistic thing to understand is that if stress can affect our actions, then being able to exercise control over our actions gives us an element of control over stress.  This is true for our thoughts and for the physical effects of stress too.

Firstly, some of the common ways we act when we're stressed.  I suspect these are familiar to many of us at some point, but note this is by no means an exhaustive list:

• Argue
• Bite your mails
• Withdraw
• Anger outbursts
• Cry
• Take longer to do [certain] things
• Go quiet

The bold ones are certainly some that I identify with, although I'm not sure whether being a serial nail biter since I was about nine years old means I've got 30 years of stress to control... It also serves as a reminder that while we feel the physical and mental manifestations of stress ourselves, there can often be consequences for those closest to us.

One of the other key things we talked about was the idea of Avoidance and the short vs long-term trade offs that can have for us.  It's fairly logical and sensible once you hear it, but I definitely needed it spelling out to be conscious of it.

It goes like this:

If there's a particular situation or task that you know will cause you anxiety, your natural reaction is to avoid it.  In the short term that's great because it's reduced your anxiety.  The issue is that in the long term, it'll undermine your self-confidence and mean dealing with the stress or anxiety is increasingly hard.

The first part of that might be pretty obvious, but avoidance is telling ourselves we can't cope with a situation and so we withdraw and identify threats we wouldn't otherwise have considered.  

Going back to session one and the key principle of facing our fears we see the opposite.  Facing up to something rather than avoiding it is likely to be worse for our anxiety in the short-term, but it's building up our confidence to deal with stress in the long-term, which will have a positive impact on both self-confidence and self-esteem.

Practice

"So how do we do that?!" I hear you cry?  It's grounded in the idea of 'testing reality' and then engaging our rational/conscious voice (from session three) to do some problem solving.

Reality testing is really asking ourselves to consider two outcomes:

1. What's the consequence if the thing we're worried about happens?
2. What's the consequence if something else happens?

Remember the Big 5 Challenges?  We can use those to help answer the first question by being more conscious of our rational voice instead of our stress voice.

So then we problem solve:

• What problem do we want to solve?
• Figure out something that's well defined that would make us feel less stressed or anxious
• What will happen when I face my fear?
• Use the skills from controlling our thoughts to make our rational voice the dominant one
• Brainstorm
• What are the different courses of action I could take here?
• Choose the best option(s)
• Simple pros and cons of our options, and some honesty about whether we think these will bring us immediate success/change or whether we may need to refine them
• Work out a plan
• When will we take these actions?  Will it be more than one our our options?  Do we need to use some other skills/techniques (such as relaxation, breathing?)
• Put it into action
• Do what we've decided to do
• Review
• Did it go how we expected?  Will we do this again?  Do we need a more gradual approach?  Do we need to try something different?

When you read most (if not all) of this, it seems to be fairly common sense, and I think that's really important.  It's not a set of complex behaviours or tools that anyone needs to learn, but it's about being able to take a step back, try and disentangle ourselves from the immediacy of our situation and approach things differently.

There are some helpful handouts in the workbook to go through some situations in detail.  As I said last week, I think the difficulty for me lies in isolating some of these things in the first place.  But it's also not designed to be a quick fix, and most of the work will come after the course finishes.

I feel like I've started to put some of this into practice, particularly around my weekly train travel, but I also know that last week I jumped straight to a set of stress-induced thoughts and behaviours in a different situation, so I've still got work to do.

Session Five is looking at panic and improving sleep.  I only really experience panic in very specific situations so hopefully that'll be some easily translated learning.  I do a lot already to try and improve my sleep, so hopefully there'll be some things I can finesse there too.

If you made it this far, thanks and I hope it was of some use.

Diabetes UK are running a hugely important campaign about improving the provision of and access to a variety of emotional support services. People with diabetes are twice as likely to suffer from burnout or difficulties with their own mental health compared to those without the condition. Some estimates suggest that one in ten people with diabetes are clinically depressed. You can read more about the vital It's Missing campaign by following the link. My story is just my story. If you need to talk to someone about how diabetes is making you feel, you can ring the Diabetes UK Helpline on 0345 123 2399 or you can ring Samaritans 24 hours a day on 116 123

The Mind

If you want to catch up you can find the pre-session, week one and week two posts in the links

No Peep Show quote this week, but hopefully you'll see how this one ties in as we go.

I'm writing this one on the train to London having popped a few pills to try and take the edge of the symptoms of a tension headache that somehow seems to have gotten worse overnight.  The symptoms for me are what I imagine it feels like having a kitchen knife stuck in your temple, with the added discomfort of that sensation coming right down your neck too.  Happy Wednesday!

Week three of StressControl is focused on the mind - specifically controlling your thoughts.  They'd mentioned last week that this session was one that many people find helpful, and I think that was generally the case for me, though it left me with a few unanswered questions I probably need to focus on.  Something I neglected to mention last week was the brief discussion of General Anxiety Disorder - a condition that causes people to feel anxious about a wide range of situations and issues rather than one specific thing.  I bring this up now as it may also be relevant later...

Theory

As ever, the afternoon was split into theory and practice, but with a greater focus on practice this week.  We talked about about worry and rumination and that worry is a preoccupation with the future ("what if...?") and rumination is a preoccupation with the past ("if only...").  I think the former is more like me generally speaking, but I know I've over-analysed every word I've said to people in certain situations in the past so definitely a lot for me this week.

My main takeaway from the theory was that stress can affect how we think, which in turn can cause more stress or anxiety creating a fairly viscious circle.  The flip side of this is that if you can identify some of those thoughts and control them, you can control or limit how stress impacts you.  I think that's a fairly common theme (and where this week's image comes into play) - it's not about eliminating stress or anxiety, but being able to reduce, manage and mitiage some the impacts it has.  Rather than dealing in the absolutes of being totally stressed or completely stress free, it's learning to find the comfortable zone in the middle of a fairly vast spectrum.

The other part of the theory that I really identified with was this idea of a grasshopper as an illustration of how thoughts can escalate quickly (i.e. grasshoppers jump quickly from place to place, and we can do that in our own minds too).  An example is to consider someone who doesn't like public speaking.  Being in that situation gives them some of the physical symptoms (see session two), but also means that this impacts their thoughts.  Catching someone yawning while they're presenting could mean a thought pattern along the lines of:
- that person's bored
- everyone's bored
- I'm boring
- I'm no good at this
- I'm useless

Of course there could be a dozen reasons why someone is yawning, such as being tired or too warm, but the mental impact of the stress is to jump to that final conclusion of being useless really quickly.   Side note - I was yawning while they talked through this bit because the room was really warm and I felt very self conscious about it.

I definitely related to that a lot - it felt very real for some situations I find (or put myself) in.  I think what I still find amazing is that this genuinely isn't how everyone approaches things.  I was talking to my wife about how this kind of stuff manifests itself when I travel for work (train is delayed, I'll miss my connection, I won't get a seat, I'll be late, I'll look disorganised and unprofessional, people will think I don't care) and she shrugged and said "I just think I'll get the next train and it'll be fine".

Practice

So the practice was broken down into a three different aspects, but I'll focus on the first two here.  The first was basically a mini mantra - Stand back, remove the blinkers, wait a minute.  The premise is really to not immediately react and have your thoughts escalate, tell yourself to focus on the potential wider factors and take a moment before reacting.  So in the above example, just beause someone is yawning doesn't mean you're useless, peeling back the blinkers means you give yourself time to see the wider possibilities like somone being tired or being in a warm room.  This is 'laying the foundation' for some of the other tools.

Again, it's not about absolutes and removing the anxiety completely, but more focused on the idea of giving the conscious/rational voice the chance to dominate the stress voice in your head.

The other main tool we went through is called the Big 5 Challenges and is a set of questions or challenges to put to ourselves when we start to encounter stressful thoughts to try and give the conscious voice a chance to dominate the stress voice.  

The Big 5 Challenges (with a short example) are:

- What's the worst thing...?   If this thing I'm worrying about does happen - what's the actual worst outcome I could encounter, and is this the same as I'm actually worrying about right now?

- What are the chances...?   I might be worrying about something happening, but how likely is it?  Have I been in this situation before and my worry has been for nothing

- What is this worth....?   Am I spending time worrying about something that is fairly trivial?  Is life too short to be giving up time to this situation?

- Weighing the evidence (The Court Case)   I might be worrying about something, but am I missing some evidence?  I'm worried I look silly but everyone's just getting on with things around me so maybe I'm wrong

- The five year rule   If I look back on this moment in five years (or five months or five weeks) will it really matter?  Am I putting too much emphasis on this now when it doesn't matter?

It's not about using all of these for every situation, but about understanding that one or more of them will be appropriate for a particular situation.   This is definitely helpful for me, and looking at them, I know I've done a couple of these more recently, so it's good to know I'm on the right track.

What's clear is that all of this takes time and it's definitely a longer journey to carry on after the course finishes.  I think that'll be the challenge, because with diabetes it's always a physical thing to understand and treat, whereas with stress, worry and anxiety it's sometimes harder to pin down.

So let's try and tie this together with a rough kind of bow on top.  I talked about unanswered questions at the start, alongside the familiar sharp pain of a tension headache, and I think this is where the difficulty lies.  I understand that the headache is a physical symptom of something and so I can use some of the breathing/relaxation techniques (alongside codeine and paracetamol), but I'm not really sure what's driving that physical symptom - I can't pinpoint a specific thought or feeling that's making me feel particularly anxious, yet here we are.  I'm definitely not diagnosing myself with General Anxiety Disorder, but I think the hard work is going to be in trying to isolate some of these things that might be in my subconscious.

Next week is about controlling our actions.  It's been a long post this week, so give yourself a pat on the back if you made it this far - we should all be doing that for ourselves more often.

Diabetes UK are running a hugely important campaign about improving the provision of and access to a variety of emotional support services. People with diabetes are twice as likely to suffer from burnout or difficulties with their own mental health compared to those without the condition. Some estimates suggest that one in ten people with diabetes are clinically depressed. You can read more about the vital It's Missing campaign by following the link. My story is just my story. If you need to talk to someone about how diabetes is making you feel, you can ring the Diabetes UK Helpline on 0345 123 2399 or you can ring Samaritans 24 hours a day on 116 123

The Body

If you're behind, you can read part 1 and part 2 via the links

I've already slipped into a routine of sorts and this is only my second of six visits into Sheffield for StressControl.  There were fewer of us this week (15 down from 20).  Not sure if the rain had put a few people off, or a few had decided after week 1 that it wasn't for them.  One person left after about 10 minutes so I guess we're a smaller group now.  Part of me is desperate to know how standard that is, but the majority of me is focusing on the course.

So this week was about controlling your body.  Next week is about controlling your feelings, followed by controlling your actions in week four.  These are basically the main principles of the Mind, Body, Life model that we keep referring back to.

Theory

The theory half of the session talked a lot about Fight, Flight and Freeze and how we have muscular symptoms of stress/anxiety (such as muscle aches, headaches and shaking) and autonomic symptoms (such as palpitations, sweating and feeling sick).

We also talked about some of the symptoms of depression, which didn't particularly make for brilliant reading when I'd mentally ticked off 11 of the 17...  It was compounded by the fact that the chairs at our meeting place are particularly uncomfortable and so I felt a bit trapped in this cycle of fidgeting and aching whilst reading about the fact that agitation and aches/pains are things to watch for.  The premise of the whole thing was that if you're more conscious of the symptoms, you can apply some of the techniques to try and mitigate some of the effects.

I'll be honest in that I felt like I knew most of the theory already, and some of the exercise from the first week's 'homework' had meant I'd been more explicit with myself about how some of those things were affecting me.  I'm focusing on the positives from each session and so I guess it was good I'm pretty conscious about the effects of anxiety.

Practice

After a quick coffee break, we briefly covered exercise and caffeine.  I'd spotted last week that the good name of coffee may be slightly besmirched and that was kind of the case.  Basically, lots of caffeine can mimic some anxiety symptoms and doesn't help.  Conversely, being more active can have a positive impact on mood and anxiety.

I gave up caffeine entirely about 10 years ago, but as I've had earlier mornings when travelling for work, some has reasonably crept back in over the last few years.  I still mostly drink decaff and I've resolved to only have proper coffee when I'm up before 6am.  I'm also trying to get back into some form of exercise, having basically become a potato since London Marathon in April.  It's one of my short term goals through the course to do 3x20 mins a week at a minimum, and not beat myself up if that's all I manage.

After that we covered some breathing and muscle relaxation exercises.  It can make you feel pretty vulnerable to be doing this in a room with 15 or so strangers, but I committed to it and even after about 90 seconds I could feel something different.  There are audio tracks we can download to aid us, but I'm been using similar things on my phone on and off, so I've resolved to persevere with those for now.

What's next

There weren't a lot of brand new takeaway bits for me this week, but I think that's OK.  Sometimes the time to just focus on some things you already knew can be equally as valuable.  I was surprised at how relaxed I actually felt for just a couple of minutes of breathing/muscle relaxation exercises so I'm definitely committing to more of that over this week.  And I'm on track with my exercise target as well.

Next week is around thoughts, and the sense I get is that it's one of the most valuable weeks of the course.  I'll report back.  Thanks for reading.

Diabetes UK are running a hugely important campaign about improving the provision of and access to a variety of emotional support services. People with diabetes are twice as likely to suffer from burnout or difficulties with their own mental health compared to those without the condition. Some estimates suggest that one in ten people with diabetes are clinically depressed. You can read more about the vital It's Missing campaign by following the link. My story is just my story. If you need to talk to someone about how diabetes is making you feel, you can ring the Diabetes UK Helpline on 0345 123 2399 or you can ring Samaritans 24 hours a day on 116 123

One Two Three Four

I'm not sure how long I can keep illustrating these with Peep Show images, but we'll cross that bridge when we get to it eh?  If you missed the first part of this mini-series (of sorts) then feel free to catch up

So yesterday was week one of six on the StressControl course (it's written like that on purpose - it's a course used worldwide so it's more of a trademark than anything else).  If everyone's stress and anxiety manifested itself in the same way as mine, and they'd all have gotten there 20 minutes early and we'd have been done and dusted in plenty of time.  But as they quite reasonably pointed out, we're all people and we're all different. And so a few people turned up 20 minutes late.

I wasn't sure what to expect, so gave myself a small tick for having confidently walked in the door.

There should have been 35 people booked on this six week course.  Twenty people turned up, and four of those were people who'd come along to provide moral support to someone attending the course.  I wasn't the youngest person there, but even at 38 I was one of the younger few which surprised me a little.  It was reassuring that I wasn't the only one who needs this kind of support, and important (like it is for diabetes) to remember that my perspective isn't the only perspective.  I think in this world of politics, health and everything else, we forget the huge spectrum of grey that sits between black and white.   That being said, there was some encouragement to be a little selfish (or to use their wording, 'think more about what's important to you and how you feel').

The sessions are very classroom oriented - two facilitators each stood delivering half the content each from the front, with nobody else saying anything (apart from in the brief coffee break).  I'd expected that - it had been made clear when signing up (and reiterated at the start) that this wasn't any kind of group intervention and nobody would be sharing personal experiences.  It was still odd to sit in silence and just listen and temper that desire to fidget, write or check my phone (all general signs of some anxiety if you're interested).

The sessions themselves are broadly broken into two sections - Information and Coping Skills.  Session was is a little different as it has a lot more of the introductory elements, but I'm expecting from next week we'll have around 40 minutes 'theory' time for a cuppa and then 40 minutes learning different practical skills or techniques.

There's 'homework' though it's all optional and is referred to as 'things to look at in between sessions'.  I've not got into it yet, but from just listening (and having a quick skim through the handbook) it was reassuring to know I have a couple of the techniques in the bank already.  A word on the handbook... it's about 170 bound A4 pages so it's very hefty.

It's supposed to be your go-to set of info both during and after the course and it was refreshing to see that whilst the info covered on the slides is replicated to some extent, there's more context and space for you to think about your own circumstances in there too.

There were two main messages that were reiterated a few times.  One is that the course is really about providing you the tools to 'be your own therapist'.  I completely get the idea and in principle I think it should work well.  Having Type 1 is really about being your own doctor (to some extent) and so in the same way that DAFNE provided skills for that, I'm hoping IAPT will provide skills for this.  My only reservation is about how easy it'll be to manage myself out of these sorts of situations.  But I'm not prejudging it and we'll see how we go.

The other message was 'StressControl in nine words'.  If we remember nothing else, it should be this - which is great except I keep forgetting the middle three:

Face your fears - this isn't about holding spiders on your hand or going bungee jumping - it's more about acknowledging the things that can cause you stress or anxiety and being able to face up to them and use the coping skills to overcome them

Be more active - does what it says on the tin really, and acknowledges that stress and anxiety can cause you to withdraw from being active, which has a compounding effect as being active can help reduce feelings of stress 

Boost your wellbeing - understand the whole picture about yourself, thinking about how your body, thoughts, actions and sleep all interlink to impact your wellbeing

So I think that about sums up the first session.  The title of this post refers to the first four steps (of 10) that we covered in some manner yesterday,  There's a lot of additional thinking and reading to do to be fully up to speed.  I might do a shorter post in the interim that sets out how some of that looks for me (time allowing) and report back on session two next week.


Diabetes UK are running a hugely important campaign about improving the provision of and access to a variety of emotional support services. People with diabetes are twice as likely to suffer from burnout or difficulties with their own mental health compared to those without the condition. Some estimates suggest that one in ten people with diabetes are clinically depressed. You can read more about the vital It's Missing campaign by following the link. My story is just my story. If you need to talk to someone about how diabetes is making you feel, you can ring the Diabetes UK Helpline on 0345 123 2399 or you can ring Samaritans 24 hours a day on 116 123