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Single Step The leading charity in England for people affected by depression

Summer 2011

Holistic health Our minds and bodies are intimately linked, so why aren’t our services?

Straight talking Is CBT the right treatment for you?


Welcome to Single Step A journey of a thousand miles begins with a Single Step In this issue we have contributions from…

About us We are the leading charity in England for people affected by depression. Through our vital information and support services we work to relieve and prevent this treatable condition so that no one has to go through it alone. We also campaign to raise awareness of depression to make it a public priority.

Join Depression Alliance • Be part of our national body of people who live with depression • Receive a free copy of Single Step every quarter • Influence national developments on depression and be part of the movement to break the stigma • Find a self help group in your area or set up a new one • Access to our unique online resource What you should know about depression, for symptoms treatments and therapies • Exclusive access to our personalised penfriend service Joining DA costs £2 a month by direct debit (or £24 a year) or £5 a year if you are unwaged or on benefits. We’d love you to join us so please email the team for a membership form or you can find one at the back of this issue. For more information you can also visit us online at www.depressionalliance.org

We’d love to hear from you! We welcome contribtions to Single Step. In the first instance, please submit any item or proposal for any item to our London office or by email to laura@depressionalliance.org Disclaimer Depression Alliance has tried to ensure that the contents of this magazine are accurate. Depression Alliance takes no responsibility for the content of articles or adverts reproduced and this should not be taken as an endorsement of any kind.

Tünde Vanko Clinical Psychologist

Michelle Mitchell Charity Director at Age UK

Dr Gabrielle Samson Chartered Clinical Psychologist

Agi Rajna Personal Trainer

Allie Cairnie Relational counsellor

This issue

When I’m in the waiting room of my local surgery I like to play a little game called ‘what are they here for?’ Helps pass the time. The mums with babies I decide are probably here for check-ups and inoculations. Older man with a walking stick maybe being seen for a dodgy hip, and stony-faced young couple I’m guessing here for emergency contraception. Likely to be someone with depression and anxiety but I know it can equally be the person we least suspect, so I choose the man in the suit chatting to the receptionist. As is human nature, we like to categorise and put people in to boxes; it helps us make sense of the world. I chose someone for help with depression and someone for help for his hip, but of course things are always more blurry. Physical and mental health issues don’t fit so neatly in to separate boxes, and whilst we work away in our different areas it’s easy to forget how closely the two are intertwined. In fact, people with long term conditions such as heart disease and diabetes are more than twice as likely to suffer from depression. In our feature on holistic health we take a closer look at the ways our minds and bodies are linked and we meet Simon, who shares his story on what it means to manage diabetes alongside depression. We’re also kick-starting our new feature on talking therapies. The Manchester conference in June laid out the action plan for the Government’s Improving Access to Psychological Therapies (IAPT) programme, so we thought it’d be apt to start the series with a look at Cognitive Behavioural Therapy (CBT). Despite being favoured under the programme, CBT continues to divide opinion amongst DA members so we take a look at what it’s really like and hear from those involved in delivering and using it. Thank you so much to everyone who shared their thoughts with us on the new look Single Step and we’re thrilled it’s been so popular. We know change isn’t always easy, but keep talking to us and telling us what you want to see in Single Step and we’ll keep on getting better and better! Laura Sacha laura@depressionalliance.org

Contacts Depression Alliance 20 Great Dover Street London SE1 4LX T: 0845 123 2320 E: info@depressionalliance.org W: www.depressionalliance.org Trustees Chair: Alison Lawrence Company Secretary: Malcolm Johnston Alan Clayton Lynsey Conway Kevin Lewis Professor Chris Thompson

Staff Chief Executive: Emer O’Neill Finance & IT Coordinator: Michael Beaven Employment & Wellbeing Team Leader: Hannah Manser Employment & Wellbeing Coordinator: Emily Wheeler Time Bank Coordinator: Allie Cairnie Time Bank Coordinator: George Redmayne Membership Services Coordinator: Laura Sacha Appeals Manager: Rupert Young Office Administrator: Simon Bartley Publications/Support Volunteer: Julia Cosby Office Volunteer: David Mark

Thanks Thank you so much to our volunteers across the country, without whose hard work and dedication we would not be able to offer the support, information and understanding that people affected by depression so urgently need and deserve. Credits Editor: Laura Sacha Design: Bananadesign Ltd Print: Stephen Austin


Contents Summer 2011 12 Holistic health Our minds and bodies are linked, so why aren’t our services? We’re calling time on the depression epidemic amongst people with long term conditions

“It was emotional support that I’d needed right from the minute I was diagnosed with diabetes”

4 News

8 Straight talking

4 News Catch up with all the news from DA

6 Have your say DA groups share their ideas on creating uplifting and inspirational self help sessions

8 Straight talking Our guide to talking therapies takes an inside look at CBT

10 Relationships Sibling rivalry and why it’s never too late to overcome it

12 Holistic health 10 Relationships

15 Online counselling

Our minds and bodies are linked, so why aren’t our services? We’re call time on the depression epidemic amongst people with long term conditions

14 Ask the experts Age UK’s Michelle Mitchell on supporting an older person with depression

15 Technology time Online counselling – the good, the bad and the disinhibited?

16 Lifestyle Your guide to what’s on and what’s out there. Step in to summer with our guide to fitness in the great outdoors

18 Your magazine, your letters


Race inequalities remain unchanged Institutional racism in mental health services remains a concern, according to a new report by the thinktank RawOrg (Rights and Wellbeing of Radicalised Groups). The Government’s 2005 Delivering Race Equality strategy has failed patients from black and minority ethnic communities, in a system that continues to disempower and stereotype. In the report entitled The end of delivering race equality? RawOrg compiles views and figures from key workers and patients, revealing that effective help is still unavailable to many and that more time is needed to bring about fundamental change. Diverse Minds Manager at Mind Marcel Vige commented, “The goals outlined by the DRE have not been realised but valuable lessons have been learnt. It’s vital that the Government’s new mental health strategy makes addressing racial inequalities in the mental health system a priority.” Download the full report from Mind at www.mind.org.uk

Latest news Going up

11 May saw over 5,000 people led by The Hardest Hit march through London to protest against disability benefits cuts.

The Neville Golf Club in Tunbridge Wells tee off to raise an incredible £12,000 for Depression Alliance.

Depression Awareness Week 11–17 April 2011 We had our biggest and best week yet, kicking off with a great start from our very own Chief Exec Emer O’Neill, who appeared on BBC Breakfast and was interviewed on BBC Radio 5live. DA member Karin Donnelly shared her experience of depression on BBC Three Counties Radio, while Sue Atkinson raised a fantastic £100 at her First Steps out of Depression workshop in Croydon. Croydon was also the setting for Afternoon tea and alternative therapies, organised by members of the Employment and Wellbeing project, whereas coffee and cake was the order of the day for the R.E.S.T Rugby self help group at their coffee morning. Helen Kitchen got her local town of Bromsgrove talking as she hosted an information stand to raise awareness of depression, and surgeries pharmacies and hospitals across the country handed out DA leaflets and magazines to their patients. Finally, the Let’s hear it for depression gig in Folkestone ended the week on a high note, along with Eden and Noah whose gig rocked Newport Town and raised awareness and money for Depression Alliance. Thank you so much to everyone who got stuck in and added their voice to our campaign for change. We’ll see you all again next year!

Gok Wan and DA’s Rupert Young lead a lesson in body confidence at Westminster for ‘Get Your School on Board’ movement. Benefits statistics are causing fear and demonization of legitimate claimants, according to Rethink. 77% of female and 61% of male mental health inpatients in England still don’t have access to single sex wards, despite it having been government policy since 2005.

Going down

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The Big Picnic for Depression Alliance Employment & Wellbeing project May saw the launch of DA’s latest innovation; the Kensington and Chelsea Employment and Wellbeing project. We’re inviting local people from all different walks of life to come together, united by the common thread of depression. The concept is a simple one and is based on what DA members tell us time and time again; nothing beats knowing that you have the support and understanding of those who’ve been in that lonely, frightening place that depression can take you to, no matter how good your relationships with GPs or therapists. Staff behind medical services in Kensington and Chelsea have listened to the local people, recognised this human need and are fully behind DA in setting up the

project and rolling it out across the borough. We want to make sure local people can come together to access fun, sociable and uplifting events. We’ll also be working with them to set up a time bank, so people can learn new skills, trade knowledge and experience and receive basic jobs and services for free. We’ll then step back so members can develop the project themselves. If you’re a Kensington and Chelsea resident and would like more information please contact George Redmayne, time bank and social events coordinator: 07976 244589 or george.depressionalliance@nhs.net

A call to action on depression and long term conditions Did you know that people with long term conditions such as diabetes and heart disease are more than twice as likely to suffer from depression? Depression Alliance will be collaborating with leading healthcare organisations throughout July to campaign for better management of depression in people with long term conditions. Turn to page 12 to find out why we’re calling time on this hidden epidemic.

Our first annual Big Picnic went off with a bang, with DA members kicking off their shoes and rolling out the rugs throughout the month of June. The Big Picnic is all about bringing people together for some fun in the sun to raise awareness of depression and to boost our mood and wellbeing. Thank you so much to everyone who took part in picnics all across the country from Stratford upon Avon to Surrey, London to Winchester.

Caroline from Leicestershire hosted her first DA picnic. “We had great fun and got stuck in to rounders, quoits and then a go on the space hoppers! You don’t need a big group and I’d encourage everyone to picnic in their own way and have some fun. I think the most common comment at the end of the day was “When’s the next one?”

Latest NHS survey suggests stigma lifting 77% of people believe that mental illness is an illness just like any other. It’s a message DA has been shouting loud and clear, but the latest NHS survey Attitudes to Mental Health 2011 shows our voice is finally getting out there. 77% would feel comfortable talking to friends or family about their mental health, but it seems some of the old stigma still prevails, with one in six people believing that one of the main causes of mental illness is a lack of self-discipline and will-power. Considering one in four people will experience a mental health problem each year, it seems we’ve still got a big challenge ahead.


Have your say Looking for ways to boost your self help group? Want to get more out of your meetings? We asked Depression Alliance self help groups to share their tips and ideas on creating inspiring and uplifting sessions Cognitive behavioural techniques If you’re looking to explore self help techniques we can recommend the online course Back from the Bluez. It’s well structured, easy to use and suitable for small to medium sized groups. There are nine modules to work through in sequence such as self management, unhelpful thinking and core beliefs. Each one includes printable worksheets, easy to understand information, suggested activities and exercises. In each session a group member introduced the topic. We then worked on individual exercises before coming back together as a whole group to discuss the findings. We found the sessions lively, fun, challenging and sometimes emotional. We found the techniques quick to learn and applicable to all life’s problems. Some comments from our members include, “I thought I was the only one who thought like this” and “it was useful because it deals with the here and now and it feels like I’m taking an active part in my recovery”. Back from the Bluez can be down loaded from www.cci.health.wa.gov.au by clicking on the Workbooks link. Shibden self help group

Confrontation and saying no We started off as a whole group by identifying and discussing the feelings and fears associated with saying no to people. For example, not wanting to appear unkind, not wanting to hurt the person with a rejection and not wanting to feel guilty. We pooled our ideas about situations that were difficult for many of us, which felt like such a relief and even funny at times as we shared lots in common. For example, a friend asking for childcare when we’re very busy, or a colleague assuming you’ll take care of something just because you offered once in the past. Our discussion at the start of the session helped us to realise by the end that saying no to something, usually for good reason would help us to say yes to something else, which could be better for us personally. We came away with a stronger sense that we don’t always have to put other people first. Woking self help group

Have you got any other tips? Write and let us know…

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Single Step Summer 2011

Out and about Try organising at least two group outings a year, maybe a summer picnic and a Christmas party. Socialising away from your usual group venue can really help people bond, get to know each other and have fun.

Shyness As a group we looked at ways of managing and accepting our shyness. We started off by exploring some alternative words for shyness (keep a thesaurus on hand!). We felt that the word ‘shyness’ was usually used in a negative way, but considering the alternatives made us think about some of the positive aspects. For example, reserved, modest, demure, wary, bashful, etc. We then split into groups, but you can also do this as a whole group. We wrote down the following questions and explored them together. ● ● ● ● ● ● ●

do you consider yourself to be shy? what do you attribute this to? do you think shyness has held you back? do you avoid certain situations because of shyness? does shyness become more manageable with age? any tips for overcoming shyness? any positives to being shy?

To finish, think about a typical example. You’re at a party where you only know the host. She introduces you to a group of people but then gets called away. Think of one sentence you could use to start a conversation. For example, tell them how you came to know the host, comment on her lovely home and ask guests how they know your friend. If all else fails, mention the weather! The first words are always the hardest, and remember that not all the guests will be feeling as relaxed as they seem! Rugby R.E.S.T self help group


More ideas for your group Mood and food Each group member brings in a healthy snack or a recipe. Discuss thoughts and experiences around mood food and body image, and try swapping tips and recipes. Ideal for getting to know each other and exploring self help.

Musical moments Each group member brings in a piece of music. Listen to each piece of music and take it in turns to share thoughts on why you chose it and what it means to you. A really lively, fun session for members to express themselves in a different way.

Money talks A focussed discussion on benefits, where group members can share the load, swap tips and find out what help and support is available locally. A useful session for anyone looking for information.

‘My thoughts are under my control’ Positive affirmations are statements repeated many times over to trigger our subconscious mind in to positive action. There are loads of examples online so print them off and cut each one out. As a group, lay them all out, discuss what they mean to you and each pick out one or two that are meaningful for you. In a followup session get creative and decorate your own credit card-sized affirmation to keep in your wallet for a handy reminder.

Seasonal sessions Certain times of the year that can be very difficult, so why not create specific group sessions that help members to cope. Whether it’s Christmas, Valentine’s day or the start of the summer, try a focussed discussion on what we find difficult, how it affects us and what helps us to manage. Great for bonding and for easing through the tough times together.

Tips for group activities • It’s easy to go off on a negative tangent, but stick to the activity you’ve agreed on. Acknowledge other issues as something to explore in a different session and keep the focus on recovery and wellbeing.

• If you’re exploring self help techniques as a group then encourage people to try them at home too. Follow up in the next session to iron out any difficulties, share tips and keep motivated. • Find a good balance between discussion-based and activitybased sessions. Both are important for trust, self expression and friendship.

My first group experience ‘I still remember the terror going up the path. Knocking on the door, to be greeted by a stranger, ushered into a room full of strangers. You feel so shy and vulnerable, unaware that they feel the same towards you. Then those words – “Tea or coffee?” Has there ever been a better phrase in the English language? At once you feel welcome, valued, among friends. Perhaps it was just me. I was battered and bruised mentally, but I was with others who felt the same. They were people looking for the same kind of help that I needed. I don’t know about them, but the help I found within groups was in trying to help others. It made me feel less worthless, but also that what I thought were unique feelings were actually common to them too – we could empathise. That was over 20 years ago. Sadly the organiser moved away and the group folded. I am not a group person (I still feel uneasy and inadequate with strangers) and my own attempts to organise one failed. I live in a rural area where it’s difficult to get groups going, but I remain a great fan of them. Loneliness is one of the great features of depression; in a group those words ‘I know how you feel’ mean something special rather than being a platitude. If there’s one in your area why not give it a try.’ Paul Lanham


Feature

An inside look at talking therapies

Straight talking Cognitive Behavioural Therapy (CBT) Who’s it for? People feeling motivated and ready to make a change

Try this for Solving specific problems and changing negative thought patterns

What it’s not A long, deep look inside yourself

What is CBT? We tend to associate therapy with lying down on a big couch and exploring our innermost fears and dreams. CBT is different. It’s about changing the way we think (cognitions) and what we do (behaviours), in order to help us feel better. With depression we often fall in to negative ways of thinking like, “I’m never any good at this” or “they’re all criticising me”, but CBT is based on the idea that it’s not necessarily events themselves that affect us, but the meanings we give them. With depression our problems often feel overwhelming. CBT can help us to solve them by breaking them down. In doing this we can see how all the parts are connected and how they affect us, meaning we can understand what’s happening and find a more helpful solution. Let’s say you’re expecting a phone call from a friend, but you wait all afternoon and don’t hear from them (see box below).

How might you think, feel and respond? Here, the unhelpful thought leads to an unhelpful action. In time this can become a vicious circle, where we’re surrounding ourselves with more problems and more negativity. CBT is about making practical changes. A therapist will agree on homework with you so you can start applying what you learn to real-life situations. The idea is to keep on practicing even after you’re feeling better, so if your problems come back you’re more likely to be able to manage them. Health warning: Confronting anxiety is necessary to overcome it, so CBT can sometimes make you feel more anxious for a short time

Is it for me? CBT is being championed by the government in its Improving Access to Psychological Therapies programme. Clinical trials suggest it’s one of the most effective treatments for depression and anxiety, and for some people even more so than drug therapies. It can help with lots of common mental health issues such as depression, anxiety, bulimia and OCD and even in managing physical problems such as pain or fatigue. Courses are generally short, lasting between just 5–20

Phone example Unhelpful

Helpful

Thoughts

They’re ignoring me, they don’t like me

I wonder what’s happened? I hope they’re ok

Feelings

Rejected, sad, angry

Concerned, curious

Physical

Heart racing, sick-feeling

Feeling comfortable

Actions

Avoid them in future

Get in touch later to see if they’re ok

8 Single Step Summer 2011

sessions per week or fortnight, and sessions usually run from between 30 minutes to two hours. However, they won’t help you to explore more deep-seated issues and can at times be quite business-like. For some people, it can feel like CBT is merely papering over the cracks. Natalie from London comments: “I was living on my own when I had CBT and had no one to talk to. I was having a difficult time at work and needed someone who’d listen, but the emphasis always seemed to be on solutions and I never had the opportunity to properly open up and talk. Eventually the CBT sessions seemed to start mirroring the problems I was having at work; more and more tasks piling up and more pressure. There were a few tools I found helpful but I never completed the course, it was a bit too bish bash bosh for me.” Like all therapies, it can take time and practice to be effective but it’s important to ask yourself if it’s right for you and discuss it with your GP. CBT checklist. The more ticks that apply to you, the better suited you could be to CBT ✔ I feel ready to make changes to my life  I feel hopelessly unmotivated and need more time to get better ✔ There are practical problems in my life I want to address (eg sleep, alcohol, mood swings, relationships etc)  It’s hard to pinpoint why I’m so down but it would help to talk it over with someone who’ll listen  There are unresolved issues in my past that I want to address ✔ I feel ready to move on from the past and deal with the here and now


The therapist Dr Gabrielle Samson Chartered Clinical Psychologist / IAPT High Intensity Therapist “Most of the people I see have been referred by their GP, although self referral is quite common now as well. I start off with a half hour phone assessment with the client to establish if high intensity CBT is suitable, as some people are better suited to working more independently with self help books and online tools. In the first session we try to understand what the problem is. The hour can fly by, so together we set an agenda at the start of each session to make sure we’re covering what’s important. At the start of the course we also establish longer term goals, such as returning to work or taking a course, to encourage people to stay focussed and make longterm changes. CBT is very much led by the client, it’s not about me telling people what to do; it has to be a partnership. It can be really rewarding when people put a lot of work in, but also very intense, so like all therapists I have regular supervision sessions to help me reflect on how I’m feeling.”

was a way of protecting myself, but I hadn’t realised how much negativity I was now creating and surrounding myself with. In fact, when I left that particular session I realised I’d fallen in to at least five of the mind traps before I’d even got home! I always keep my list of mind traps handy and to this day I still find them really useful.” CBT is available on the NHS so ask your GP about local services. However, waiting lists can be very long so it’s worth exploring self help techniques in the mean time.

Books on prescription GP’s can now prescribe self help books, which you can borrow from your local library. The Overcoming series from Constable and Robinson is a good place to start. Each title is based on CBT and they cover over 30 mental health issues including depression, low self esteem, anxiety and anger.

The client

Online self help

Dallas, DA member at the Employment and Wellbeing project, Croydon “My depression was getting worse, so about a year and a half ago I went to my GP to ask for help. They prescribed a self help book but after a month it was obvious I needed more help. Unfortunately there was a six-month waiting list for a CBT therapist, but thankfully I was also able to join the DA Employment and Wellbeing project in the mean time, which helped me to feel stronger. I had eight CBT sessions with eight other people. It was a great to be part of a group as we were able to run things by each other. The part I found most helpful was the list of mind traps. There was a time when I suppose my negative thinking

MoodGYM is a free online training programme for learning CBT skills. Work your way through the interactive modules before trying the activities to apply what you’ve learned. http://moodgym.anu.edu.au

CBT top tip Set yourself one or two tasks to tick-off each day and write them down. It can be anything from doing the dishes, phoning a friend or going for a walk. Even the smallest of tasks can feel impossible in a period of depression, so it’s vital to acknowledge that you’re achieving things and give yourself plenty of credit.


Feature

Sibling rivalry Relationships are crucial to our health and happiness. We’ll be looking at ways to build healthier and more fulfilling relationships to strengthen our resilience and wellbeing. By Tünde Vanko elationships are complex, but struggling with depression can make it even more difficult to maintain or close relationships. We might experience exhaustion, as well as anxiety about the impact of our depression on others but it’s also true the other way round; our relationships can affect our mood, triggering or exacerbating depression. I’ve come across more and more clients in my practice who feel that in an indirect way, their brother or sister has contributed to their struggle with depression. Some talk about how being the less favoured child led to their low self-esteem, while their sibling never seemed never to fail and always achieved no matter what. Unequal parental attention is definitely one of the main resentments. Laura explains: “There are only 18 months between me and my younger sister Kate, but she was always considered the little one of the family. Since she wasn’t as talented or as pretty as me she always received more encouragement and special attention – she was always the baby and the special one. I ended up feeling defective, that I’m no good at anything. I get panic attacks when I have to face up to a new challenge, while she just succeeds in whatever she does. I hate family Christmases because it’s always about praising Kate.”

R

“Josh was a good looking child, always popular at school and excelling in both sports and his school work. I wasn’t popular because I was a chubby little girl, really bad at sports and very self conscious. I got good marks, but what I achieved with hours of studying came naturally to Josh. He seemed to have a talent for everything, which used to infuriate me. It seemed so unfair. I always felt like I was in his shadow, especially as my family would always talk about him and how well he was doing. As we became teenagers, Josh became even more popular as all the girls wanted to go out with him. My only friend was Carol, so when Josh started going out with her at secondary school I felt he’d taken everything I had. He wasn’t even that interested in her and dumped her after a few months.” Laura’s and Eleanor’s stories are entirely different, but both feel strongly that their siblings have contributed to their low self-esteem and anxiety. Today, psychologists believe that the quality of sibling relationships depends not only on the parenting, but on many other factors such as birth order, age spacing, our physical appearance and temperament and the emotional climate of our family.

“We love you all equally” “He was always the talented one” Even when parents go to great lengths to treat their children the same, other factors can create rivalry such as the way we look and the order we were born in. Eleanor feels that although her parents loved both of them, her elder brother was always in the spotlight.

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To understand how these factors might influence the lives of siblings, Judy Dunn has a conducted huge amount of research in the US and UK. Judy Dunn, Ph.D Professor at the University of Pennsylvania claims that as children, we’re much more sophisticated socially than we might have imagined. From about 12 months of age we can already read

social interactions and clearly distinguish differences between motherly affection towards us and our siblings. From just 18 months we can understand how to exacerbate the pain of our brother and sister, or how to comfort our siblings. Children notice very early if parental love and attention is not the same towards one child or the other.

“We can’t choose our siblings” Of course, rivalry and animosity can continue even in adulthood when the circumstances have long since changed and siblings have their own families. About a third of siblings claim that although they haven’t stopped occasionally contacting each other, they still feel resentment or that they simply don’t have anything in common. When families unite after a long time at weddings or funerals the same old patterns play out and the old unresolved conflicts prevent family members from behaving as adults. As we can slip so easily into child-mode, it’s unsurprising that family reunions commonly end in disaster. Judy Dunn claims that the conflict between the siblings is not necessarily the result of family conflicts or unequal parental devotion. She says simply, “we can’t choose our siblings”. The difference between two children’s personalities can be striking, and having to live together can generate deep animosity and conflict.

“I felt I had to protect them” Sometimes it’s the family climate that determines the relationship between siblings. Markus’ story shows how the father-figure can determine the role


He seemed to have a talent for everything, which used to infuriate me. It seemed so unfair.

of the eldest child among the siblings. “I’m the eldest of seven and my mum pretty much had to bring us up on her own. She met my stepdad when I was little and by the time I was 16 I had to move out. He could be really violent and aggressive around us and I just couldn’t stand it anymore. I always felt like I had to protect my mum and my brothers and sisters because I was the eldest but I was only a kid myself really, it’s the way I grew up. I never asked for anything because I knew I’d never get it – we didn’t have the money and in the middle of everything people just forgot, even birthday presents. I’ve had years of therapy for depression and it’s only now that I’m starting to realise the knock-on effect this has had on my life. I feel like I do everything for my wife and my mates but I always end up being let down, which just makes the depression worse.” Through Markus, Eleanor and Laura, we can see how the special

bond between siblings can affect our self-esteem and anxiety and how it maintains old, dysfunctional patterns. It is never too late to improve your relationships ● understand that you’re no longer part of the original childhood family that caused your dysfunctional patterns. You may slide back into that role at family get-togethers and it might trigger those familiar feelings, but be mindful that you’re not children anymore. You can now set boundaries and ask for those to be respected ● don’t bring up old resentments ● realise that your sibling has had different experiences in her/his life. Don’t expect them to be like you and accept that they might have a totally different perception of your childhood and parents to you ● try not to compete over how successful you or your children are – you’ll be setting yourself and

your children up to repeat the same patterns avoid interpreting your siblings motives and behaviours. It’s easy to slide into the old animosity such as “Oh God, she’s just showing off again to get Dad’s attention” if your sibling rivalry is an unsettled matter and is contributing to your feeling worthless and depressed ask for professional help

Useful reading Why can’t we get along?: Healing adult sibling relationships. Peter Goldenthal (2002) “Mom loved you best” Sibling rivalry lasts a lifetime. Hapworth Hapworth & Heilman (1993)

Tünde Vanko, PsyD is a Clinical Psychologist and a CBT and Schema Therapist. She worked as a psychologist at the Priory until 2010 and currently works in private practice.


Feature

Holistic health Our minds and bodies are intimately linked, so why aren’t our services? Depression Alliance calls for more joined-up working By editor Laura Sacha hen Simon was diagnosed with diabetes at the age of 29, the doctors and nurses were meticulous. Despite having walked to the surgery, his GP took no chances and had Simon safely whisked away in an ambulance, where he was referred to a top diabetes consultant. The consultant insisted on rigorous clinical testing, before he was visited at home by specialist nurses, who took great pains to ensure he could inject himself properly. But there was one thing missing. Something big. At no point did anyone ask Simon,“how are you feeling about all this?” Simon isn’t alone. One in three adults in the UK suffers from a long term condition such as diabetes, heart disease or arthritis. That’s 17 million people with a life-changing diagnosis, with all the emotional and psychological consequences that surround it. Life suddenly looks very different. Our body has let us down. We’re no longer the same person anymore and can’t enjoy the same things. Perhaps unsurprisingly, research now shows that people with long term conditions are more than twice as likely to suffer from depression. So what’s going wrong?

W

Treating our hearts and minds Countless studies have shown us that feeling good significantly boosts our recovery from illness or injury and in turn, looking after our bodies can make us feel stronger and happier. We’ve come a long way since the old theories of a mind-body split and we know that our physical and psychological selves are intimately connected. It might seem logical for

It was emotional support that I’d needed right from the minute I was diagnosed with diabetes. 12

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a life-changing diagnosis to lead to depression, but in fact it can work the other way round too, with stress and

research now shows that people with long term conditions are more than twice as likely to suffer from depression depression identified as significant risk factors for heart disease. For our health services to be affective it seems logical that they too should be linked. Sadly, mental health services still remain separate from traditional medicine. Physicians are trained to specialise in their own fields, with emotional and mental factors regarded as outside their remit. Studies suggest that medical students still receive inadequate training to recognise mental health issues and can feel uncomfortable discussing the emotional and psychological aspects of healthcare. Despite this, people with diabetes have almost three times the rate of depression than the general population and amongst people who’ve had strokes, as many as 61% also have depression. Far from being the exception, many seeking help for long term physical problems will benefit from psychological support too.

Counting the cost However, is it reasonable to call for change and more integrated services at a time when cuts are already in force across? We might see reform as the expensive option, but when depression becomes an issue longterm conditions become significantly more costly to treat. For example, depression leaves Simon feeling utterly hopeless. The more hopeless he feels, the less interest he takes in his health, which means he’s less likely to manage his diet and blood sugar

levels. The lower he sinks in to depression the more uncomfortable and distressing his symptoms become. In turn, Simon’s more likely to need time off work, to use a hospital bed and to see his doctors regularly. In fact, the cost of healthcare for people with long term conditions can be 50% higher in those with depression. Reform is not only vital for our health, it’s vital in the battle for NHS efficiency and savings.

A call to action Despite all this, depression is a condition that can be treated. With the right help and support it’s something that can be managed alongside a job, relationships, good health and happiness. The problem for people accessing traditional medical services for long term conditions is that it’s not being recognised. In fact, only a quarter of people with mental health issues receive treatment. As with anyone experiencing depression it can be hard

the cost of healthcare for people with long term conditions can be 50% higher in those with depression to know who to approach for help, impossible to explain what you’re going through or to imagine getting better, and alongside managing a long term condition the idea of further treatment can feel overwhelming. Without help, depression can spiral, bring us to our knees and ultimately consume us. Depression Alliance is urging Government to recognise the need for better diagnosis and management of depression in people with long term conditions, and for more joined-up working. During April’s Depression Awareness Week, Chief Executive of Depression Alliance Emer O’Neill stated:


“I am urging policy-makers and all those involved in the NHS reform debate to consider one of the biggest challenges the NHS faces. No matter who is holding the budget, reforms must support the delivery of joinedup and integrated working across the health, social care, and public health services, so that we can improve the opportunity for recovery and support people in leading better quality lives.” Depression Alliance is calling time on the depression epidemic, alongside leading health charities including Diabetes UK, Stroke Association, National Rheumatoid Arthritis Society (NRAS) Mental Health Providers Forum and the Centre for Mental Health, and other patient and professional groups. July will see the organisations collaborate to campaign for the better management of depression in people with long term conditions, and we’ll keep you update in the next issue of Single Step. It’s time to raise our voices and rise to the challenge.

Simon: On being diagnosed with type 1 diabetes “I was expecting the news, but hearing the words coming out of the doctors’ mouth was still a great shock. It almost felt like she’d punched me in the stomach and winded me. I saw a diabetes consultant and specialist nurses who were all very thorough with the practical side of things, but at no point did anyone ask me, “how are you feeling about this?” It was a few weeks later when the news started to sink in. I began to realise that this was a change for the rest of my life, that I’d always have to be extremely careful with my diet and lifestyle and that things I’d taken for granted like my limbs and kidneys could be very badly damaged. I’d had depression before as a child when I lost my grandparents and my mum, and going through something so life-changing brought me

down again. I was diagnosed with clinical depression, forced to take time off work and felt low enough to consider ending it all. I had Cognitive Behavioural Therapy (CBT) but it was very practical and it wasn’t right for me at all. It was emotional support that I’d needed right from the minute I was diagnosed with diabetes. I wanted to meet other people who were going through it, who understood what it was like and who I could talk to. Unfortunately there were no support groups around for people my age as type 1 diabetes tends to affect children and young people. Sometimes when I’m in a depressive period I stop caring about my drug regime and my blood sugar levels. It’s swings and roundabouts really; having the depression makes me lose interest in my health and having diabetes makes me depressed, so it becomes a vicious circle.”


Questions

?

Ask the experts Putting your questions to those that know This month we ask Age UK’s Michelle Mitchell for advice on supporting an older person with depression Michelle Mitchell Charity Director of Age UK “My 74 year old dad has become more and more difficult to be around and it’s driving the whole family away. He’s become very critical and negative about everyone and everything, and only seems interested in lying in front of the TV with a glass of wine. We lost my mum about 10 years ago and the whole family made a big effort to spend time with him, but these days he can be so cruel and disinterested that it’s becoming unbearable. He used to be very sociable but now he makes excuses not to go out and has put on a lot of weight. He’s so difficult to talk to but we want to help, what can we do?” Mark Depression can come from nowhere, but in many cases it’s triggered by significant life events, especially those connected with loss. We tend to think of loss in terms of the distress we feel on losing a partner or close friend. However, other types of loss are more common as we grow older too and can affect our self-esteem or how we see our place in the world. They include loss of your job and daily routine when you retire, loss of good health, independence, a much loved home or social network. Try and talk to your dad about it. The risk of developing depression increases when people feel alone and unsupported. It’s an illness that can affect anyone, so he’s not to blame for feeling down. Reassure him that things will get better with time, although as we know, depression doesn’t change overnight and no one can just ‘snap out of it’.

Encourage the person to get help from their GP Sounds easy enough, but this can be tricky. Many people can be reluctant to see a doctor about depression. Instead, gently suggest they go for a physical check-up instead. The GP may be able to spot underlying problems. Ask if they would like you to go along with them for moral support.

Be watchful Offer emotional and practical support, particularly if the person does not live nearby. Look for signs that they are neglecting themselves or perhaps drinking more alcohol than usual. Express your concerns and let them know what you’ve observed.

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Single Step Summer 2011

Be willing to listen Encourage the person to share their feelings and try to be a good listener. Avoid offering advice unless they ask for it and saying things like, “I know how you feel”.

Encourage activity and a healthy lifestyle Exercise and healthy eating go a long way to relieving depression. Suggest things you can do together like go for walks, take up a hobby, join a group or class. And remember to lead by example!

Support their treatment It can be weeks before people feel the benefits of treatment for depression, so encourage them to follow through with any appointments and medication. Treatments should not be stopped, or doses changed, without speaking to the doctor first.

Offer practical help Depression can affect our energy levels, so things like organising appointments and transport, picking up prescriptions, cleaning, buying food and paying bills can be a big help. Try to do things together as being included can boost our self-esteem.

Look into befriending schemes Older people can often feel lonely or isolated. In a befriending scheme someone will visit them at home or call them regularly on the telephone. This could be a trained volunteer or a similarly-aged person also experiencing depression who could do with a chat too.

Get a free benefits check Money worries can be a trigger for depression and can stand in the way of your loved one affording things that can help them to cope (e.g. taxis or a cleaner). For advice on benefits, call Age UK Advice on 0800 169 6565. More advice on money, local services and befriending schemes, call Age UK Advice on 0800 169 6565. To find out more about the money you could be missing out on, read the More Money in Your Pocket booklet available to download at www.ageuk.org.uk/moremoney


Tech talk

Technology time Online counselling – the good, the bad and the disinhibited? Allie Cairnie Relational counsellor

What is it?

‘Live’ counselling

Does it work?

Instead of attending sessions with a counsellor face-to-face, online counselling takes place via the internet.

Live sessions happen in ‘real time’ and involve either writing to your counsellor using a live chat programme or talking to your counsellor via Skype. Clearly there is quite a difference between talking over Skype or writing in live chat, but with both you’ll get an immediate response, helping it to flow more like a regular conversation.

For anyone feeling lonely and isolated having someone to talk to can feel like a huge relief. Counselling gives you an opportunity to open up to someone warm and empathic, which can set you on your way down the road to recovery. However, as with all therapy it’s worth really thinking about yourself and what might work for you, so you can find the type of therapy and therapist to meets your needs.

The good bits ●

sessions can take place at a time and location that suits you it can sometimes feel easier to open up to a counsellor you haven’t met face-to-face

The pitfalls ●

online and face-to-face counselling are worlds apart. If you are looking for something that’s ‘just the same,’ this probably isn’t for you for some people online relationships can feel less personal and less intimate

Useful for Anyone, but particularly those who find it hard to leave the house because of social anxiety or mobility problems, as it can feel more manageable. Of course, there are costs involved and rates vary from therapist to therapist.

A pick ‘n’ mix selection Having someone to open up to can help us feel understood, supported and less alone, but how do you go about choosing a counsellor? There are lots of types of online counselling and at times, too much choice can be confusing. Some online counsellors conduct ‘live sessions’ using MSN chat or Skype, which is known as synchronous online counselling. Others offer email sessions, which is known as asynchronous online counselling. Many counsellors offer both so you can pick and choose what feels right for you.

Email counselling This involves emailing your therapist, who then responds by email within a certain length of time. Usually you’ll already have agreed how often you’ll email. Having time to formulate an email and time to digest the counsellor’s response can be helpful, particularly as you’ll be able to keep copies of the emails and revisit them again in the future.

Will it feel okay? Some people find they’re able to open up and share things with their online counsellor they might never have discussed face-to-face. This is known as ‘online disinhibition’ and can be both a blessing and a curse. Whilst it might help you get to the heart of your issues more quickly, the counsellor will be careful to make sure that you don’t feel too exposed, share too much too soon and withdraw as a result. A skilled online therapist should be watching out for this to make sure you feel safe and comfortable.

Make online counselling work for you: Know yourself Do you enjoy writing and like words? Do you often communicate online and how will it feel to share personal information with someone you’ve never met? Make informed choices Like face-to-face counsellors, online counsellors usually work with different training models. Some may offer CBT whereas others may use Psychodynamic or Humanistic approaches. It’s worth doing a bit of research into the different types of therapy before choosing a therapist. Useful organisations Shop around and find a counsellor that works for you. British Association for Counselling and Psychotherapy (BACP) – search the online directory of accredited therapists. www.bacp.co.uk Association for Counselling and Therapy Online (ACTO) provides details of therapists with established online practices. http://acto-uk.org


Lifestyle

Your reviews Every issue we ask you to tell us what’s on and what’s out there… If you fancy writing a review we’d love to hear from you, so get in touch today!

Anti stigma action pack http://time-to-change.org.uk/ node/31148 Time to Change has produced a new personal action pack. As a Time to Change blogger, I ordered it to celebrate the news. The aim of the pack is to encourage those of us with depression and other mental illnesses to talk to our friends about our experiences, leading to a greater awareness and reduction in stigma. It includes several postcards such as, “give me call”, “how u feeling?” and “hope you’re ok”. There are posters with the same message to put up in GP surgeries or your local clinic, a bag displaying the Time to Change logo and message and a stack of leaflets to distribute, giving handy tips on how to start talking about your depression with friends and colleagues. For example, choose a good time, be prepared for lots of questions, or none, and have some information ready. I’ve already come out as depressed to all of my friends on Facebook and extended family, and have had only positive responses. It’s good to talk and it helps to share your problems. Order the free personal action pack for yourself and see if it helps to boost your mood! Ian, Lancashire

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Single Step Summer 2011

The Brahma Kumaris Global Retreat Centre, Oxford www.globalretreatcentre.org/ about/index.html I first heard about the centre through a Depression Alliance group member in Croydon. A retreat is an opportunity to explore the deepest insights into the true nature of our being, review the purpose of our life and learn practical methods to sustain calm and clarity in everyday living. As a service to the community the retreat charges no fees, so my weekend stay was completely free. Anyone can apply online and although you can expect to go on a long waiting list (mine was about six months) it’s well worth it. I particularly enjoyed the morning exercises, which took place outside at 7am where we did movement accompanied to beautiful music. I also enjoyed learning more about meditation and spirituality and it was wonderful to spend a whole afternoon in silence. I have a full and hectic life in London and am aware that I can overdo things and become stressed and depressed, particularly through the winter. I discovered I was not alone, and that many people at the retreat centre had come to take some time out from the daily grind of life and manage depressive symptoms. The tools that I’ve taken away from the weekend have been instrumental in helping me feel more balanced and calm. Although I find it hard to

meditate every day I’ve gained new insights and perspectives on how to manage my mood. I found the whole experience of my weekend stay here really amazing and left the centre feeling calmer and more relaxed. I do have to stress though that although they’re not a religious group they are a spiritual group, so it might not be right for everyone. Emily, London

The Revolutionary Trauma Release Process David Berceli (2008) £16.99 I’d like to recommend this book that I borrowed a while ago. I’ve been doing the exercises for a few months now and have felt some benefit from them. The exercises in the book are specifically designed to cause a slight vibration or tremor in your muscles, and as I understand it, it’s this that helps your body release stress and trauma and so help depression. It might sound a bit wacky but David Berceli’s explanation made sense to me. However, there was a note of caution in the book. Doing the exercises can sometimes (but not always) bring up distress at first, so I think people should read the book before they try them. The exercises themselves are not that difficult though. Julie


Active

Step into summer We all know that physical health is crucial to our overall health and happiness, but how do we get started and keep it up? Agi Rajna Personal Trainer, Pilates instructor and founder of Chelsea Personal Training Dawn from Cheshire thought she’d never run again. “I used to be a very keen jogger but when I was ill I could barely manage a short walk. My body felt like a doddery old and unstable woman and I didn’t think I’d ever regain my ability to run again. While I was recovering my aunt talked me into doing the 3k Race for Life, so I had to get training. I noticed that even though I didn’t have much energy to begin with, the more regular exercise I did the more energy I had as a result. That’s what motivates me to keep it up. Try to get outdoors as much as possible; it’s amazing the effect that greenery and fresh air can have on your sense of wellbeing.”

● ● ●

Getting active is a great way to increase our self-esteem and self-confidence decrease stress levels improve mood and wellbeing decrease feelings of tension, sadness and anger

Government guidelines recommend 30 minutes of moderate activity a day, five times a week. But how can we make this fun, rather than just another issue to manage?

busy day. Enjoying the summer season and getting to a park or natural surroundings can boost your mood after just five minutes. Gardening Pushing, bending, squatting, carrying, digging, and picking things up will all use different muscle groups. Gardening for 10 minutes can burn up to 50 calories, and both you and your garden will reap the benefits. Walking Did you know the average person can burn up to 150 calories in just 30 minutes of brisk walking? It’s free, builds stamina and helps relieve stress and tension. Skipping If you’ve not tried it since your school days you’ll be surprised at how beneficial skipping can be. Start slowly and try skipping for 20–30 seconds, marching on the spot for 30 seconds and then repeat. Great for heart and lung fitness, and just 15 minutes of skipping can burn up to 200 calories.

Do it together Warm up It’s vital to spend 5–15 minutes warming up and preparing your body. Warming up prevents injury by adapting your body for exercise, raising your heart rate and mobilising your joints.

Choose something you enjoy An energetic session doesn’t need to last longer than 60 minutes (yes, including warm up and cool down!). Short, regular sessions will feel less daunting and are easier to fit in to a

Exercising with other people can boost our feel good endorphins, and having a laugh and a chat means you’re more likely to have fun and stay motivated. Joining a group can feel scary but you can guarantee that others will be feeling the same! Walking for Health Over 600 free health walks across the country where you can make friends and discover new places. Perfect for beginners, no special equipment needed and no pressure! www.wfh.naturalengland.org.uk

Fit as a fiddle A programme of group activities for over 50’s from Age UK. Meet new people in one of the dance classes, football matches or cooking lessons, or explore your adventurous side with tai chi, Nordic walking or yoga! Call Age UK: 0800 169 8787 Green gyms There are 95 green gyms across the country where you can meet others and get a free workout by planting, digging and path-clearing. Run by the British Trust for Conservation Volunteers, you’ll be guided on a range of projects to boost strength, stamina and practical skills. Find your local green gym at www2.btcv.org.uk

Reward yourself Depression can make even gentle exercise feel exhausting and overwhelming, so it’s vital to give yourself credit. It’s easy to become disheartened and stop, but it takes time and practice so build up your fitness gradually and be kind to yourself.

For more on getting active GP’s across the country are prescribing exercise as a treatment for depression. Your GP can refer you to an active health team where together, you’ll decide what type of activity will suit you. You’ll receive a fixed number of sessions with a qualified trainer, but services and availability vary across the country so speak to your GP to find out what’s available.


Letters

Your letters & emails Do you have something to get off your chest? A question or a tip to help other DA members? We love getting your feedback so write or email your thoughts to Depression Alliance

I was quite startled by the change in format of the recent Single Step and didn’t know whether I liked it! Then I realised that most of this was of the because I am thrown by change. Once I’d looked at it for a while I calmed down! I was drawn to the article Why are we all so negative? (Spring 2011) The remark, “It can be difficult to accept that making mistakes is a normal part of life” is interesting, as I was brought up to believe that if you make mistakes you’re a complete failure. I’d be interested to hear from DA members about how they feel when they have to make arrangements to go anywhere. I find it hard to commit myself, mostly in case I can’t sleep beforehand, feel ill or show myself up. Sometimes I spend days worrying but once I’m there it’s much better. Is this common? Barbara

Letter month

I strongly identified with the responses from people ‘across the pond’ in the article Why are we all so negative? (Spring 2011). As someone who grew up in Canada, spending a lot of time outside was very common, but in Britain I’ve noticed that a person who prefers being in natural surroundings is regarded as something of an oddity. I’ve found British people enjoy their gardens, picnics and dog walking, but indulge in anything more and it’s thought to be abnormal! Audrey

Contact us “My sister doesn’t trust me to look after my nephew” (Spring 2011) Readers share their suggestions for Nicky… I feel sad that your worries about the lack of trust from your sister has undermined your “hard work and progress.” That lack of trust may be more about her as a mother than about you as a person, or about common prejudices surrounding mental illness. Most people with depression underestimate their abilities, including their ability to care. A book about sibling relationships might be of interest: My Dearest Enemy, My Dangerous Friend, by Dorothy Rowe. Cedric I’m sorry that your sister fears for her child because of your mental health problems. Clearly she needs to be educated about mental health so talk to her and show her the DA website, which has loads of information that may reassure her. Audrey

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Single Step Summer 2011

I love the new look magazine! I was so pleased to get it in the post today. I love how the word content is broken up and spaced and the pictures are really good too. I particularly value the book reviews and have bought books reviewed in the last two magazines. Clare Congratulations on another very good Single Step. However, I’m slightly concerned about whether the magazine gives sufficient validation of people who are really down. It might be useful to consider people who (whether because of childhood emotional deprivation or other reasons) lack the social skills and self-confidence or opportunity to form relationships at all or even make friendships. Cedric

We love hearing your ideas, suggestions and opinions and our Letter of the month will receive a £15 voucher to spend in Marks and Spencer or Debenhams. Write to: Depression Alliance 20 Great Dover Street London, SE1 4LX info@depressionalliance.org


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Want to meet new people? Want to share support, motivation and self help techniques? We’re looking for committed volunteers to set up and facilitate self help groups

Depression Alliance needs you! Ever wished there was a depression self help group near you or fancied setting one up? Let’s do it together. Our groups are facilitated by volunteers just like you, and we’re here to help you get started and to keep supporting you along the way. There’s nothing like the warmth and understanding you can share with people who know what it’s like. People who live with depression, who’ll be there during the ups and downs and who’ll never, ever tell you to snap out of it! And it doesn’t all have to be about sitting in a circle and talking. Why not set up a walking group, a book group, a creativity group or even a Friday night pizza group! Talk to us about it at info@depressionalliance.org or leave a message for us on 0845 123 2320 and we’ll call you back.


Single Step magazine (Summer 2011)