Mental Health Tool-kit

MENTAL HEALTH AND WELLNESS RESOURCE BOOKLET

CONTENT WELCOME TO ANGLIA RUSKIN UNIVERSITY ..............................................................05 WHAT IS COUNSELLING AND HOW DOES IT WORK? ...........................................06 MEN AND COUNSELLING .......................................................................................................09 WHAT TO DO IF YOU’RE FEELING ALONE..................................................................... 10 THINK YOU COULD BE SUFFERING FROM STRESS?..............................................15 HOW TO COPE WITH AND REDUCE STRESS...............................................................19 PUBLIC SPEAKING ANXIETY...................................................................................................25 A SHORT GUIDE ON GIVING PRESENTATIONS.........................................................30 WORRIED ABOUT EXAMS?......................................................................................................35 WHAT TO DO IF YOU ARE ALWAYS DISTRACTED.....................................................39 SOME PRACTICAL WAYS TO ORGANISE YOUR TIME.............................................41 AM I DEPRESSED – OR IS IT SOMETHING ELSE?.......................................................55 HOW TO COPE AFTER EXPERIENCING TRAUMA......................................................61 POST-TRAUMATIC STRESS; WHAT IT IS AND HOW TO COPE............................63 DEALING WITH GRIEF................................................................................................................69 EATING DISORDERS....................................................................................................................76 WORRIED ABOUT A FRIEND?...............................................................................................80 CONFLICT MANAGEMENT......................................................................................................85 KEEPING CALM UNDER PRESSURE...................................................................................86 HOW TO BE ASSERTIVE.............................................................................................................87 RELATIONSHIPS.............................................................................................................................96

WELCOME TO ANGLIA RUSKIN UNIVERSITY We hope you’re looking forward to your course here.

Whether this is your first time away from home or you’re going back to studying after a break, starting university can be a time of great change. And change, even if it’s exciting, is not always easy to cope with.

The first few days can be quite bewildering - so many meetings, things to do, finding your way around the campus, a sea of new faces. It’s not at all unusual or surprising to feel lost or lonely in a new situation. Other new students may be feeling just the same, and this is the ideal time to meet and make friends.

LOOK AFTER YOURSELF Make sure you find time to do something that’s familiar and reassuring. This might be playing your favourite music, doing sports you enjoy, keeping in touch with people you feel comfortable with.

Get to know what you need to feel good. It may be lots of activity or lots of time on your own, or a mixture. Find out what’s best for you.

If you can, resist the temptation to withdraw and hide away.

CONCERNS You may have worries about what’s going to happen in the next few weeks - so will lots of other students. These may be worries about: The course. Is it what you expected, can you keep up?

Making friends. Will anyone like you?

Finances and managing practical things on your own: can you do it?

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You may feel homesick - a sense of loss of familiar places, people and routine - and be surprised at how this is affecting you. You may be trying to live up to other people’s expectations: this can be a real burden. You may also have expectations about yourself that are unrealistic.

NEW RELATIONSHIPS Going to university can be an opportunity to make a fresh start, to make new friends, especially if you had difficult experiences with school mates. You can start afresh.

If you have lots of friends at home, that’s wonderful, but do take the opportunity to meet the wide range of people you’ll come across as a student. Getting involved in sports or social activities or volunteering to do some charity work can be good ways to meet people.

Whether you’re just out of school or a mature student, you’ll find someone at Anglia Ruskin University you can get along with.

WHAT CAN I EXPECT? Counselling aims to help you explore and clarify concerns that are important to you, and to develop resources and skills to deal with difficulties in your life.

Your counsellor will encourage you to speak about yourself and your concerns at a pace which is manageable for you. There is not a right or a wrong way of doing this.

You may have a very clear idea of what you want to talk about or you may be feeling confused and anxious, perhaps not sure what it is that is troubling you.

Your counsellor will try to listen attentively to what you are saying and to understand how you are experiencing your world and what is happening to you. Putting your thoughts and feelings into words may feel helpful and a relief. You may also find that you are helped to recognise and make sense of these thoughts and feelings and how they affect your behaviour and choices. Your counsellor will not tell you what to do, but can help you explore some of the options open to you and you might decide you want to change something about yourself or your situation.

WORK/LIFE BALANCE

STUDENT FEEDBACK

You don’t only have study and life; you may have a job and a family to look after as well. Getting behind with academic work is a major cause of anxiety; never going out socially can make you feel quite isolated; fitting in a job may help your finances but limit your socialising or studying. Student Services can help you with quite a number of these problems.

Here are some comments from students about what they found helpful about counselling:

I’M STRUGGLING, WHERE CAN I GO? WHAT IS COUNSELLING AND HOW DOES IT WORK? To understand how counselling works, it’s worth thinking about what it’s not. It is not the same as going to a doctor or other ‘expert’ to be advised, instructed or directed in some way. Nor is it the same as having a chat with a friend, family member or someone you know, when both of you may well do an equal amount of talking, sometimes not in confidence.

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“I could talk about anything, knowing it was confidential and I wouldn’t be judged.” “An unbiased outside listener who can sum up very well my “Somewhere I can thoughts and help me let rip with feelings understand them.” which otherwise I would be wary of letting out.”

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“Talking through my thoughts was very helpful.”

“Helped me to see things better and to take action in certain areas of my life.”

“Good, quiet atmosphere where I can concentrate on real feelings.”

MEN AND COUNSELLING THE FACTS Depression occurs as frequently in men as in women; but women get diagnosed and treated twice as often as men.

Suicide is the biggest killer of young men in England. Men are less likely than women to recognise that they are under stress or unhappy.

Men are significantly less likely than women to go to their GP with emotional and psychological problems; if they do they are more likely to describe physical symptoms of mental distress such as sleep problems, chest pains or headaches.

Alcohol and substance abuse is five times more common in men than in women.

Male students are significantly less likely to access university support services than female students. But the dropout rate is much higher among male students.

IS IT FOR ME? You may have made an appointment after someone has suggested counselling. It will be possible in the first session to think about whether counselling is right for you and what you want at the present time. Sometimes one or two exploratory sessions may be necessary before this can be decided. You may feel that one session is enough to deal with your concerns. It is common for students to come for 4 or 5 sessions, though some may need more.

The number of sessions you have is discussed and agreed with your counsellor. Each session will usually last for 50 minutes and will probably be at weekly or fortnightly intervals. Your counsellor may ask that you also consider seeking help from other facilities within Student Services such as The Employability and Careers Service, The Employment Bureau and The Study Support Service.

THE OBSTACLES Many men have been brought up feeling they shouldn’t talk about their problems or express their feelings. To do so is seen as a confession of weakness. Therefore men are often reluctant to ask for help for their emotional or psychological problems.

Avoidance of talking about things can put you at risk of more serious problems developing or getting worse such as drug or alcohol abuse, aggressive behaviour, physical ill health, relationship or sexual problems and depression.

Men often only seek help from their GP or a counsellor when they’ve hit crisis point.

Research indicates that more men would use counselling if they knew in advance the ‘nuts and bolts’ of what’s involved. Once they’ve seen a counsellor the vast majority of men say they’d recommend others to do the same.

THE SOLUTION Recognise and acknowledge the symptoms. It’s important to recognise when a problem is getting more serious and it’s affecting your relationships, work or general health. Take action before it gets out of hand.

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Take control and get support. Our experienced counsellors are there for anyone who needs to talk something through in complete confidence. Make use of the free service available. Putting it off won’t sort it out.

Talking to a counsellor really can make a difference. You can be your real self, talk openly and have time to think without pressure. A counsellor will listen objectively and help you make sense of things.

Set yourself goals. A counsellor can work with you to explore your options, find a new perspective and identify steps forward to help you sort your problems out.

Learn new ways to deal with things. Your counsellor will help you to explore what’s not working and find new approaches to deal with problems and feelings such as anxiety, anger, low moods and relationship problems.

THE NEXT STEP If something is bothering you, however trivial you may feel it is, contact the Counselling and Wellbeing Service to arrange to meet with a counsellor.

The counsellor will give you time to talk things through in confidence to identify what changes you’d like in your life and how they could help.

WHAT TO DO IF YOU’RE FEELING ALONE It is a cliché that we can feel lonely, even particularly lonely in a crowd. Unfortunately it is one that is only too true and all too common at University. Here, surrounded by people of a similar age and, supposedly with lots in common we can nevertheless feel wretchedly isolated and awkward. This is made worse by the sight of others who seem perfectly at ease, are rapidly making friends and are becoming embedded in groups from which you feel excluded or only tolerated on the margins.

Looked at from another angle, however, it is not surprising that loneliness at University is common especially among first year students. Coming to University is a major stage in ‘leaving home’. It may indeed be the first time you are away not just from the supportive familiarity of home and family, but also from friendships that may have been built up over the years.

Leaving home and coming to University involves a number of changes: in lifestyle, work patterns, and degree of independence. The accumulated effects of these can

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make people who feel uncertain of what to do or how to be. Social insecurities can then creep in, even in people who feel quite socially adept. So, for some, loneliness is a new and disconcerting experience, while for others it is more familiar, but may be accompanied by disappointment that University has not bought a hoped for change.

If you are starting a new job at the University, you will be meeting new people and wanting to prove yourself in your new role. Academic and research work can often feel very isolated.

LONELINESS IS COMMON AT UNIVERSITY FOR MANY REASONS INCLUDING: You are away from friends and family It may be the first time in years - maybe even since primary school - when you have had to ‘start from scratch’ making new friends You may be missing old friends and finding it hard to replace them - or perhaps even a bit reluctant to replace them with substitutes You may have high expectations of University as a place where you will make friends for life, and be disappointed in the people you initially meet You may have a long distance relationship and feel torn between social life here and elsewhere You may be anxious about work and feel in conflict about spending time on social activities YOU CAN FEEL LONELY: When you are alone and have no choice in this When you do not feel part of a group or event When there is no one with whom to share your feelings and experiences When you feel disconnected and alienated from your surroundings When there is no one to know how miserable and isolated you feel

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LONELINESS CAN MAKE YOU FEEL:

Do not deprive yourself of things you would like to do just because you have nobody to do them with e.g. going to a concert or going for a walk, or seeing a film;

Unloved and unwanted Socially inadequate

Self-conscious and ill at ease with others

Try not to be critical of your efforts. Remind yourself that intimate relationships take time to develop. Do not disparage friendships in the belief that only romantic relationships will relieve your loneliness or give you confidence and social status;

Angry and critical of others

Build relationships by being a good friend to others;

Convinced that there is something wrong with you

These feelings, of course, can then result in lowered self-esteem; a (usually unfounded) conviction that people do not want you around; a reluctance to even attempt to make friends or take part in social activities; an inability to assert yourself and say ‘no’ to things you do not want to do and a consequential feeling of being exploited.

Respond to others and their interests (but do not feign an interest you do not feel)

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WHAT YOU CAN DO ABOUT LONELINESS? Remember that loneliness is very common. Almost everyone feels it at some time. It is not a defect. It is something that can be changed. It is a sign that important needs are not being met. Changing the situation may involve finding and developing a circle of friends, but it may also mean finding ways of learning to your enjoy your times alone; use them more constructively and pleasurably; Do not wait for other people to visit or speak to you. Try to talk to people you sit next to in class or at meals or in breaks at work. Say, hello, or even just smile, at people you pass on the staircase or elsewhere in college or in your workplace; Try to put yourself in new situations where you will meet people with interests in common. Choose activities that you are genuinely interested in and enjoy - societies or sports or voluntary work. Do not, however, over extend yourself, filling your time with too many things just to avoid being alone;

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CONTACT US

To arrange an appointment for counselling: Phone 01245 686700 or 01245 686701 Email wellbeing@anglia.ac.uk Visit anglia.ac.uk/wellbeing Drop in and see us: Cambridge HEL341 Chelmsford 2nd Floor, Tindal Building To contact the Students’ Union Advice Service: Phone 01223 460008 (Cambridge) 01245 258178 (Chelmsford) Visit angliastudent.com/advice

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We need a certain amount of stress in order to keep ourselves going but a build-up of stress over a prolonged period can seriously affect both your mental and physical health. To maintain healthy stress levels we have to find the right balance of diet, exercise, work and relaxation for our own body and mind.

STRESS QUESTIONNAIRE To see how your stress levels rate at the moment answer Yes or No to the following questions. Keep your score and check out how stressed you are below: 1 Are you finding it hard to concentrate or to remember things?

2 Do you feel angry or irritable much of the time?

3 Are you having trouble sleeping?

4 Are you smoking or drinking more than normal?

5 Are you having frequent headaches?

6 Do you have a dry mouth or sweaty palms?

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Are you having trouble making decisions?

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Are you often feeling anxious for very little reason?

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Do you frequently put things off until later?

10 Do you have tense or aching shoulder and neck muscles?

11 Do you often feel unable to cope?

12 Have you lost interest in food, sex or things you’d usually find pleasurable?

13 Do you have an upset stomach, diarrhoea or constipation?

14 Are you always getting colds or infections?

15 Do you constantly feel tired?

16 Are you feeling more impatient than usual?

17 Are you eating erratically?

18 Do you find it difficult to relax?

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If you responded ‘Yes’ to 4 or less It seems from your answers that you are not under a great deal of stress or if you are you are at least not experiencing any major negative consequences. Try and keep aware of your stress levels and build on the positive things you already do.

If you responded ‘Yes’ to 5 or above Your answers suggest that you are experiencing moderate stress and are also feeling the consequences of this stress in various aspects of your life. You need to look at the stresses in your life and how you are dealing with them. Make sure you try to deal with this stress positively for example, by taking regular exercise, eating healthily and making time for yourself.

If you responded ‘Yes’ to 8 or above It appears that you are experiencing a great deal of stress. This can affect many aspects of your life in a negative way (not least your physical health and your relationships with others). Consider thinking about how you might be able to reduce your stress levels. This can sometimes be a lot easier when you talk to someone else about how all this stress is making you feel. Seek help. Talk it over with a friend, partner or a member of the Counselling and Wellbeing team at Anglia Ruskin.

If you responded ‘Yes’ to 12 or above Your answers suggest that you are experiencing extreme stress. Such signs are a serious warning. You must seek help. You need to take immediate positive action to reduce those things in your life that are causing you stress and to develop skills for dealing with stress. You need to seek professional help from your GP or from the Counselling and Wellbeing service.

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TOP

WHAT IS STRESS?

Stress can result from pressures outside ourselves or TIPS those we put on ourselves. Stress can build up over a long time and it can take only a small thing to tip the balance and make you feel you can’t cope. A certain level of stress can be helpful – it can motivate us and be exciting.

However, too much can seriously interfere with your wellbeing.

HOW CAN YOU TELL IF YOU’RE STRESSED? There are physical, emotional and behavioural signs of stress. We can often adapt to increasing levels of stress and ignore signs that may provide a warning. Sometimes it takes a physical symptom for us to realise something is wrong. Do any of these signs apply to you?

Tiredness

Can’t sit still

Headaches

Feeling overwhelmed

Muscle tension

Worsening of skin complaints

Irritability

Talking very fast

Impatience

Loss of appetite

Tearful

Finding it difficult to make decisions

Sleep problems

Can’t concentrate

Drinking more than normal

Faster heartbeat

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TRY

HOW TO COPE WITH AND REDUCE STRESS

WAYS TO RELIEVE STRESS

STRESS REDUCTION AND RELAXATION Listen to music One of the best ways to relieve mild stress. It doesn’t have to be peaceful music, just something you like and that brings up good memories.

Sleep The less sleep you get, the more tense you’re likely to feel.

Avoid smoking and alcohol Drinking alcohol and smoking may feel relaxing but they only temporarily mask stress. They don’t reduce it.

Eat well Some nutrients are used up more quickly when you’re stressed. Eat plenty of vitamins B (green vegetables, fruit, nuts, eggs) and C (fruit juices) and complex carbohydrates (oats, pasta, rice).

Exercise A short daily brisk walk will help relieve anxiety, burn off excess adrenaline and will boost your mood.

Talk to other people Get support (and you’ll probably find you’re not the only one feeling stressed!)

Cut down caffeine Tea, coffee, chocolate and cola all raise your stress levels.

Relax Include regular relaxation in your life. Have a bath, do yoga or breathing exercises, sit in silence or watch a film.

Be more assertive Ask for what you want and learn to say no without feeling guilty.

Get help Don’t struggle on your own. Deal with what’s causing your stress. Get help from your tutor, your boss, your family or Anglia Ruskin’s Counselling and Wellbeing Service.

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TOP

All our body functions (heart rate, breathing, production TIPS of hormones, adrenalin etc.) are normally controlled automatically so that we do not have to think about them.

At the first sign of danger, we start to breathe quickly, take in more oxygen and a whole host of reactions happen in our bodies to prime us to be at our best to fight or to run away to save our lives.

Unfortunately we are nowadays rarely in real physical danger but our bodies still react the same way – whether we are worried about exams, presentations, money, relationships, interviews etc. Our bodies then get stiff and tense because we are not running or fighting. It gets harder to think clearly so we may get irritable, tearful, and ill. The good news is that once we recognise what is happening, we can do things to change this reaction: 1 Try to recognise the fear stimulus as a problem to be solved and not a life or

death worry. Talk it over to get fresh perspective or make changes if possible.

2 Train our bodies not to automatically go into the stress response but to learn how

to replace it with the relaxation response. This is calmer, more productive state for problem solving. We can do this with our breathing.

BREATHING EXERCISE Autogenics is the jargon word for regaining control of our stress responses and replacing them with the relaxation response. Although it might seem strange, we can quickly and easily learn how to reduce the production of adrenalin, lower the heart rate etc. The answer is with consciously controlling our breathing.

Enjoy yourself Do something purely for enjoyment at least once a week.

Meet a friend, watch TV, shop, read, do karate, play an instrument or go out dancing. Do whatever you enjoy and whatever helps you to feel relaxed.

When we are stressed we breathe fast and take in lots of oxygen. If we breathe slowly and deeply with the emphasis on a nice long outbreath, we will gradually decrease the amount of oxygen and increase the amount of carbon dioxide in our bodies. This acts as a powerful biochemical signal to the rest of the body and brings about a reduction in levels of adrenalin, a lower heart rate and a steady blood flow around the whole body. It is this that makes it easier to think more clearly as the blood flows freely to

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the brain then. People sometimes think that they have to be stressed in order to revise for exams. In fact revision and recall is much better if you can relax.

TRY

The important thing is to breathe out for slightly longer than you breathe in.

A simple exercise is to breathe in to the count of 4 and then breathe out to the count of 8. Do this at least 10 times and you will feel calmer. If you start to feel dizzy, then this is a very useful signal to you to indicate that you are still taking in too much oxygen. Make your out breathe a little bit longer.

Like any new thing, it gets easier with practice. Try doing it several times a day e.g. in between lectures, before meals etc. The more you practice, the easier it will be to do it at those times when you really need it.

The Counselling Service has a short relaxation exercise which is available to students. This exercise will help you to learn the relaxation response. If you have been feeling anxious and tense for a long while, it may take several goes before you begin to feel any benefit. Try not to force the feelings as this will obviously not help and we don’t want to add to your worries by fears of not doing the exercises right. Just give yourself time. Gradually, you will find that as you become more familiar with a relaxed state by the end of the exercise, you will find it easier to get in touch with that state when you are feeling stressed in the day, i.e. by noticing when you get tense, a few breaths will help you calm yourself down. Eventually, you will get used to calming yourself this way and may not need to do the full exercise every day.

To start with you must do the full exercise at least once a day: Set aside 20 minutes at a regular time and arrange to be undisturbed by phone or other people. You need to be warm and comfortable where you lie down. Wear clothing that is loose enough for you to breathe easily and remove glasses and shoes.

OTHER ACTIONS TO HELP REDUCE STRESS Exercise to “burn off” the extra adrenalin e.g. walking, running, dancing, active sports, swimming etc.

Avoid caffeine which stimulates the production of adrenalin. Reduce intake of coffee, tea, cola drinks and chocolate (reduce gradually if you are used to a lot, as you you could get withdrawal headaches).

Don’t have sudden large amounts of sugar. Avoid sugary food, sweets etc. A sudden rise in blood sugar levels can also trigger high adrenalin levels. It is better to snack on carbohydrates (bread, potatoes) or fruit.

TALK WITH FRIENDS To unload fears To get fresh perspectives To help think about other things Get out and about and enjoy fresh air Be creative and make things, draw, paint etc. It will help you feel calmer Explore meditation, yoga and tai chi

OTHER SOURCES OF HELP

If your stress symptoms are causing you concern, consult your GP.

Remember throughout this exercise that you are relaxing yourself through letting go of your tensions and breathing away the stress. When you are relaxed, your brain can function at optimum and you feel clear, calm and focused.

Finally: do make sure you breathe out fully and completely – try breathing in to the count of 4 and out to the count of 8 at any time in the day to help you stay calm.

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CONTACT US

To arrange an appointment for counselling: Phone 01245 686700 or 01245 686701 Email wellbeing@anglia.ac.uk Visit anglia.ac.uk/wellbeing Drop in and see us: Cambridge HEL341 Chelmsford 2nd Floor, Tindal Building To contact the Students’ Union Advice Service: Phone 01223 460008 (Cambridge) 01245 258178 (Chelmsford) Visit angliastudent.com/advice

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“THE MIND IS A WONDERFUL THING - IT STARTS WORKING THE MINUTE YOU’RE BORN AND NEVER STOPS UNTIL YOU GET UP TO SPEAK” As a student at Anglia Ruskin University you may be required to give an oral presentation as part of your course work. The thought and the reality of this may be scary.

Public speaking anxiety is very common among students and the general population.

Students who are very anxious about public speaking may avoid modules where this is required, rarely speak in seminars, or decide against certain careers which require occasional speaking before a group.

The good news is that public speaking anxiety can be alleviated. Some nervousness is necessary. You need to be nervous but not overwhelmed by nerves. Think in terms of an “adrenalin thermometer” where the reading is not too high or too low. You can also see nervousness positively, as excitement/arousal rather than as anxiety.

Practical exercises and information are offered in this booklet for coping with excess nerves before and during a presentation.

Mental, behavioural and physical techniques can help you manage nerves. Equipped with these, taking a role and ‘having a go’ will not seem so daunting. Jumping into the pool with ‘psychological armbands’ - as one student put it. Confidence develops from doing things and being open to learning from mistakes.

Transferable skill being able to manage anxiety level is a very useful skill, transferable to other situations e.g. exams, interviews, as well as life beyond University.

WHAT IS PUBLIC SPEAKING ANXIETY? Public speaking anxiety often involves a central fear of being scrutinised and judged unfavourably by others. Students who are very anxious about presentations often say that they fear being the centre of attention and will feel self-conscious and embarrassed when they speak. Some worry that they will “look stupid” to others,

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make a mistake or be judged unattractive. Others may express a belief that what they have to say is not worthwhile as no one would be interested. It is easy for such worries to spiral into negative thoughts such as “I’m a failure”.

Negative, unhelpful thoughts can build out of all proportion and affect feelings, behaviour and physical symptoms.

Catastrophe scenario - anxiety about giving a presentation may be traceable to a previous negative, humiliating or distressing experience - perhaps at school or college - and you may be predicting that future presentations will not go well. This is a prediction not fact.

Perfectionism - self-imposed pressure to do the perfect presentation (something not reasonable or expected) may also fuel anxiety, particularly if this is your first time of doing one at University.

Physical symptoms of anxiety often include racing heart, blushing, shaking, dry mouth, sweating, dizziness, being tongue-tied, butterflies in stomach, rapid breathing.

These are normal physiological reactions to fear linked with the body pumping out too much adrenalin.

WHAT CAN I DO? STEP 1 BEFORE THE PRESENTATION Ask yourself “what am I really afraid of?”

Naming a fear sometimes helps to diminish it. You may also gain a more realistic view of what is expected or not expected.

Ask yourself “what is the worst that could happen during a presentation?”

Looked at calmly, the ‘catastrophe’ may not be so bad after all.

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What can I do about the ‘catastrophe’ if it does happen?

What are my strengths as a public speaker?

It is easy to overlook these if you are focused on your perceived limitations.

STEP 2 Recognise your negative self-talk which is anxiety generating. Practise challenging and then changing negative thoughts into positive ones.

Negatives

What is the evidence?

Positive

1. They know more than me

1.

1.

2. They think I’m nervous

2.

2.

3. I’ll go to pieces

3.

3.

4. They won’t listen

4.

4.

5. I’ll fail this presentation

5.

5.

6. I’m no good at this

6.

6.

7. Other

7.

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STEP 3 MANAGING PHYSICAL SYMPTOMS OF ANXIETY Learn and practise the skill of physical relaxation. Relaxation techniques can help you to reduce the physical symptoms of anxiety. If practised regularly, which is important, the overall level of anxiety can reduce. Being able to release bodily tension and achieve a relaxed state can also be mind calming. This will help you to feel more in control, better able to concentrate, and remember what you want to say.

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Nervousness will not necessarily go up when you give your presentation, but if it starts from a low level it is much less likely that it will go too high - remember the adrenalin thermometer.

Remind yourself not to overdose on caffeine - tea, coffee, fizzy drinks etc.

BREATHING EXERCISES Focus your attention on your breathing. Become aware of how fast or slowly you are breathing, whether you are breathing shallowly or deeply.

TENSE AND RELEASE MUSCLE RELAXATION

Now put one hand on your upper chest and one on your stomach just below your rib cage. Relax your shoulders and hands.

You can listen to a relaxation CD from the Counselling and Wellbeing team which includes tips for quick relaxation.

As you breathe out let your stomach flatten. As you breathe in through your nose allow your stomach to swell.

Relax with the Counselling and Wellbeing Service

Try to keep movement in your upper chest to a minimum.

Slowly and evenly breathe through your nose.

STEP 4

Allow your breath to become smooth, easy and regular.

CONTROLLED BREATHING Breathing is one of the activities of the body where there is conscious control and automotive activity. Most of the time we do not give much thought to how we are breathing. Altering the way we are breathing can be the most single effective way of achieving a calm relaxed state and remaining calm in a stressful situation.

BREATHING AWARENESS Next time you are very anxious notice how you are breathing. It may be shallow, rapid, irregular or you may be holding your breath, not exhaling or inhaling fully. In a situation of threat, real or imagined, this type of breathing is likely. Physical exertion also tends to be characterised by chest breathing.

VISUALISATION As you breathe in, imagine you are drawing a half circle with your breath and as you breathe out, you complete the second half of the circle.

Imagine being on a swing, breathing in as you go up and breathing out as you go down.

Regular diaphragmatic breathing requires around 8 - 10 breaths in a minute, breathing in and out counts as one breath.

You might also want to try the breathing exercises in Appendix 2.

Find what works for you.

DIAPHRAGMATIC BREATHING When we are resting breathing tends to be deeper and slower from the diaphragm.

This type of breathing is easily observable in a sleeping baby - the tummy moves outwards with each in-breath and inwards with each out breath.

STEP 5

TAKE A DEEP BREATH

PRESENTATION PLANNING

This is conventional good advice for calming down the nervous system, though sometimes easier said than done.

Careful preparation of your talk is essential if you are to feel confident about what you have to say and that you can do it. Lots of advice is accessible on planning a talk, structure, notes and cards, choosing visual aids.

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A SHORT GUIDE ON PRESENTATIONS REHEARSAL Each practice helps you to know your material, check on your timing, and experiment with getting your message across e.g. voice level, speed of speaking, conveying interest/enthusiasm.

You can: Practise out loud by yourself.

Tape yourself and give yourself constructive feedback - don’t do this if you think it will make you more anxious.

Physical movement helps to discharge anxiety, prevent ‘freezing’, e.g. walk around, shake your hands and arms, screw up your face and relax it.

Use physicality to support you, e.g. perching on a table, sitting on a chair.

Take a few deep breaths as your turn approaches, letting go of as much tension as possible, letting your shoulders drop and relax. When it’s your turn, use the adrenaline rush to feel alert and enthusiastic about what you have to say.

Do no concentrate on yourself as you give your talk, e.g. “do people think I’m nervous?”, “how do I look?” Focus on the important information you want to give to others and how it will interest them.

Give your talk to a friend or friends. If a friend cannot be cajoled, a Counsellor will be an audience.

If worrying thoughts creep in during your talk, say to yourself firmly STOP - take a deep breath in and out. You can mark your work with a red dot to remind you of your stop message.

Familiarise yourself with where you will speak, e.g. stand at the front of the classroom.

Blushing? Ignore it. Remind yourself that it will die down, and you will not be marked down for turning pink.

Know and rehearse well the beginning of your talk so that you can confidently get going, anxiety is often highest at the start.

Keep your breathing going - out and in regularly. You can only speak on an out - breath (Try it!).

Think about what would help you in giving your talk, e.g. sitting rather than standing.

You might want to let your module tutors know that you are very nervous. They might have helpful suggestions.

Slow down your speaking if you are speeding, as this will help you to feel more in control. Again you can mark your work to remind you.

Remember - you never look as nervous as you feel.

AFTER THE PRESENTATION

ON THE DAY Use your preferred breathing and relaxation exercises to calm you.

Think positively, challenge negative thoughts. Say to yourself “I can do this, I am well prepared.”

Give yourself appreciation for having done it. Don’t berate yourself for mistakes.

You can think realistically about what you will try differently next time. You might even enjoy giving a talk!

Picture your audience as friendly - they may well be pre-occupied with their talk to you.

Talking informally with your audience, or members of it, before you start your talk can help to defuse anxiety, e.g. “Can you hear me?”, “Is everyone here?”

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APPENDIX 1, PRESENTATIONS

Speak clearly and audibly and maintain eye contact

PLANNING A PRESENTATION

Briefly outline what you are going to talk about

Make sure you know the requirements of the presentation: time allocation, content and purpose

MIDDLE SECTION Go through the main points one by one with a logical, coherent progression

Prepare carefully, research thoroughly, and structure with an introduction, middle section and conclusion

Don’t overload the audience with facts and figures

Don’t read out an essay

Don’t just say everything you know about the subject

Use headings, bullet points and keywords

Speak to the audience, not the board

Prepare brief notes for each heading on numbered cue cards

Avoid blocking the view of your visual aids CONCLUSION

Decide on appropriate visual aids Keep text clear, simple and in an appropriate font size

Summarise the main points and draw a conclusion

Do not use too many visual aids

Invite questions

Display key points for the audience and as prompts for yourself Familiarise yourself with the material and the equipment

APPENDIX 2, BREATHING EXERCISES

Rehearse ‘authentically’, using all the equipment and material you intend to use

THE THREE PART BREATH

Stand back to check the appropriateness of your visual aids

Can be done anywhere.

Time yourself and be prepared to edit, both in rehearsal and on the day

Do it each time you look at your watch or the clock.

Make sure you have the necessary equipment set up and working, your overheads, hand-outs and cue cards

Before you answer the telephone or whenever you feel pressurised. Empty your lungs and imagine a conical shape.

First fill the top third of your lungs, the apex of the cone, breathing in slowly and steadily through your nose.

INTRODUCTION Make a conscious effort to relax

Then fill the middle third.

Look at the audience Smile

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Continue breathing - push out your stomach and fill the base of the cone.

Then exhale through your parted lips like a sigh.

Imagine as you let all the air out of your lungs that you are letting out all the tension and pressure. Visualise a black cloud of tension drifting away with your breath.

You will find this very calming and refreshing, and after three circuits feel quite tranquil.

If you can’t do three, one circuit will help in emergencies.

WORRIED ABOUT EXAMS?

THE CIRCUIT BREAKER

Anxiety is a normal reaction to a stressful situation. Most people experience some anxiety and tension about preparing for and sitting exams. A certain amount of adrenalin flowing is useful and appropriate, a spur to being alert, to concentrating fully and to performing well. Too much anxiety, however, can be debilitating and accompanied by unpleasant feelings, sleep disturbance and physical symptoms such as headaches, sickness, shakiness.

Use whenever you feel the symptoms that bother you, e.g. butterflies or panic feelings when the pressure is too great or you feel stressed. Use in traffic jams, at meetings or before attempting something that is difficult for you.

Noticing these symptoms might add to your worrying, which can also use up a lot of energy. The good news is that you can learn to manage anxiety more effectively and to strengthen revision and exam skills.

Let your lungs completely empty and go on with your work.

Do this breath as often as possible during the day.

Breathe in through your nose

LEARN HOW TO RELAX MIND AND BODY

Breathe out through your mouth

Using relaxation skills and breathing techniques can help you before and during the exam to keep calm, be alert and to think. Altering breathing can also optimise oxygen uptake, helping the brain to be alert.

Breathe very calmly and gently Imagine a feather about 12” away from your lips. You must not disturb the feather with your breath.

Count between breaths.

You may find it helpful to picture an adrenalin thermometer and that you can keep the reading low by using relaxation techniques when you need to. Learning how to relax may also help with sleep difficulties, allowing the mind to ‘switch off’ and quieten prior to sleep.

Count more quickly each time so that there is no pressure on your breathing.

Close your eyes and relax (where appropriate).

Breathe in through your nose. Out through your mouth (not disturbing the feather).

OTHER SOURCES OF HELP S.Jeffers, Feel the Fear and Do it anyway H.Kennerley, Overcoming Anxiety - a self-help guide using cognitive behavioural techniques

Count one.

D.Brookes, Breathe away stress

Breathe again. Count two. Breathe again, count three, and so on up to ten.

J.Van Emden and L.Becker, Presentation Skills for Students

Repeat the one to ten circuit three times.

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CONTACT US

To arrange an appointment for counselling: Phone 01245 686700 or 01245 686701 Email wellbeing@anglia.ac.uk Visit anglia.ac.uk/wellbeing Drop in and see us: Cambridge HEL341 Chelmsford 2nd Floor, Tindal Building To contact the Students’ Union Advice Service: Phone 01223 460008 (Cambridge) 01245 258178 (Chelmsford) Visit angliastudent.com/advice

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Public Speaking Anxiety 37

WHAT TO DO IF YOU ARE ALWAYS DISTRACTED Writing this leaflet was not as easy as you may think! Do you put things off?

Do you often think “I’ll do that tomorrow”?

Probably everyone procrastinates at some time in some aspect of their life, putting off doing something that needs to be done today. The word procrastination comes from the Latin for ‘until tomorrow’. University students can become vulnerable to developing, or entrenching, the procrastination habit. This may be because there is little formal structure, deadlines can seem far off, the workload feels overwhelming in amount and/or difficulty, and there are, of course, the numerous distractions.

You will have your own preferred way of studying and the general rule is ‘if it works for you, don’t change it’. Allowing tension to build and then get going may work well at times. Procrastination can have advantages and disadvantages.

DISADVANTAGES OF PROCRASTINATION INCLUDE: Missed deadlines, too much last minute rushing, not doing justice to yourself, unnecessary stress, worrying, nagging guilt spoiling leisure time, energy sapped and nothing to show, and ……. ?

If any of these are familiar, please read on.

BREAKING THE HABIT Ask yourself how you might be stopping yourself from doing what needs to be done now.

Are you afraid of failure?

Do you want to get something perfect, so you don’t get started or perhaps complete the task?

Are you resentful about studying?

Are you avoiding something difficult or something you don’t know how to do?

Are you feeling overwhelmed, not knowing where to start?

Are you thinking negatively about yourself and what you can accomplish?

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Working out the personal and emotional meaning of procrastinating behaviour may by itself help you to get unstuck and started on what you are putting off.

OTHER SOURCES OF HELP Andrea Perry, ‘Isn’t it about time?’ How to stop putting things off

PRACTICAL TIPS MAY ALSO HELP Write down what you have to do, when and then prioritise. List making can make you feel more in control, but beware of it becoming another distraction or depressing energy.

Use the Swiss cheese method - make a number of holes in an overwhelming task by turning it into a series of small manageable sub-tasks. Get started on the first one, if only for a few minutes.

Andrea Perry, The Little Book of Procrastination - How to stop putting things off Susan Jeffers, Feel the Fear and Do It Anyway Stella Cottrell, The Study Skills Handbook

Start somewhere, anywhere; e.g. the middle of an essay.

SOME PRACTICAL WAYS TO ORGANISE YOUR TIME

Set aside 15 minutes today which you will devote exclusively to the task you are putting off. Once started it is often easier to keep going.

This guide has been developed from workshops for Anglia Ruskin University students on time management. Many students have found these useful for studying more effectively, juggling demands on time, coping with stress, and increasing their motivation.

Make a start on an easy task then switch quickly to a difficult one Be playful if you are putting off writing e.g. scribble down notes or ideas in any order, speak your words out loud and tape yourself, write as quickly as you can for 3 minutes, ignoring mistakes.

Stop telling yourself you must do really well. Remind yourself that doing it is what matters Boost your motivation; dwell on your strengths, on tasks which you have accomplished Plan rewards for when you have accomplished something Energise yourself physically e.g. shake out legs and arms, jump up and down, then get going on the task Take a break. If you are very tired or stressed you may need to rest and relax before you can act effectively Don’t be afraid to ask for help e.g. friend, lecturer, Anglia Ruskin University Study Support Service. The Counselling and Wellbeing Service is also able to help you understand and change procrastinating behaviour.

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The guide contains practical exercises to help you explore your current use of time, strengths and weaknesses, and changes you may wish to make.

You may find it helpful to work through it with a friend. Discussion can sharpen self-awareness and help you to make and monitor any changes in how you organise your time.

LIFE, STUDY AND WORK BALANCE Being a student can feel like being a Britain’s Got Talent act who keeps several plates twirling on top of poles, running from one to the other. Much like them, we can feel that we are balancing many things - classes, study, a part-time job, family commitments, time for friends and self. Some of us have the opposite problem when large amounts of unstructured time can feel difficult and we can feel lost.

“If only I had more time” is an understandable, often heard lament. But there are only 24 hours in a day, 168 in a week which no magic wand can change. What can be aimed for is to make the most of the time available to accomplish what we think and feel is important. Exploring the choices we make, or wish to, can entail a shift from a passive to a more proactive stance.

Organising time effectively is a life skill. There are, however, many different ways of being ‘organised’ or, indeed, ‘disorganised’. Some people love making lists and

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timetables, others abhor them. What works well for one person will not necessarily work for another. Time management tips and advice can be daunting and frankly unappealing. Simply knowing the advice is usually not enough and can feel like a threatening criticism of existing ways of doing things.

If you answered ‘yes’ to question 1, jot down three ways you think you waste time.

The suggestions in this booklet are for experimenting within the context of self-reflection on your current use of time and recognition of your strengths.

ii)

EXERCISE 1

i)

iii)

HOW DO I MANAGE MY TIME NOW?

E.g. procrastinating, not knowing where things are, perfectionism, not saying ‘no’, attempting too much at once or unrealistic time estimates.

Answer questions and add comments if you wish.

1 Do I waste time?

EXERCISE 2

2 Do I know what I want to accomplish?

TIME TRACKING – HOW DO I ACTUALLY SPEND MY TIME?

3 Do I give time to my priorities?

In doing exercise 1 you may have realised that you have little idea about how you actually spend your time. One way of finding out is to keep a log of your activities, rest, relaxation, using a 24 hour time span. This is not an exercise for the faint-hearted but even doing it for one day may reveal surprises.

4 Do I put things off?

5 Do I meet deadlines?

6 Am I in control of my time?

SUN

MON

TUES

WEDS

THURS

FRI

SAT

01.00

7 What or who distracts me from study?

02.00

8 Do I often have to rush things at the last moment?

03.00 04.00

9 Do I plan my time?

05.00 06.00

10 Do I spend too much time on some tasks?

11 Are there times in the day when nothing seems to get done?

07.00 08.00

12 Do I spend too long trying to get something perfect?

09.00

13 Do I manage to fit in most of the things I need to do?

11.00

10.00 12.00

14 Do I have effective rest/relaxation time?

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Continued

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SUN

MON

TUES

WEDS

THURS

FRI

D Work (includes paid work and domestic duties)

SAT

13.00

14.00

E Study

15.00 16.00

17.00 18.00

% actual distribution of time

19.00 20.00

A

21.00

B

22.00

C

D

E

âž”

âž”

23.00 00.00

Preferred distribution of time

Are you clearer about any adjustments you could make which would help you to give time to what is important and necessary?

A

B

EXERCISE 3

C

D

E

LIFE, STUDY AND WORK BALANCE You can use information from exercise 2 to help you estimate how your time is currently distributed and what is your preferred distribution.

A Personal (activities, relaxation, rest etc. which is just for yourself)

a) Jot down three strengths you have in managing time.

B Immediate family/significant other

i)

ii)

C Social (satisfy own need for belonging)

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STRENGTHS AND WEAKNESSES The first three exercises may help you to complete exercise 4.

EXERCISE 4

iii)

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b) Key difficulty or issue in relation to time

Strategy for dealing with it

MAKING CHOICES ABOUT YOUR USE OF TIME “What choices?� you may be saying to yourself.

Sometimes it may feel like there is little scope for choice-making, particularly if you are feeling overwhelmed, there feels too much to do, too many commitments and demands to juggle. On the other hand, you may be finding large quantities of unstructured time difficult, particularly if you have been used to more structures and routines in your pre-university life.

EXERCISE 5 ME AND TIME - BRAINSTORMING What do you want and/or need to give time to in your life at the moment?

ME AND TIME

Add as many spokes to the wheel as you wish.

Refer back to exercise 3 if it helps.

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Write down your longer term goals for areas of your life

Planning ahead my help turn goals into action and accomplishments.

STEP 1

Using exercise 5,

Identify priorities/commitments for the week ahead and write on blank sheet, e.g. lectures/seminars; leisure activities; paid work; time for self; adequate rest/sleep.

You may want to photocopy the sheet below

PERSONAL TIMETABLING

PERSONAL TIMETABLE

Setting goals can be energising, motivating and focussing. Word of caution: goals, long or immediate, are not set in concrete. Sometimes it may be necessary to change or modify goals. This is not a sign of failure or weakness, it is just a realistic response to a current situation.

SUN

MON

TUES

WEDS

THURS

FRI

SAT

01.00 02.00 03.00

A goal is a dream with a deadline – or so it has been said.

04.00

For example:

05.00 06.00

I want to be a poet

07.00 08.00

I want to write poetry

09.00

I want to write a poem

10.00

I want to write 10 lines of poetry

11.00 12.00

I want to write 10 lines of poetry today

13.00

On the subject of dreams, dreaming and day-dreaming may be very productive times for generating and “simmering” good ideas.

14.00 15.00 16.00 17.00 18.00

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PERSONAL TIMETABLE SUN

MON

TUES

WEDS

THURS

MON FRI

SAT

TUE

WED

THURS

FRI

SAT

SUN

Week 1

19.00 20.00

Week 2

21.00 22.00

Week 3

23.00 00.00

Week 4

SEMESTER PLANNING 1. Deadlines and events

Week 5 MODULE 1

MODULE 2

MODULE 3

MODULE 4

MODULE 5

MODULE 6

MODULE 7

Module title

Week 6

Week 7

Essay/ report deadline

Week 8

Tests/ exams

Week 9

Seminar

Week 10

Field trips/ visits

Week 11

Week 12

Other events

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PERSONAL TIMETABLING MAY HELP YOU TO:

STEP 2

Acknowledge to yourself what you have achieved

PRIVATE STUDY

Save mental energy and avoid panic

Before filling in private study time ask yourself:

Be purposeful and realistic

When do I work best?

Meet deadlines and keep up with work

Where do I work best?

Have effective study time and effective relaxation/rest (e.g. not spoilt by worry/ guilt about study)

Do I want a study-free day/weekend?

Do I want to schedule private study between 9am to 5pm when possible?

How much private study? - (See “What am I doing here anyway? - Answers to 13 common questions asked by students at APU).

WHAT TO DO WHEN - DEFINING PRIVATE STUDY TASKS Probably you have scheduled in private study periods of varying lengths. You are likely to concentrate more effectively if you are clear about what you are trying to do, and if this is realistic given the time available. Some study tasks may almost define themselves e.g. reading relevant chapters for tomorrow’s seminar. Other tasks link to a longer time frame e.g. the semester or academic year.

THINKING AHEAD Semester plan? Use or adapt the sheet on page 9, or devise your own.

Get started, look after yourself and keep going.

TWO USEFUL QUESTIONS TO ASK YOURSELF FROM TIME TO TIME: 1 How am I using my mental and physical energy now?

2 Is this good use of my time?

Finally, if you like tips, an alternative version makes the point.

OTHER SOURCES OF HELP Andrea Perry, Isn’t it About Time? How to Overcome Procrastination and Get on with Your Life Stella Cottrell, The Study Skills Handbook

Deadlines? e.g. presentations, essays.

‘Artificial’ deadlines? i.e. deadlines you set for yourself before the actual deadline.

CONTACT US

Daily “to do” lists, identifying priority tasks e.g. A, B and C.

To arrange an appointment for counselling: Phone 01245 686700 or 01245 686701 Email wellbeing@anglia.ac.uk Visit anglia.ac.uk/wellbeing Drop in and see us: Cambridge HEL341 Chelmsford 2nd Floor, Tindal Building

STEP 3 Try out your personal timetable for one week and then review what worked well, what not so well and what changes do you want to make?

Remember: It is intended to be a support not something to berate yourself with when things don’t go according to plan. The process is essentially a self-monitoring loop involving flexibility, prioritising, re-prioritising, and focussing.

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FEELING LOW? AM I DEPRESSED - OR IS IT SOMETHING ELSE? Our mood naturally varies with time and from day to day and everyone gets down at times. We may say that we are “down”, “fed up”, or “feeling blue”, or put it down to “feeling under the weather”; we may get disheartened about something that happens or doesn’t go the way we would have liked. Although people often say “I’m depressed” to mean these things, this would not clinically be called depression and is simply part of the normal ups and downs of life. Some people naturally experience frequent mood changes, while others have relatively stable equilibrium.

Similarly, if we suffer a major loss, we readily understand that it is normal to grieve.

Although some of the emotions we feel when we are bereaved appear similar to depression, grieving is a natural and ultimately healing process. Sometimes, though, past losses which were not fully mourned at the time may appear as depression much later.

SO, WHAT IS DEPRESSION? Put simply, the distinction between feeling “down” and being depressed is one of both degree and duration. Depression certainly includes a persistent low mood and loss of interest or pleasure in life - it also commonly involves: A change in eating, weight and/or sleep patterns Lowered energy levels and a reduced level of physical activity Difficulty with concentration Feelings of worthlessness Loss of interest, enthusiasm and enjoyment Feeling irritable and short-tempered or tearful Being unable to continue as usual with work and interests, maybe because of feeling listless, “they cannot be bothered” or things feeling pointless. Sometimes people feel that it is just not worth going on, or think about suicide.

Please note that we may feel some of the above for reasons other than depression, or even several together for a brief while, without this being of major concern.

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Someone who is depressed will experience a number of these changes persisting for quite some while. Nonetheless, depression is very common - it affects people of all ages and backgrounds and is one of the most common reasons for people seeking help from counsellors or GPs.

I am a fraud - I should not be here Nobody will ever want to have a relationship with me About your situation:

WHY DO PEOPLE GET DEPRESSED?

My town is a horrible place

Often depression is a response to events or circumstances that are felt to be deeply troublesome or distressing, or which seem to threaten our personal identity. Usually these circumstances seem too hard or even impossible to change. There can be a sense of powerlessness, hopelessness and an all-pervasive gloom.

I will never be able to do all the work

However, sometimes people seem to get depressed for no obvious reason. In these cases, it may be that something that hurt deeply some time ago (even years ago) begins to surface now. Although this is perplexing and just as distressing, this process is not uncommon. Sometimes, though, the onset of depression seems to be caused by nothing other than chemical/hormonal changes affecting our body-chemistry.

It is understandable to feel down for a while after something upsetting has happened, like the end of a relationship or feeling disappointed that you have not done as well as you would have liked. Usually this disappointment passes with time, and people find that they can come to terms with what has happened and start to look forward to the future in a more positive way. However, if the low persists, or seems so severe that it affects your ability to function normally, it is time to seek out some help.

NEGATIVE THINKING When people are depressed they usually find themselves thinking very negative thoughts about themselves and the world; typically these thoughts are felt to be absolutely true and that there is no way of things ever changing. However, studies have shown that when people are no longer depressed they go back to seeing things in a more positive balanced way.

Negative thoughts affect the way people feel, so seeing things in a strongly negative way will exacerbate feelings of depression. Negative thoughts are usually:

Nobody likes me I am doing really badly on this course

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About the future: It’s hopeless Things will never get any better I am always going to feel like this Situations which people describe as making them vulnerable to becoming depressed include: Feeling lonely and thinking that nobody cares much about them Finding work difficult Thinking that they are a failure HOW TO HELP YOURSELF There are some things you can try which have been shown to help lift a depressed mood. These involve changing your behaviour and challenging your negative thoughts.

People who are depressed often stop doing pleasurable activities which would make them feel better in the short term, for example they may stop going out, opt out of regular sporting activity or stop going to see friends or to lectures.

Encourage yourself to start doing things again - activity can lift your mood and you may well find that you can do things better than you fear. Any activity will be helpful, but enjoyable activities and physical exercise/sport are particularly effective. If you usually enjoy going to the cinema or swimming, for example, try these things to start with.

About yourself:

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I have nothing in common with anybody here

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Break down tasks into steps or manageable “chunks” and tackle these one at a time. Although it may not seem so to you, you will probably be able to do things just as well as when you are not depressed; Start with easier tasks and then progress to more difficult ones. This will help you to regain your confidence;

SITUATION

NEGATIVE THOUGHTS

Getting critical feedback for an essay

I am stupid

I didn’t have much time to do this essay - the workload has been very heavy recently. I chose to do other things as well. The work is supposed to be challenging. Constructive criticism helps me to improve. I’ve done well in the past - which shows I can do well.

My partner does not want to see me tonight

They don’t care about me anymore

They said they had to work all night this is most likely true. We saw each other at the weekend and had a good time. They said some nice things to me lately and seemed caring the last time we met.

Be realistic and allow yourself more time to do fewer things; Allow yourself to feel pleasure at what you have achieved and reward yourself for each achievement; It is very important to spend time with people who are supportive. Isolating yourself increases depression, while social support helps lift a low mood; Find people with whom you can be honest about how you are feeling, and with whom you do not have to put on any pretence - but don’t take up all their time.

CHANGING NEGATIVE THOUGHTS As already stated, there is a link between negative thoughts and increased feelings of depression. If you are not aware of any specific negative thoughts and are confused about why you are depressed, you may find it helpful to talk with someone.

A trained counsellor can help you understand the depression and find the most effective and appropriate ways of dealing with what you are experiencing. There are different ways of challenging your thoughts. One way is to use a structured cognitive approach (such as described here) which involves being aware of your negative thoughts and allowing yourself to consider alternative explanations for your situation.

Some examples are given in the table below:

OTHER EXPLANATIONS

Do not automatically believe your negative thoughts no matter how strong they feel at the time. By considering other explanations, your worst “possible” conclusion will be seen as only one of a number of possible explanations for your situation. This allows you to consider each explanation and see which is most likely to come true, or try to collect “evidence” which will help test the different explanations.

If you feel it is appropriate, try talking to other people to help you get a balanced perspective on which are the most likely explanations.

MEDICATION Modern antidepressant medication is not chemically addictive and can be safely taken over extended periods of time. Usually it takes two to three weeks before having any beneficial effect. GPs will probably remind you that medication of this kind is not in itself a cure. If there are difficult circumstances contributing to your depression, medication won’t make them go away - but it may help you to rediscover our natural abilities to address these issues.

If you feel this may be an appropriate way forward, you will need to speak to your GP. Be as open as you can with him/her about how you feel and your circumstances, so that you can decide together on the best course of action.

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It is important that you only change your use of medication after talking to your GP.

HOW TO COPE AFTER EXPERIENCING TRAUMA

WHEN TO SEEK FURTHER HELP

WHAT IS TRAUMA?

If your low mood and negative thoughts persist or are so strong that you feel powerless to do anything about them If you have nobody to confide in who can help you look at why you are feeling depressed If your low mood is interfering with your life, work and relationships

A trauma is a stressful event or incident of a threatening nature which is likely to have a pervasive impact on anyone experiencing it. Examples include events like serious accidents, physical and sexual assault, crime, natural and man-made disasters, witnessing a shocking event. Less dramatic events and incidents can have a similar effect if they exceed a person’s capacity to cope, or if they are perceived by the person as a threat to their physical or psychological integrity.

COMMON REACTIONS

WHERE TO SEEK HELP Talk to a member of the Counselling and Wellbeing service.

Call the First Response Service (FRS) on 111, option 2. A service to call if you are in mental health crisis.

Most people involved in a traumatic incident experience some kind of emotional and physical reaction. Knowing about common reactions can be reassuring because it can help you to see that you are not going crazy and are not weak or inadequate. They are normal reactions to an abnormal event.

Talk to your GP who can discuss the range of treatments available to you, including medication.

Shock and disbelief at what has happened, confusion, feeling numb as if things are unreal, feeling isolated from or different from other people, physical symptoms ,e.g. shaking, palpitations

If you feel really desperate and despairing out of normal working hours, telephone your GP practice (a message will give you an emergency number) and a GP will call to talk to you.

Fear for your safety or that of others, apparently unrelated fears and anxiety, feeling vulnerable, the world might seem threatening and the future uncertain.

Telephone the Samaritans (Local: 01245 357357 or National 08457 90 90 90).

Look at Students Against Depression, an excellent website on depression for UK students which is packed with information, resources and real student stories.

You may also experience a wide range of emotions such as anger, sadness and guilt. Anger is a common response. You may feel angry because of what has happened to you, angry because you don’t feel in control of your life any more, angry with others.

Sadness may be about the losses, human and material, and also about the loss of feelings of safety and security. Some people may start blaming themselves for what happened and feel guilty. Some may experience survivor guilt (guilt over surviving while others did not), although they are not responsible for it in anyway.

Frequent thoughts or images of the incident may occur. You may also experience episodes of repeated reliving of some aspect of the trauma in the form of intense memories (called flashbacks), nightmares and frightening thoughts.

Physical reactions to trauma are various and include: sleep difficulties, exhaustion, being easily startled by noises, general agitation and muscle tension, headaches, breathing difficulties, changes in appetite.

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Feelings of previous trauma and loss can be rekindled by a traumatic event.

Problems in concentrating, e.g. on your studies, when watching TV Preoccupation with questions about the meaning of life. Is there life after death?

While the above reactions and more are common, it is important to realise that each person reacts differently to a life threatening experience because each person and each situation is unique. Most reactions are part of the normal process of recovery and help the person to adapt to the trauma. They can, however, be very unpleasant for those affected. Usually symptoms will diminish over a period of a few weeks, although some may last for considerably longer, especially if the experience was particularly frightening.

Using alcohol/drugs to help you cope with your reactions may be tempting but may lead to more problems in the long term.

Be careful - accidents are more common after experiencing serious stress.

If you are concerned about your reactions or are unsure about anything, you may wish to contact your doctor or a counsellor. Sometimes it helps to talk to someone not known to you. A university counsellor will be pleased to see you.

POST-TRAUMATIC STRESS; WHAT IT IS AND HOW TO COPE WHAT IS IT?

HOW CAN YOU HELP YOURSELF? Don’t blame yourself for any of the above reactions, they are normal human responses.

Treat yourself extra-kindly and don’t ask the impossible of yourself. Take time out to sleep and rest, and be with close friends and family.

Find a way to talk about your distress and shock with someone who will understand. When you are ready, talk about what you saw, what it was like for you and what you feel now. If you want to talk about it again and again, that is fine. Talking about the experience can help to make it less overwhelming. You may also need time by yourself.

A collection of reactions - feelings, thoughts, behaviour - which are experienced following a sudden distressing event which is outside the range of normal everyday human experience. It is the unexpectedness of the incident which seems to evoke the stress because it undermines one’s trust in normalcy - one can never quite believe in an ordered existence any more. Incidents that can sometimes lead to signs of posttraumatic stress (PTS) include such things as burglary, an attack or an accident.

WHEN DOES IT OCCUR AND TO WHOM? Signs of post-traumatic stress, such as those listed below, may not appear for days, weeks or months after the event, and can affect those not directly involved in an incident - e.g. to those who witness an accident, or to rescue workers, or to relatives of those involved.

Writing down your feelings and thoughts just as they come -jottings, prose, poetry- can help to express emotions and may make them more manageable.

WHY DOES IT OCCUR?

Re-establish, if possible, familiar routines and ordinary every day activities. This will help you to restore some sense of order and normalcy in your life.

It is the way by which our mind and body ‘process’ the event, to try to make sense of it, so that we can eventually react to it in a less distressing way. The processing is often made apparent through physical, emotional and psychological signs.

Look after your health. Rest when you need to even if you can’t sleep, eat healthily and regularly, avoid stimulants such as caffeine. Regular exercise like walking, jogging, swimming is good for reducing the physical effects of post-traumatic stress.

With time you may be able to access positive memories to counter-balance the negative ones.

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SIGNS AND SYMPTOMS Recurrent intrusive recollections of the event Changes in sleep (e.g. not being able to sleep, or wanting to sleep all the time) Recurrent vivid dreams about the event

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Feeling or behaving as if the event were happening again Changes in behaviour (e.g. short temper) Changes in feelings about yourself (e.g. feeling useless) Numbed responses Changes in work effectiveness (e.g. poor concentration) Reduced interests in the external world (e.g. feelings of detachment and estrangement) A sense if always needing to be ultra-alert

HOW CAN YOU HELP YOURSELF? Keep in touch with information about the event and any developments. This keeps the trauma ‘real’ and helps you come to terms with what has happened and how it has affected you.

It can be a relief to receive other people’s physical and emotional support, even though part of you might want to reject it as part of wanting to deny what has happened. Sharing with others who have had similar experiences can feel good, barriers can break down and close relationships can develop.

As well as being with other people, you will sometimes want to be alone in order to deal with feelings: privacy (as opposed to isolation) is important.

SOME DO’S AND DON’TS

A sense of being vulnerable, leading to a fear of losing control

Don’t

Avoidance of activities and/or places which arouse recollections of the event

Don’t bottle up feelings

Forgetting an important aspect of the event

Don’t avoid talking about what happened

Guilt at surviving, or for things not done

Don’t let embarrassment stop you giving others as well as yourself the chance to talk

Post-Traumatic Stress is different for a bereavement reaction (in that it is about a stress reaction to a perceived threat) although the two can occur together and interlink. It is also linked with depression, in that 30% of those in whom the condition is not recognised and dealt with early go on to develop depression.

HOW DOES YOUR BODY HELP YOU COPE? Numbness At first you may be numb because your mind will only gradually allow you to feel the experience. So the event may feel unreal, as if it couldn’t have happened to you. But as you allow your experiences to become more real in your mind, there is a need to think about the event, to talk about it, and at night to dream about it over and over again.

Don’t expect the memories to just go away. The feelings could stay with your for a long time.

Do Do express your emotions Do take opportunities to review the experience with yourself and others Do try to keep your life as normal as possible after the experience.

Activity To be active, maybe through helping and giving to others, may give some relief. And doing things routinely can give a sense if bringing life back to normal.

But both of these ‘natural’ ways of coping have inherent risks. Some people seek refuge in numbness by avoiding any remainder of the trauma - and so it is never dealt with. And over-activity is also a way of diverting attention from the fact that you might need help yourself.

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WHEN TO SEEK FURTHER HELP If you feel disturbed by intense feelings or body sensations that you can no longer tolerate If you think that your emotions are not falling into place, and that you feel very tense, confused, empty or exhausted If after a month you continue to be numb and do not have appropriate feelings, or you have to keep active in order not to feel distressed If you continue to have nightmares and poor sleep If you have nobody with whom to share your feelings with and you feel the need to do so If your relationship seems to be suffering, or sexual problems develop If you have accidents If you smoke, drink or take medication to excess since the event If your work performance suffers WHERE TO SEEK FURTHER HELP? Talk to a member of the Counselling and Wellbeing team. We can offer you an opportunity to try to understand your symptoms.

PTS can be associated with loss of cognitive skills such as the ability to think clearly, to conceptualise, to concentrate and to remember, so you may need to discuss how best to manage your work.

The NHS has specialised PTS clinics, which can be accessed through your GP. Your GP might also discuss whether medication might help you cope with some of the symptoms.

KNOW SOMEBODY WHO HAS EXPERIENCED TRAUMA? When someone close to you has been through a traumatic incident you may want to be supportive but it can be difficult to know what to do. The most important thing you can do is to offer to be there with them. Immediately after a trauma people are likely to be in shock and may not be able to talk about the incident or their feelings.

Be gentle, comfort them in non-verbal ways - warm sweet drinks are good, holding hands or touch, if appropriate - letting them know it’s OK to cry or rage or be silent if they need to. Being there is ‘doing’ a lot and listening if they do want to talk. Do not attempt to ‘debrief’ them with endless questions, as there is some evidence that this can reinforce the trauma and may make it harder to deal with later.

When your friend feels more like talking, being specific about the amount of time you have to listen to them can be helpful for both of you (e.g. I want to spend the next hour with you, but then I need to go and write an essay, phone parents etc.)

This allows your friend to relax, knowing it’s OK for that hour and that they are not burdening you, an understandable worry between good friends. Sometimes it may be quite harrowing to hear about what they have to say. If so, you may want to suggest that someone else may be better able to help them, such as a counsellor, doctor or chaplain. You can still continue to show your support in other ways, e.g. going along with them to make an appointment, meeting them for coffee, continuing to socialise.

HELPFUL HINTS Do: Ask them if they want to talk about it and offer a listening ear.

Respect their decision if they are not ready to.

Ask how you can be most helpful to them Offer help in practical ways (shopping, note-taking, child care etc.).

Encourage them to be gentle with themselves.

Encourage others to be patient

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DEALING WITH GRIEF

Do not: Tell them to stop crying, raging, feeling whatever they are feeling.

Tell them someone else is worse off.

Be afraid to mention the trauma for fear of upsetting them.

Pretend that nothing has happened.

Don’t take their anger or other feelings personally; they are part of the normal response to trauma.

Ask them lots of questions about the trauma directly after the event.

If you are worried that your friend needs help from a doctor, counsellor or other helping agency but is reluctant to go along with this idea, you can contact the University Counselling and Wellbeing Service for advice. We will do our best to support you.

‘Grief’ is the word we use to describe the feelings and reactions that we have when we lose someone we care about or something we value. Grief affects everyone: it is the universal reaction to loss. It is painful and stressful, but also natural, normal and necessary.

THOUGHTS AND FEELINGS There are no right or wrong reactions to death. We all need to grieve in our own way and in our own time. For some this might mean crying, for others not. For some this is likely to take months and years, for others not. Reactions and feelings can change from hour to hour, and day to day. Some days are good while others are bad; some days you’ll be up and others down again.

Over time the emotional swings will lessen in intensity as you learn to adapt to your changed circumstances, but to begin with it can be hard.

The following is a summary of the most common feelings: Shock and disbelief: It can take quite some time for news of the death to sink in. You don’t want to believe it - who would? You can’t believe it, not at first.

Loss: You’ve lost so much - the person, their love, their friendship, their companionship, intimacy, opportunities, hopes... and accompanying the loss can be a deep sense of sadness.

Guilt and regret: Maybe you regret having said that hurtful thing or not visiting the previous week as you’d promised. You feel bad for feeling angry. Some will feel “survivor guilt” - to be alive when another is dead. If the death was suicide, feelings of regret and guilt will probably be heightened. You might also feel shame or blame yourself.

Injustice: Why did s/he have to die so young? Why did this have to happen to me? It’s not fair!

Envy: You might envy others for having what you don’t have - the friend, lover, mother, father... that you have just lost. You could also envy others their apparently carefree lives.

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Anger: You might feel angry with the world or with people for: Causing the death Not being able to cure the illness

Restlessness: You may find it hard to relax and ‘switch off’. Your mind goes into overdrive trying to make sense of what has happened, especially when you are alone or in bed at night.

Exhaustion: Grief is stressful, and if you are also not sleeping or eating well, you are bound to feel tired and worn down.

Not understanding your feelings

Preoccupation: You might be so preoccupied with thoughts of the dead person that you imagine seeing or hearing her/him. (You are not going mad - this is quite common!)

Making thoughtless remarks Carrying on with life and having fun.

You might feel angry with yourself too, for what you did or did not do. But perhaps most difficult of all, you might feel angry with the dead person for dying and abandoning you and for the pain you are suffering as a result of their death.

Loneliness: Grieving can be a lonely process. You may feel that no-one can possibly understand what you are going through or that no-one cares. And you might have just lost someone who played a big part in your life. See Self-help Information > Loneliness Depression: Feeling low is a natural part of the mourning process. For a time you could lose interest in life and feel that there’s no point in going on. At worst you might feel despair. See Self-help Information > Depression Relief: You might feel relieved, especially if the death follows a long illness or if the person’s life has been reduced to a shadow of what it once was e.g. through advanced old age.

Despair: And finally you might feel as if it will go on forever, which of course it won’t.

You might wish to avoid such difficult feelings, but for the process of healing to occur (and it will, given half a chance!) the pain of grief has to be experienced and expressed.

Effect on Behaviour: Grief also affects our behaviour and functioning. You may find it affects you in some or all of the following ways:

Anxiety and panic: With so many powerful and unfamiliar feelings aroused, you might become anxious - that you’re going crazy (which you’re not) or that something terrible might happen. See Self-help Information > Top Tips for Stress Relief.

Inability to cope: You might find it difficult to cope with ordinary, everyday things like shopping, cooking, and your work.

Loss of interest: Things that were once a source of great pleasure to you now feel meaningless and tiresome.

Irritability: You might find yourself ‘snapping’ even if you are not the sort of person who normally reacts in this way.

Tearfulness: You might cry a lot; in fact, sometimes it’s all you can do. Crying can bring relief as it is an outlet for the emotions, tension and strain that have built up.

Other physical symptoms: Palpitations, nausea, dizziness, tightness in the throat and digestive problems - all can be experienced during grieving. If you are concerned, consult your GP. These are all normal and understandable reactions to bereavement and a natural part of the mourning process. Given time, support and understanding they will lessen and eventually disappear.

WAYS OF COPING

Loss of appetite: You might not feel like eating, or you may feel sick when you do.

Most of us have within ourselves greater reserves of strength than we are aware of.

Mostly we don’t need to call upon them, but when we are grieving we do. There may be times when you feel that it is all too much and that you can’t cope - but with the help of friends and these inner resources you will.

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Sleep disruption: You may find that you can’t get to sleep or can’t stay asleep, or that you wake early.

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The following can also help: Ask for help: It’s not always easy and it takes courage. Start by accepting that you need help. Ask someone you feel you can trust - a friend, a tutor, a chaplain, or a parent. It may make sense to seek counselling - many people get help following a bereavement.

Go easy on yourself: Don’t expect too much of yourself too soon - grieving takes time. Take each moment or hour as it comes. Concentrate on living through the present and don’t worry too much about tomorrow or next week. Give yourself credit for surviving each day.

The following can also help:

Talk about it - “get it off your chest”: It brings relief and helps you clarify and understand what has been going round and round in your head. It also helps counteract feelings of isolation. Again choose someone you feel you can trust. Even talk to a favourite pet. And, if you are a believer, talk to God.

Ask for help: It’s not always easy and it takes courage. Start by accepting that you need help. Ask someone you feel you can trust - a friend, a tutor, a chaplain, or a parent. It may make sense to seek counselling - many people get help following a bereavement.

Express yourself in some other way: If you don’t feel like talking, see whether you can write about your feelings and experience. Choose a form you feel comfortable with - a diary, letter, prose, poetry, song... If you can’t find the words to describe what you’re feeling try “speaking” about your experience through dance, song, painting, clay modelling... Let shape, form, texture, colour, rhythm be your words.

Talk about it - “get it off your chest”: It brings relief and helps you clarify and understand what has been going round and round in your head. It also helps counteract feelings of isolation. Again choose someone you feel you can trust. Even talk to a favourite pet. And, if you are a believer, talk to God.

Keep some mementos: Gather together some photos or jewellery, a piece of clothing, anything that helps you to remember the person who has died.

Remembering can be painful to begin with, but over time painful memories will be replaced by ones that can give you pleasure and comfort.

Get some exercise: This might be the last thing you feel like doing, but it will help.

Exercise uses up excess energy and it’s also a way of expressing some of the frustration and aggression you might be feeling.

Listen to music: Many people find music has the power to get through to us in a way that nothing else can. Choose music to suit your mood. At other times you may need to take your mind off the bereavement. Use music to help you escape for a time.

Take good care of yourself: You may feel you can’t be bothered or that there’s no point, but it will help. Eat well, bath or shower regularly and get the sleep and rest that you need. Some people attempt to block out their feelings using alcohol or drugs - but these only bring short-term relief and merely serve to postpone the process of grieving.

Trust yourself: Within reason, follow your feelings and reactions. If you want to be alone, or to go out and be with people, then do that. Remind yourself as often as you need to that ‘it is normal to feel the way I do’ following a bereavement. Acceptance allows your feelings to be expressed and understood - an important part of the healing process.

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Express yourself in some other way: If you don’t feel like talking, see whether you can write about your feelings and experience. Choose a form you feel comfortable with - a diary, letter, prose, poetry, song... If you can’t find the words to describe what you’re feeling try “speaking” about your experience through dance, song, painting, clay modelling... Let shape, form, texture, colour, rhythm be your words.

Keep some mementos: Gather together some photos or jewellery, a piece of clothing, anything that helps you to remember the person who has died.

Remembering can be painful to begin with, but over time painful memories will be replaced by ones that can give you pleasure and comfort.

Get some exercise: This might be the last thing you feel like doing, but it will help.

Exercise uses up excess energy and it’s also a way of expressing some of the frustration and aggression you might be feeling.

Listen to music: Many people find music has the power to get through to us in a way that nothing else can. Choose music to suit your mood. At other times you may need to take your mind off the bereavement. Use music to help you escape for a time.

Take good care of yourself: You may feel you can’t be bothered or that there’s no point, but it will help. Eat well, bath or shower regularly and get the sleep and rest that you need. Some people attempt to block out their feelings using alcohol or drugs but these only bring short-term relief and merely serve to postpone the process of grieving.

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Trust yourself: Within reason, follow your feelings and reactions. If you want to be alone, or to go out and be with people, then do that. Remind yourself as often as you need to that ‘it is normal to feel the way I do’ following a bereavement. Acceptance allows your feelings to be expressed and understood - an important part of the healing process.

Go easy on yourself: Don’t expect too much of yourself too soon - grieving takes time. Take each moment or hour as it comes. Concentrate on living through the present and don’t worry too much about tomorrow or next week. Give yourself credit for surviving each day.

BACK TO THE FUTURE After the initial shock most people begin, albeit slowly, to adjust to living without the person who has died. The time it takes to adjust is different for each person. The change is usually gradual, but over time you will feel less and less overwhelmed and preoccupied by the loss.

To begin with you may think about what happened and about the person who has died almost constantly, but in time you will begin to ‘forget’ - at first just for a few minutes, then for hours and eventually for days at a time. This is not a betrayal and it does not mean that you love them any Bereavement v2.1 Counselling and Wellbeing Service 19/06/2017 less. It is perfectly natural to not think about someone - we do it all the time with our living friends and family. People, living or dead, do not cease to exist for you when you stop thinking about them. You will always have your memories and the times you spent with them. Nothing can take that away from you.

In time you will be able to give your attention and emotions to others and begin to get on with the rest of your life. The goal of the grieving process is to learn to live with loss. As you grieve, life will slowly begin to feel meaningful and enjoyable once more. There will be times, though, when you are taken by surprise - a piece of music or a place may remind you of the person who has died and you will find yourself flooded by grief all over again. This, too, will lessen in time.

Special days or anniversaries, especially the first one or two after the death, can be difficult. Some people find it helpful to plan for these anniversaries and to mark them in some quite personal way.

also find that you are: More aware of your and others’ difficulties and needs More understanding than before More able to live with the often unanswerable question “why?”

Better able to cope with life’s knocks, especially losses of all kinds WHEN TO SEEK ADDITIONAL HELP If you are alarmed by your physical symptoms or if they persist – consult the Counselling and Wellbeing service or your GP. If your work is affected speak to your tutor or your director of studies or to your manager or someone from HR. You need them to be understanding at a time like this. It is quite possible that you won’t be capable of working effectively for a time following bereavement. It may be possible to shift deadlines or to lighten your workload in other ways for a while. If sleep disturbance persists, if your appetite or interests don’t begin to return to normal, speak to a member of the Counselling and Wellbeing team or your GP you may have become depressed and they can help.

If you feel overwhelmed by your feelings, particularly if you continue to feel hopeless and despairing and especially if you start to feel suicidal - contact the Counselling and Wellbeing service. An appointment can be made for you to see a counsellor quickly.

Talking to a counsellor can help you find your way through the painful and otherwise lonely process of grieving. All our counsellors are aware of the issues involved in bereavement and mourning and have considerable experience in this field.

OTHER SOURCES OF HELP Cruse: National charity for bereaved people in England, Wales and Northern Island https://www.cruse.org.uk First Response Service (FRS): A service to call if you are in mental health crisis Call 111, option 2

You will probably be changed by the experience of grieving. You might find yourself reassessing your priorities, values, beliefs, hopes, aspirations, friendships. You could

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EATING DISORDERS

Bulimia Bulimic people may well maintain their normal weight. The condition is characterised by:

WHAT ARE EATING DISORDERS? Eating disorders are often described as an outward expression of internal emotional pain and confusion. Obsessive thoughts about, and the behaviour associated with, food are maladaptive means of dealing with emotional distress which cannot be expressed in any other satisfactory way. The emotional distress is often to do with a negative perception of self, a feeling of being unable to change “bad” things about oneself: food is used as an inappropriate way of taking control.

Perhaps due to cultural ideas of what constitutes perfection, people often feel a strong desire to be thinner than their bodies naturally tend to be - “when I am thin everything will be alright”. They confuse who they are with what they look like. As a result they change their eating patterns and may as a consequence be at risk of developing an eating disorder.

An eating disorder involves a distorted pattern of thinking about food and size/ weight: there is a preoccupation and obsession with food, as well as an issue of control or lack of control around food and its consumption.

There are several recognised eating disorders which can be described as follows:

Anorexia Anorexic people starve themselves with the aim of losing weight to a point which others would consider to be very thin (although the sufferer is unlikely to perceive themselves as such). The longer the condition continues, the more difficult it can be to tackle, and in severe cases can necessitate hospitalisation and can even prove fatal. Sufferers are typically in their teens or twenties and most are women, although around 10% are male. The following are symptoms: Distorted perceptions of one’s weight, size and shape Behaviour which results in a marked weight loss A morbid fear of gaining weight or becoming fat

Bouts of eating followed by purging Distorted perception of own weight, size and shape A powerful urge to overeat, leading to binge eating and a resultant feeling of being out of control Compensatory behaviour such as self-induced vomiting; misuse of laxatives, diuretics or other medication; fasting; or excessive exercise A morbid fear of gaining weight or becoming fat

Compulsive eating Recurrent episodes of binge eating and consequent feeling of being out of control Marked distress about binge eating and the attempts to control it During a binge may: eat more quickly than normal; eat until uncomfortably over-full; eat large amounts when not hungry; tend to “graze” rather than eat meals; eat alone in secret; feel disgusted and guilty with oneself

Food deprivation Weight-loss accomplished primarily through extreme dieting, fasting or excessive exercise

Non-specified Other, but related difficulties with food include: Anorexic behaviour though still menstruating

Excessive exercising (while starving)

Anorexic behaviour where, despite significant weight loss, current weight is still normal

Cessation of periods in women

Someone of normal weight inducing vomiting or purging

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WHAT CHARACTERISES EATING DISORDERS? Apart from the characteristics described above, there are other fairly common features which are often present. Some are more likely to be recognised by friends rather than the person with the problem.

Preoccupation with thoughts of food so that diet and food become the central focus of one’s life A reliance on behaviour associated with food to deal with difficult emotions, stresses and tasks A desire for control over at least one aspect of one’s life Perfectionism Low self esteem from failing to meet expectations, which is then reinforced by the behaviour associated with the eating disorder, resulting in more self-disgust, shame and guilt, leading to lowered self-esteem Distorted thinking - e.g. when I am thin I will be able to cope with…

Secondary disorders caused by the behaviour - e.g. dental and digestive system damage, depression More women than men are affected Sometimes, difficulty in adapting to being adult and to being sexual HOW TO HELP YOURSELF The earlier help is sought the easier it is likely to be to change, but people do get over even very serious difficulties in time. The suggestions below may sound rather simplistic - in practice it usually helps considerably to talk about these with someone who is trained - and it may take some persistence!

example, are there difficulties in relationships or within the family, or events in your past that have hurt you and changed how you feel about yourself?

Challenge the distorted thinking. Although you may still think of yourself as overweight, at least allow yourself to recognise that others may see you quite differently, or even that they may be disinterested in your weight and just see you for who you are.

Develop a pattern of eating that suits you and keeps you healthy. This isn’t the same as saying develop a rigid routine of eating that cannot be varied! Maintaining a generally balanced diet is important, but allowing yourself to party (and break the rules’) is also OK sometimes!

Accept your body, i.e. respect your body regardless of it’s current shape or size; set realistic expectations for changing it; recognise and understand its strengths and limitations. Recognise, too, that your body is not the same as your identity confidence and personal contentment can be present however you look.

Don’t keep it a secret any longer - and it is unfair to expect a friend to keep secrets for you. Rather, seek support in dealing with the disorder from a professional helper or a self-help group.

HOW TO HELP A FRIEND WHOM YOU SUSPECT HAS DIFFICULTIES WITH FOOD Remember that your friend is a person first, and someone who has difficulty with food second. So continue with whatever activities you would normally engage in together, and don’t let issues of food dominate the friendship.

Tell them of your suspicions - and be prepared for them to deny it

Acknowledge that the problem exists!

Be supportive and encourage your friend to seek professional help. Ultimately, the problem is your friend’s; if they won’t seek help the consequences will be theirs. Your responsibility is only to encourage them to seek help, or, in more extreme circumstances, to alert others - even against your friend’s wishes.

Rather than just trying to tackle the unhelpful behaviours connected with food, try to identify what the eating disorder is disguising or helping you avoid - for

Don’t nag about food, spy on your friend or get inveigled into imposing some form of external monitoring or control.

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Be available to listen when your friend can express his/her distress, but don’t take on more than you can comfortably cope with. We all have limits - of knowledge, ability to help, understanding, time, etc. - so offer the level of support you feel able to sustain. If you try to offer more than that, you are likely to feel burdened and in time, perhaps, annoyed or angry, which is unlikely to help either of you, or the friendship.

Look after yourself! Maintain your normal range of friendships and balance in your activities. Don’t let this one issue take up all your time.

If you are unsure whether your style of supporting your friend is actually helpful, or are quite concerned for your friend, you can seek out a professional (such as a counsellor) yourself, just to check out these things.

WORRIED ABOUT A FRIEND? If you are a student worried about the emotional and mental health of another student or friend, this leaflet is for you. It offers practical guidelines about what you can do in the situation and what help is available for you and your friend, on and off the Cambridge and Chelmsford campuses.

WHAT CAN I EXPECT?

You’ve noticed dramatic changes in your friend’s appearance e.g. weight loss/ gain, decline in personal hygiene You’ve noticed changes in, or heightened, mood e.g. more sad, withdrawn, hyperactive, aggressive Other friends have expressed concern about your friend You’ve noticed recent changes in behaviour or attitude e.g. towards work, friends, commitments You are concerned about the safety of your friend

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Try not to avoid the situation and try to talk with your friend and tell them you are concerned. If they don’t want to talk, respect their privacy.

Be prepared to listen sympathetically and show that you understand your friend’s predicament. Listening can be very effective and may be all that is needed. You don’t have to come up with solutions.

Try not to take responsibility for your friend’s problems and be aware of what you can take. Being with someone in a personal or emotional crisis is exhausting and time consuming.

Decide in your own mind how much help you are able to give to your friend in this particular situation. Setting limits on the time you are prepared to give can be helpful and may reassure your friend that they are not over burdening you. Taking on too much, usually not sustainable, is unlikely to help you, your friend, or your friendship in the long run.

Involve others where possible so that your friend has support other than you which may ease the pressure.

Look after yourself which means giving time to your own needs and priorities, including study. Don’t forget your other friends and accept any support for yourself.

Accept that you will have mixed feelings about the situation and your friend. It is common to feel frustrated and angry as well as sympathetic.

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HELPFUL THINGS TO DO

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Encourage your friend to seek professional help, if this is appropriate, and suggest who they can contact. You can offer to go with your friend which may help if they are feeling scared.

If your friend refuses help and you’re still worried and feel you need to tell someone, try to get your friend’s consent. If you don’t have this you can still get advice and help for yourself by talking to a personal tutor, a counsellor or someone you trust without revealing your friend’s name.

If you are seriously worried about your friend’s safety or that of others you may need to talk to someone or act without their consent.

Do look after yourself and get appropriate help and support from others.

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CONTACT US

To arrange an appointment for counselling: Phone 01245 686700 or 01245 686701 Email wellbeing@anglia.ac.uk Visit anglia.ac.uk/wellbeing Drop in and see us: Cambridge HEL341 Chelmsford 2nd Floor, Tindal Building

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To contact the Students’ Union Advice Service: Phone 01223 460008 (Cambridge) 01245 258178 (Chelmsford) Visit angliastudent.com/advice

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CONFLICT MANAGEMENT Everyone comes up against difficult people, demanding situations and disappointing circumstances in every area of life - including studying, work, house or flat sharing and friendships, the most common sites of conflict for students.

WHAT CAN YOU DO IF YOU FIND YOURSELF IN ONE OF THESE DIFFICULT SITUATIONS? Doing nothing in the hope that the problem will just go away is worth a try, but this usually only postpones the problem. Also, the downside of this option is that resentment and anger can build up in you, you explode, and then you are perceived as the difficult person.

Talk to someone you can trust, either someone who is part of the situation or someone outside, like a counsellor. Friends and family back home can also be helpful.

The very helpful thing about talking to someone else is that you can get a reality check - is this person really being difficult or is there something about them or the situation that is pushing one or more of your buttons? That is, you are responding as if to previous conflicts in a way that is not appropriate for now? That bossy house mate is not your mother, sister, father, brother, your old teacher or your ex.

If you are away from home for the first time, you may also be living for the first time with people who are different in every way from the people you grew up with, and it can be very uncomfortable to have basic assumptions about everyday living challenged. Can it really be that others do… or never?

You’ve looked at the situation thoughtfully and decided there is really something that needs addressing. This means someone needs addressing, and the best way to start is by talking to them on their own. And not when you’ve just had a confrontation!

Decide what you want to get across during the conversation and what action you want to come out of this talk, but make absolutely sure that you give the other person the chance to get their point of view across too.* Understand that you may not get everything you want, but know what is the minimum that is acceptable to you (for example, politeness or consideration for your feelings). If this doesn’t work, arrange another meeting, with a ‘referee’ that you both trust, who can keep you both on track and cool things down if necessary. You might prefer to write a letter to the person concerned.

If things turn more serious, and enter the realm of harassment, bullying or victimisation, then you have to turn more serious too. Keep records detailing witnesses, times, dates and a full description of events and ask for help from the Students’ Union.

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KEEPING CALM UNDER PRESSURE

TOP TIPS

1 Walk away

You do not have to stay and explode. You can talk later when you have calmed down and thought about what you have to say.

2 Walk away in your head

If you cannot walk away physically visualise a real or imaginary place that is safe and peaceful for you. Do this for 10 seconds or more.

3 Breathe deeply

Slowly and steadily. This will calm you down.

4 Count under your breath

Before speaking. This gives you time to calm down and think about what you want to say before you react. The higher the number the more time you get.

5 Act calmly

Speak quietly, relax your body and suggest that you talk about it later.

6 Talk yourself down

Tell yourself - stay cool, calm down, easy does it. Remind yourself that you can stay in control and that getting angry doesn’t resolve anything.

HOW TO BE ASSERTIVE Most people find it difficult to be assertive at one time or another but some of us find it very hard to assert ourselves even when we really want to.

In this leaflet we will look at some of the underlying assumptions about self-assertion and also think about some techniques which can be practised and which will help you to be more assertive in your daily dealings with other people.

A COMMON FALSE ASSUMPTION Many people wrongly believe that being assertive is the same as being aggressive.

Nothing could be further from the truth. If we look at the assumptions underlying the two kinds of behaviour it will help us understand a great deal about the difference between self-assertion and aggression.

AGGRESSION The underlying feeling when we are being aggressive is one of insecurity (‘I am not ok’) - this feeling of insecurity is covered over with aggression. The person who is being aggressive is feeling pretty insecure but pretends he or she is not (‘I am not ok but I pretend I am ok’). He/she sets out to intimidate. The other person is made to feel inferior and because of this the aggressive person may achieve what they want, but they will do so at the expense of the other person and will thus create bad-feeling. This is not good either in personal relationships or in any kind of professional relationship.

Here is a diagram of the underlying feelings in aggressive behaviour

7 Adjust your thinking

Remind yourself that the other person may not be trying to make you angry or obstruct you, and may not mean you any harm. They simply have different needs and feelings from you in the situation.

Agression

8 Be assertive

Getting what you want at the expense of others

Tell the other person clearly, calmly and in a way that is not aggressive how you are feeling and what you want in the situation. By doing this you are taking control of yourself and your anger and are less likely to explode or get violent.

When you feel you are about to blow your top, remember - It is okay to feel angry, but you do NOT have to act on it.

Try to look big

Defensiveness

Pretend I’m OK and make you feel you’re not

Low self esteem

Lack of confidence

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ASSERTION The underlying assumption here is that the other person is a reasonable person and that I, too, am a reasonable person and that if I state my case clearly and in a reasonable and respectful manner then the other person will respond in a similarly reasonable manner. With this attitude I will probably get what I want and the other person will be pleased to have been treated in a respectful way. The trick here, if you are feeling frightened of being assertive, is to take the risk, say to yourself, ‘I have a right to make this statement and I expect the other person will respect my right.’

(Take a risk and believe ‘I am ok’ and say to yourself ‘and you are ok too’).

what they want, (if it is not at the other person’s expense) and that the other person has an equal right to discuss the issue and to assert their point of view. This is where negotiation comes in. We will come to that after learning some self-assertion techniques.

Here is a diagram of the underlying assumptions in passive behaviour Passivity

Allowing myself to be used

Here is a diagram of the underlying feelings in assertive behaviour

Assertiveness

Assume you’re OK and I’m not

Not getting what I want

Lack of confidence No need to play roles

Low self-esteem Take risk and believe I’m OK and you’re OK

Getting what I want

Confidence

TECHNIQUES IN LEARNING TO BE ASSERTIVE First of all learn and practise experiencing the difference between Passivity, Aggression and Assertion. Here is an exercise which will help you feel the difference between passive behaviour, aggressive behaviour and assertive behaviour.

High self-esteem

A COMMON MISTAKE A common mistake in people who fear being assertive is to allow themselves to be used - to be passive. To allow the other person always to get what they want. The underlying assumption here is that the other person ‘is ok’ and has a right to whatever it is they want, but that I am nobody - I am not someone with any rights - ‘I am not ok’. With this way of thinking, the other person gets what they want, but they do not respect you because you have not respected yourself. Mutual respect comes from each person respecting themselves, understanding that they have a right to assert

With a friend, think of an example of a difficult or compromising human situation and then practise responding firstly in a passive way, then in an aggressive way, and finally in an assertive way. Here is an example: You are standing in a long queue at the cinema. When you are near the front an acquaintance from college approaches you and asks you to buy tickets for her.

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Here are some other examples of difficult situations. Practise responding first in a passive way, then in an aggressive way and finally in an assertive way.

You have a brand new expensive bike. Someone you don’t know very well asks you if they can borrow it. What would you reply?

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You are in a seminar with someone who addresses the men by their names but who calls the women ‘dear’ when calling upon them to make a response. How would you respond to this situation?

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You have been working jointly on a project with another student. That person suddenly says they have to go and do something else and asks you to finish the project on your own. What is your response?

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The person next to you is chain-smoking which you find annoying. That person is about to light up another cigarette and turns to you and says ‘You don’t mind do you?’

What do your reply?

TECHNIQUE 1 THE THREE STAGE MESSAGE Use this technique when you want to negotiate a specific change in somebody’s behaviour - particularly if you find them uncooperative or intimidating.

1 Begin by owning your own thoughts and find words to express them.

Make an ‘I’…. statement, rather than a ‘you’ statement. A ‘you’ statement provokes defensiveness and aggression. For example: ‘I feel tired and I want to spend some time on my own’ is more assertive than: ‘you are invading my privacy’.

2 Identify the behaviour you find unacceptable. Be very specific. ‘When you get

angry with me’, or ‘when you start throwing your weight about’ is too vague and sounds insulting. Think what it is that really gets you - the shouting, a gesture?

Think this out in advance and state the effect the behaviour has on you. The more specific you can be, the less likely it is the other person will take offence: e.g. ‘When you wag your finger at me . . .’

Ask for the change you want.

Examples: ‘I feel like a child when you wag your finger at me. I would like you to keep your hands still.’

‘I couldn’t sleep last night because of your music. Please could you not play music after 11pm?

Even if the person is not prepared to fit in, you may well find that you’re having drawn attention to it very specifically will reduce it.

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Think of an example in which you would like a change in someone’s behaviour and practise the Three Stage Message.

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Once you have yourself experienced practising the difference between a passive response, an aggressive response and an assertive response you are ready to learn some useful techniques which will help you make an assertive response.

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TECHNIQUE 2

TECHNIQUE 3

THE RECORDED ANNOUNCEMENT TECHNIQUE IN ACTION

NEGOTIATION

This is a very useful technique. It enables you not to get distracted - to keep your focus. It helps you not to get caught on: Manipulative bait

When you negotiate you make use of both the above techniques i.e. The Three Stage Message - (taking ownership of your own thoughts and feelings, identifying what you want clearly and then asking for the change you want) - and The Recorded Announcement Technique - repeating the desired outcome.

Irrelevant logic

When you are negotiating:

Argument Here is an example of how the Recorded Announcement technique might work: You might try role playing this dialogue with a friend and take turns playing the two parts.

Ann comes up to the cheese counter in a shop and says: Ann: I bought this cheese today. When I opened it I found it was mouldy. I want my money back please.

Shopkeeper: (using irrelevant logic) Nothing to do with me I wasn’t serving.

Ann: I bought it at this counter, it is inedible and I want my money back please.

Shopkeeper: (argument) That sort of cheese is meant to be mouldy.

Ann: I know what kind of cheese I buy. This is bad and I want my money back please.

Shopkeeper: (using manipulative bait) Look there’s a queue of people waiting behind you. It is not fair that they have to wait.

Ann: I can see there is a queue, but I bought this cheese today. It is inedible and I want my money back please.

Shopkeeper: (Seeing she has been cornered) Oh, all right! How much was it then?

Practise the Recorded Announcement Technique with an example of your own. ........................................................................................................................................................................ ........................................................................................................................................................................ ........................................................................................................................................................................ ........................................................................................................................................................................

1 State your case in as few words as possible. (The Three Stage Message).

2 Listen to the other person and acknowledge what they say. Try to understand

what it feels like to be in their shoes.

3 In the face of aggression or strong opposition, keep calm and repeat your state-

ment in the same words. (The Recorded Announcement Technique).

4 If there is a sense that you are both behaving assertively, negotiation should

come easily. Assertive statements and responsive listening lead to this.

Here is an example. Sally has decided to drop out of a Choir tour because she and her boyfriend have split up and she prefers not to go on tour. She goes to speak to the Director of Music about her decision.

Sally: Thanks for meeting with me. I suppose you’ve heard I’ve broken up with John. I hope you’ll understand that I have changed my mind about going on the choir tour.

Director of Music: I heard you two had broken up but surely you can still come on the tour. You are both such valuable members.

Sally: I can see that you are really disappointed about my decision not to come and I am really sorry to let you and the choir down. But I feel that I really cannot commit to the tour.

Director of Music: I was depending on you, you know, Sally.

Sally: I can see that you are really annoyed and angry about this. But I have thought it through carefully. I am really sorry but I cannot commit to the tour. But of course I will be there on Sundays and weekday practices.

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Director of Music: And the Festival concert?

ASSERTIVENESS MEANS

Sally: Yes, I’ll commit to that.

1 Respecting myself, that is who I am and what I do.

Director of Music: OK. I guess I’ve got some keen reserves who would like to do the tour. Thanks for being straight with me.

2 Taking responsibility for myself, that is for how I feel and what I think and do. For

Think of a situation in which you have had to present someone with a decision you have made and in which you might have used negotiation skills such as those demonstrated above. Or think of a fictional example where you need to negotiate with another person.

3 Recognising my own needs and wants independently of others, that is separate

Set up a dialogue in which you role-play the situation bearing in mind the four points made above.

4 Making clear the “I” statement about how I feel and what I think. For example,

*If the other person raises a distracting side issue, acknowledge it, without being deflected from your purpose. Say something like: ‘We can talk about that as soon as we settle this.’

5 Allowing myself to make mistakes, that is recognising that sometimes I will make

If the other person does not seem to be hearing or understanding, ask them to repeat back what you have said. Say something like: ‘What do you think I am asking you to do?’ *Even if compromise cannot be reached, at the very least state your feeling about the situation. You may both feel justifiable anger. In such cases don’t forget to congratulate yourself on your courageous effort, because it can easily be overshadowed by the disappointment of not getting what you want.

Role play with a friend an example of negotiation ........................................................................................................................................................................ ........................................................................................................................................................................ ........................................................................................................................................................................ ........................................................................................................................................................................ ........................................................................................................................................................................ ........................................................................................................................................................................ ........................................................................................................................................................................ ........................................................................................................................................................................ ........................................................................................................................................................................

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example, “I feel angry when you put me down” is more assertive than “You make me feel angry when you put me down”. from what is expected of me in particular roles, such as ‘wife’, ‘husband’, ‘lover’, ‘daughter’, ‘son’.

“I feel very uncomfortable about this decision”. “I think that it is a good idea to draw up a plan of action”. a mistake and that it is OK to make mistakes.

6 Allowing myself to enjoy my successes, that is validating myself and what I have

done and sharing it with others.

7 Changing my mind, if and when I choose to.

8 Asking for “Thinking it over” time. For example when people ask me to do

something and I need time to consider whether or not to do it, “I would like to think it over and I will let you know my decision by, say, the end of the week”.

9 Asking for what I want rather than hoping someone will notice what I want and

moaning later that I didn’t get what I wanted.

10 Setting clear boundaries. For example, “I know that you would like me to visit

you, and thank you for inviting me. I am, however, unable to come this weekend and would like to visit you later in the year”.

11 Recognising that I have a responsibility towards others, rather than being

responsible for others. As adults we have responsibility for and towards our children which is different from having responsibility towards each other as adults.

12 Respecting other people and their right to be assertive.

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Capacity for boundaries It is easy enough to see that people are separate individuals physically, or in their area of study for instance. Sometimes though, we can forget that it is unrealistic to expect others to think as we do, be able to solve all our problems or meet all our needs. We are not “joined at the hip” as the phrase has it.

OTHER SOURCES OF HELP Birch, C., Asserting Yourself Lindenfield, G., Assert Yourself Rosenberg, M. B., Nonviolent Communication

Operating mainly in the present Once relationships focus on repeatedly picking over past events, or else are based only on the hope that things will be better in the future (ignoring how unsatisfactory things are now), they tend to go off the rails.

Berne, E., Games People Play

RELATIONSHIPS Relationships are central to our lives. If you think about it for a moment we are all in a relationship of some kind with other people from the moment we are born. It follows that relationships of all kinds are of great importance, and indeed help to shape and develop our own personalities. Problems with relationships arise for most people at some time in their lives and this is one of the most common areas of life that people come to counselling about.

Just getting on with your house mates or the people you work with can be difficult or stressful at times. However, probably the most important of our relationships are with our family or the intimate relationship with a partner or valued friend. These can be a great source of love, pleasure, support and excitement. However, they can be a source of grief and anguish if they go wrong.

The issue is made more relevant for students by the fact that most people in a university are in a period of personal change, which can make them feel less sure of what they want or how they can expect others to react. There is, of course, no exact fail-safe recipe for getting it right, but there are some areas common to most relationships that it is helpful to consider.

Respect for individual choice Try and accept that each person has the right to decide their own direction in life; the relationship then adapts to follow this.

Skill in negotiating Where interests diverge, good listening to the other, and clarity about what is important to you will help you to work out a way to settle differences in opinion or fulfil different goals.

Sharing Positive feelings An important point! Don’t only communicate when you have a grouse. Let your family members, friends and partner know they are important to you. Nobody likes being taken for granted.

If we have become overanxious about our relationships this may be because we have lost our own self-respect and sense of our personal worth; it may be because we have had unfortunate experiences in past relationships and so have temporarily lost our ability to trust. It could help to think things through with a sympathetic and unconnected person who will not tell you what to do but help you to clarify your situation and find your own way through.

The Counselling and Wellbeing Service is staffed by friendly and experienced people who will listen without judging.

Acceptance of difference Generally speaking, people in successful relationships do not try to force the other to be exactly like them; they work to accept difference even when it is profound. Cultural and religious beliefs, especially if strongly held, are two areas which can cause tension, and this can extend to the families of the individuals concerned.

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OTHER SOURCES OF HELP

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Books W. Dryden & J Gordon, How to Cope with Difficult Parents R. Skinner & J. Cleese, Families and How to Survive Them

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J. Trollope, Other People’s Children

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H. Lerner, The Dance of Intimacy

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H. Lerner, The Dance of Anger

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M Beattie, Codependent No More

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Dickson, The Mirror Within

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A Dickson, A Woman in Your Own Right

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R. Norwood, Women who Love too Much

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CONTACT US

To arrange an appointment for counselling: Phone 01245 686700 or 01245 686701 Email wellbeing@anglia.ac.uk Visit anglia.ac.uk/wellbeing Drop in and see us: Cambridge HEL341 Chelmsford 2nd Floor, Tindal Building To contact the Students’ Union Advice Service: Phone 01223 460008 (Cambridge) 01245 258178 (Chelmsford) Visit angliastudent.com/advice

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Counselling and Wellbeing Opening Times Monday to Thursday, 9.00am - 5.00pm, Friday, 9.00am - 4.30pm Last appointments are one hour before closing.

Drop in and see us Cambridge: 11.00am - 12.00 noon and 2.00 - 3.00pm (not available June, July and August) Chelmsford: 11.00am - 12.00 noon CONTACT US

To arrange an appointment for counselling: Phone 01245 686700 or 01245 686701 Email wellbeing@anglia.ac.uk Visit anglia.ac.uk/wellbeing Drop in and see us: Cambridge HEL341 Chelmsford 2nd Floor, Tindal Building To contact the Students’ Union Advice Service: Phone 01223 460008 (Cambridge) 01245 258178 (Chelmsford) Visit angliastudent.com/advice