Controlling Your Future

If you want to catch up you can find the pre-session, week one ("What is Stress?"), week two ("Controlling Your Body"), week three ("Controlling Your Mind"), week four ("Controlling Your Thoughts") and week five ("Panic and Sleeping Well") posts in the links

And so StressControl comes to an end.  The title is from one of the slides in this session, but there was an open understanding that it's something easier said than done.  We followed a broadly similar approach as previous weeks, this time looking at our personal wellbeing and then covering a quick summary of the previous five weeks.  I'm going to talk a bit about wellbeing here as well as covering some of the things I've noticed or that have changed since I started, as well as what some next steps might be.

Wellbeing

In week one, we covered the idea that stress is a continuum with high levels of stress at one end, and low levels at the other.  This is a distinction worth making because it's not the goal to eradicate stress entirely, but to try and put ourselves towards the lower end of this particular spectrum.  If we think about stress as this horizontal line, wellbeing can be thought of as a similar, vertical continuum with poor wellbeing at the bottom and good wellbeing at the top.

The World Health Organisation talks about these two extremes as 'languishing' and 'flourishing' and of course, the idea is to move ourselves towards the flourishing end more often than not, whilst also increasing our ability to manage our stress.  As with anything worth knowing, overlaying these two concepts gives you a handy 2x2 matrix:

Recreated on my phone so more simplistic than it should be, but you get the idea...

Obviously we want to be in the top left as often as possible and in the bottom right as scarcely as possible, and because we're people, we'll often move around all four of these.  Some high level stats suggest that for every 10 people, three are langishing, five are middling and two are flourising and the tools we have at our disposal are aimed at keeping us away from the languishing end of the spectrum as often as possible.

We talked about what sort of things you could do to try and improve your own wellbeing, and with my work hat on for the briefest of moments, I was pleased to see that volunteering your time was something that was encouraged.  Being able to contribute to the wider world around us increases our own personal wellbeing too.  Listening to music, being more physically active, getting more fresh air and practicing mindfulness were all suggested too.  Learning something new or picking up an old hobby came up too and the idea is that our brains value the sense of accomplishment that comes with learning or completing something.

Mindfulness is something we hear more and more of but it was interesting to hear the definition they gave, which was really about focusing on the moment we're in without letting ourselves worry about the future or brood about the past.  It sounds fairly simple when you hear it like that, but trying to let your mind focus purely on what our sense are experiencing right here and right now can be hard.  I think autumn is a good time to try more of that as the leaves change colour, the air gets a little cooler and the familiar scent of fireworks starts to fill the air.  It's definitely something that needs practice, but along with some of the breathing exercises we covered, I think it can be really helpful.

We also talked about the fact that we almost certainly talk to ourselves much more harshly than we would do to anyone else who may be going through something similar. We're often our own worst critic, telling ourselves that something should be easy to do, or that worrying or feeling down is something we can just snap out of, when we'd take a kinder and more gentle approach to friends or family or came to use with the same feelings.  I think we all probably recognise that, and it's useful to think about what our compassionate self would say to our stressed self.

The final thing we covered was something I've heard of before but am yet to try and it's the idea of finding three things to be grateful or thankful for each day.  I suppose the idea behind it is that we're allowing ourselves to think about the positive things we've experienced rather than having that feeling that there's nothing good going on.  I'll see where I get to...

We finished the course with a quick tour back through the other five sessions but I won't repeat those here - links at the top of this post if you want to check out anything particular

What's changed?

So what have the last six weeks meant practically?  Well six weeks isn't really a long time so some of the changes or differences are in their infancy and as they said, it's almost like the hard work starts now when putting these things into practice every day away from the course.

I'll start with the positives:

• I've definitely used my rational voice more when I'm approaching known stressful situations (e.g. travelling).  I now need to think about being able to have that midset when more unexpected areas of stress arise.
• I've cut out more caffeine later in the day.  This is pretty difficult sometimes as my work schedule can be a little unpredictable but overall it's an improvement.
• I've followed some of the progressive muscle relaxation and breathing techniques fairly regularly and I think the breathing in particular has been really helpful.
• I've started blogging again - admittedly only about this course, but it's got me back into something I enjoy when I feel like there's something worth writing down
• I've started listening to a bit more music and watching a little less Netflix.  Music has been a longstanding passion of mine but it had become a smaller part of my day and redressing that has been good
• I've done more to cut out eating/snacking to try and cope with feeling tired or stressed.  Early days but it's a step in the right direction
• I've gradually started doing a little more exercise.  It's not quite as regular or frequent as I'd like, but definitely feels like a positive step
• I've only had one tension headache in about two months - that's definitely worth celebrating!

And a couple of things that aren't as good:

• I'm a lot more conscious that sometimes I just find myself clenching my jaw and I'm not sure how often it's been going on, but it needs to be very deliberate recognition of it before I stop
• I'm a lot more conscious of a pain or ache in my neck.  I can't work out if it means my pillow isn't quite right, or whether it's just holding tension in that part of my body
• I'm equally more conscious of the pain I get in my hip/leg that came before, during and after the London Marathon in April so I think I need to dig out the foam roller again for that
• I still feel knackered all the time

So what next?

We did a wellbeing questionnaire in weeks one, four and six and whilst my score in the stress half of it decreased (10 to 9 to 8), the low mood half remained fairly static (14 to 13 to 14) and I guess that's something to think about.  A lot of the symptoms associated with stress also correlate to the idea of low mood and whilst that might make the stress part of the diagram more manageable, it means you end up being fairly static on the wellbeing axis.

One of the facilitators suggested I ring up the IAPT wellbeing number and book in for some one-to-one discussion about disentangling the stress and anxiety from the low mood.  That feels like a pretty big step.  Part of me thinks that it should be easier having done this course - remember it took six months for me to ring up to book onto this in the first place.  Having taken the first couple of steps it should be easier to take the next few.  But it also feels hard to put yourself in a vulnerable place to talk about something you probably don't really understand yourself.

I'm going to keep plugging away with the techniques we learned on the course, and keep reinforcing the positive things I've started as best I can.  Progress isn't perfectly linear in things like this and it's OK to have the occasional step backwards as long as you're taking a couple forward too.  And I'm probably going to make that call...

If you made it this far (both on this post and throughout the course) then I hope it's been helpful in some way.  Everyone's experiences and circumstances are different so use what you can and discard the rest.  Hopefully I'll keep coming back to the keyboard more often than not - the focus can be quite cathartic sometimes.

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

Panic and Sleep

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

Welcome to week five - dealing with panic and getting a better night's sleep.  Instead of covering these with the usual 'theory/practice' approach, I'm going to talk about them as two separate topics as that's really how we went through them in the session.  We were down to 10 (plus three people observing) yesterday which is a far cry from our 20 we started with, and I was a little surprised as I'd expected sleep to be a big draw.  One of the facilitators actually said that many people book onto StressControl explicitly for the sleep info as it's something that a lot of people want to know more about.  But first - panic:

Panic

We talked about what panic is and how those extreme feelings linked to fight or flight can, in some circumstances make us feel like we're dying.  A lot of the symptoms of panic are (unsurpisingly) similar to those of stress or anxiety - sweating, dizziness, heart palpatations, clammy hands, shortness of breath etc... Some regular readers may also notice that these are also symptoms some people experience when having a hypo (happy Hypo Awareness Week by the way...) so understanding the cause is really important.

We also talked about panic can be a response to a particular situation (confined spaces and having bloods taken from my arm), or can also be 'out of the blue' panic.  If you've never had a panic attack, it's not something I'd recommend.

In terms of management, a lot of techniques we've covered over the last few weeks came in to play.  Focusing on breathing is key as it helps us regulate our internal biology. We talked quite a bit about hyperventilating and how this adds to feelings of panic as you're upsetting the oxygen/carbon dioxide balance whichcan fuel some of the symptoms.  It's not something I have a lot of personal experience with though.

Aside from breathing, remembering to engage our rational voice helps - you might feel like you're going to faint, but if you never have, is that a likely outcome or is the fear fuelling the problem?  We didn't cover avoidance in relation to panic so based on my own experience, I can tell you I actively do avoid situations that involve confined spaces where I can.  I can't avoid blood taking though so it was reassuring that my own personal brand of coping (deep breaths, play some music, focus on something else) is largely in line with proper advice.  I think it's helpful to add in the rational thinking bit too though (although I very nearly did genuinely faint once...)

Sleep

It did feel like sleep was the thing with the biggest build up, so it may be disappointing to here how it was nearly all grounded in the most mundane, common sense approach imaginable.  As with most things throughout the course, it's reassuring that there's nothing too complicated to learn that's brand new, but also makes you wonder why you can't always see the easy common sense stuff for yourself.

We covered difficulty getting to sleep as well as difficulty staying asleep - I guess the difference between quantity and quality of sleep.  Very few silver bullets here, but some of the things worth remembering are:

1. Avoid caffeine before bed (and bear in mind it can stay in your system for up to eight hours)
2. Reduce hot drinks closer to bed time (although the benefits of an Ovaltine are the exception there)
3. Alcohol might help you get to sleep but it can affect the quality of your sleep and you shouldn't end up being dependent on it
4. Eating a big meal before bed means your body will be digesting if after you've gone to sleep which again can affect the quality of sleep you get
5. Cool (but not cold) temperature is best - around 18 degrees.  I felt particularly vindicated by this point as I'm a fan of sleeping with the window open
6. Reduce noise and light where you can (ear plugs, blackout blinds) but playing white noise can reduce the affects of environmental noise
7. Reduce screen time before bed (even where there are blue light filters)
8. Keep your bedroom for sleeping and not working, emails etc

We also covered how even small changes can have an impact so if you're struggling with sleep then some of these may be for you.

I think what I found frustrating here was the X factor that diabetes can chuck into the mix.  I didn't have a decaf coffee after about 5pm yesterday, cooled the spare room (early start means I get the spare room) and had ambient noise that I know helps me get to sleep.  And then I had a hypo at 2am and was up for about 40 mins before getting up at 4:40am...  

I guess you can only control what you can control, but the impact that diabetes can have on sleep is catastrophic sometimes.  I also know that weeks like this where I'll be sleeping in four different beds in seven days means I'll struggle.

So we're nearly at the end - next week is the final week of the course where we'll link all these bits together in an attempt to have a more concrete plan about improving our wellbeing and thinking about how we continue the work after the course has finished.  All the hard work is still to come I think as it's the ability to stay focused on these techniques away from a weekly structure.

Hopefully this has been helpful - see you 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

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