63 Chapters
Medium 9781855754744

Stepped care and self-help

Young, Courtenay Karnac Books ePub

A“stepped care” approach to mental health is now becoming the norm within the National Health Service. What this means is that there are various steps to be taken in assisting people with their mental health issues.

The first step is usually a combination of “watchful waiting” by the GP and, more importantly, encouraging the use of self-help techniques. In the NICE Guidelines for Anxiety (No. 22) and Depression (No. 23), “Bibliotherapy” (reading about your issues, or problems), and “Social Prescribing” are also considered important. All these come before psychological assistance or any medical treatment (medication).

Before considering any form of treatment for stress, depression, anxiety, low self-esteem, problems with bereavement or loss, or any other conditions of distress, a self-help approach should really be considered first. There is probably nothing actually wrong with you, just that much has happened to you. There may well have been a number of things that you, the “patient”, have done, or have tried to do, already, but they have not fully helped you yet. This does not mean that they are wrong, just that other things might also be helpful. There might also be information “out there” that you have not been able to access yet. There might be other resources— voluntary organizations, specialist support groups—that you are not aware of. These should probably be explored first, before you are referred to, or ask for, counselling, and especially before you get any medication. These latter options are now identified as being the second and/or third steps.

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Medium 9781855754744

Basic information

Young, Courtenay Karnac Books ePub

Stress is one the major problems facing all of us today. We were simply just not designed—we did not evolve—to live in cities, to work in offices and factories, and especially to live at the pace that we seem to live at now, and it is getting worse! Essentially, our bodies are not able to cope very well with the number, variety, and constancy of the stressors found in modern everyday life. They are able to do an amazing amount, but we work longer, commute further, shop more, stay awake longer, and sleep 20% less than we did 100 years ago. This eventually causes stress overload—physically, emotionally and mentally. In the UK, it is estimated that at least 40 million working days are lost each year because of stress. Psycho-physiological disorders (those concerning the body–mind) are nearly always caused by stress, or are considerably worsened by stress. Stress also damages our immune systems, and this then has further implications on our health.

Causes of stress

The causes of stress are numerous and include: major life changes and life events; noise; crowds; poor sleep, bad diet, unhealthy lifestyle; alcohol or drug misuse (also symptoms of stress); aggravation and abuse; pressure to perform (work, school, sports, etc.); traffic; chemicals; trauma; poverty; discrimination; frustration; pregnancy; work pressures; negative emotions; loneliness; family conflicts; money worries; alienation; uncertainty; illness; unemployment; sexual problems; identity problems; relationship difficulties; going to school or college; Christmas; loss of any kind, including theft, relationship break-up, divorce, redundancy, abandonment, death (of someone close to you)—anything can cause stress!

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Anger management

Young, Courtenay Karnac Books ePub

Basic theories

There is some instinctual basis for anger and aggression as a necessary part of survival. However, despite the prevalence of aggression and violence throughout all of human history, aggression is not inevitable, anger and violence can be managed. Anger is both an emotional reaction against pain and it also carries with it (because of the increased adrenalin output) a natural anaesthetic: by getting angry you cover the pain. Other theories propose that aggression arises from environmental factors, especially if our basic drives are blocked or frustrated, but the hypothesis, that frustration always equals aggression and aggression always stems from frustration, is much too simplistic. Much investigation has centred on how the level of arousal affects aggression, as arousal often triggers a strong emotional response. There is also little doubt that past experiences and social conditioning have a powerful effect on aggression. Nearly all these effects can be modified to a degree by emotional and cognitive processes. This gives hope for the effective management of aggression.

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Introducing issues of self-esteem

Young, Courtenay Karnac Books ePub

In the Bible it says, “Pride goeth before destruction, and a haughty spirit before a fall” (Proverbs, 16, v. 18). In Ancient Greece, one of the great sins was that of hubris—an overwhelming pride or arrogance that meant that you thought that you were like a God—so the Gods punished this “sin” and brought about your downfall. This was one of their belief systems, anyway. In the Middle Ages, the prevailing Christian view of man in relation to God ran along these lines, written by Thomas à Kempis:

But if I abase myself, and bring myself to nought, and shrink from all self-esteem, and grind myself to dust, which I am, Thy grace will be favourable unto me, and Thy light will be near unto my heart; and all self-esteem, how little so ever it be, shall be swallowed up in the depths of my nothingness, and shall perish for ever. [Kempis, 1427]

However valid these views may have been then, they are not really so relevant for us, in relation to other people, at least six hundred years later. These are all pretty much “either … or …” views in that there is a basic polarization: pride = fall, etc. What seems to work better nowadays is more of a “both … and …” perspective: where two seemingly opposing views are both held as reasonably valid. Thus, we can both relish our accomplishments and tread a reasonable line to stay clear of excessive pride or narcissism. If we hold a different opinion, we may be seen as both “eccentric” and “interesting”: that is not necessarily a bad thing.

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Becoming more assertive

Young, Courtenay Karnac Books ePub

Basic principle

Becoming assertive is communicating our thoughts and feelings, openly, honestly, clearly, and without violating any other person’s rights. It is the healthy alternative to being aggressive, or to being passive. Being assertive means that we are able to say what we think and feel;

•  we are able to ask for what we want;

•  we can say “Yes” or “No” clearly and firmly;

•  we can express a range and depth of emotions;

•  we can express personal opinions;

•  we do not feel constrained by other people’s proclivities.

This means that we can start to communicate more effectively in our relationships—all without restricting ourselves unduly through fear of criticism, censure, or lack of confidence. This is improved self-esteem.

Being unassertive

We are usually quite unassertive (compliant, conforming, submissive, obedient, reserved, repressed, or quiet) because we have learnt or been forced to be so. Young babies are naturally self-assertive; their survival depends on it. These babies—and you were one once—tell those around them exactly what they need. But, as children, those around us also gradually shape our behaviour through the messages they give us, and the general level of encouragement (or lack of it), as well as by more overtly repressive or deprived circumstances. Lack of self-assertion can become chronic. In the long-term, being unassertive depletes our self-esteem, and the more we become unassertive, the more we lack a sense of identity. This can result in a corresponding lack of sense of purpose, faith, good feelings about the world and ourselves, feeling in control, trust, joi

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