Anxiety Worries about Health

Anxiety is the response that the body and brain have when we think something bad will happen.

Anxiety is a survival instinct and can keep us safe from danger in real life-threatening situations.

However, we have the same physical and mental response to actual threat and perceived threat. Perceived threats can be a thought, a feeling, or a situation.

How do people respond to anxiety? Anxiety impacts our body, mind and behaviour (actions). Here are some ways that people can respond or react to anxiety:

These responses can be overwhelming, make you feel like you are unwell, and, sometimes, they feel like they will never end or get better. We know that the physical symptoms of anxiety always pass eventually and with some tips and strategies for managing anxiety, it can and will get better.

Because anxiety impacts the body, mind and behaviour, some of the ways to interrupt or change anxiety is by focussing on calming a physical response, challenging negative thinking or changing our behaviours.

It can be helpful to practice one technique at a time. It takes time to practice and learn these strategies. Think of it like building a toolkit – different strategies or techniques will be useful in different times.

It is important to practice these techniques when you are feeling calm so that when there is an anxiety-provoking situation, you know what to do.

Ways to calm a physical response. The physical response to anxiety can feel unmanageable but it will not last forever. There are a number of techniques that you can use to manage your physical anxiety response.

These include:

Calm breathing (see sheet below)

Use sensory strategies (e.g. lavender oil, Vicks, weighted blankets, darkness)

Progressive muscle relaxation – some guidance on how to do this can be found here: https://www.getselfhelp.co.uk/relax2.htm

Body Mind Behaviour (actions) Breathing quickens or

becomes more shallow Racing thoughts Avoid other people

Heart beats quickly Difficulties with decision making Stop hobbies or interests

Muscle tension Difficulties focusing or concentrating Criticise or blame self

Stomach flutters Overwhelming, big feelings or no feelings Check things over and over

Sweating Getting stuck on details (hyper-focussing) Complete rituals to try to reduce anxiety

Pain (stomach, chest) Negative thoughts

Feel sick Repetitive thoughts

Ways to challenge your anxious thoughts.

Choose and hold a mindful object. This could be something small and transportable that has a nice texture or colour. Focus on the object when you are feeling a bit stressed. Think about why you like the object and how it makes you feel. You might like to describe to someone else why you like it.

Distraction! It can be helpful to distract yourself by doing an activity deliberately focus your attention on other thoughts or focus on something mundane (tidy a room, or plan out the process of making your dinner, play a game, watch TV – not the news).

When you find activities that take your mind away from worries, write them down! For example, you might write ‘when I feel stressed or worried I can go into the garden’. Keep adding to this list as you discover useful ways to direct yourself away from worrying.

Notice the positive. Start a gratitude journal. A gratitude journal can be good for reducing low mood and/or anxiety. Write down some positive things that happen around and to you; things like ‘what I am grateful for today…’ or ‘small things that made me smile today…’ or ‘small victories I had today…’

Focus on the present

o Grounding techniques. When you are feeling especially stressed out try grounding techniques. You might like to use this short exercise to ‘ground’ yourself. Grounding yourself will reduce your stress levels for a while and give you space to think more clearly.

Take a deep breath and sigh it out, feel the ground and your feet or the chair and your bottom.

Name five things you can see around you and name them out loud.

Now name four things you can hear around you. Say them out loud.

Next name three things you can feel or touch close to you and name them out loud.

Then name two things you can smell and say them out loud.

Finally, name one thing you can taste whether actual or imagined. Describe out loud what it is and how it tastes!

(If you prefer, you can do this same exercise but just say the words in your head, to yourself, as you name things around you…)

Ways to challenge your anxious behaviours.

Recognise that avoidance doesn’t stop anxiety. In fact, it often makes the thing you are avoiding more scary and harder to do.

Try new things. Try something new, however small, as it will help you learn that it is okay to try something, even if you don’t like it. Do remember, it usually takes trying something multiple times before we adjust to it.

Take small steps. Take very small steps towards doing things that you avoid.

Try some self-help for worries and anxiety online. There are apps, podcasts and some free courses to help you with mental health. See the list at the end of this Guide.

Managing Stress Tips for Coping in Uncertain Times

What is stress?

Situations or events that put pressure on us – for example, times where we have lots to do and think about, or don't have much control over what happens.

Our reaction to being placed under this pressure – the feelings we get when we have demands placed on us that we find difficult to cope with.

Stress effects health; both mental and physical wellbeing. It can also impact our relationships, daily life and how we feel about ourselves.

The more stress we have in life, the harder it can be to cope and manage our responses. Stress can be a big, sudden event, (e.g. coronavirus) or regular, daily events (e.g. family stressors). Sometimes we do not notice how much stress, especially everyday stress, impacts our wellbeing.

How can stress impact my life?

Stress can lead to:

Irritability or moodiness

Feeling very sensitive or emotional

Interrupted sleep

Worried thoughts or anxiety

Back and neck pain

Frequent headaches

Feeling sick or having an upset stomach

Increased blood pressure

Changes in appetite – eating more or not feeling hungry

Rashes or skin breakouts

Chest pains

These feelings can be overwhelming, and it can make us feel that we cannot cope. They can also make us feel unwell.

It is important to note that while stress can make us feel unwell, these can also be symptoms of illness. If you feel unwell, it is important that you check physical symptoms with your GP or by calling 111.

What can I do to manage stress?

We cannot always control the stresses in our lives, nor can we avoid them. This can make times of extreme stress feel overwhelming or hopeless.

But we can make changes to how we manage stress – these can greatly reduce the impact of stress on our lives, it can also make it feel easier to cope.

What practical steps can I take to manage stress?

Here are some useful tips to help cope.

Acknowledge stress. There are times when life is very stressful. In these times, it is reasonable and normal to be overwhelmed. Know that this situation will not be overwhelming forever and there are ways to cope.

Give your day some structure. Get up at a regular time, make lists of things you need and want to do, make a schedule or use to-do lists, if helpful.

Take time out. Take deliberate steps to have time out and do something you enjoy every day, or several times a day.

Build regular exercise into your life. This can give you more energy, improve mood and reduce anxiety, in addition to physical benefits.

Eat well. Eat a balanced diet, make time to stop and eat at mealtimes.

Improve sleep with a sleep routine. Try to manage sleep with a regular bedtime, limited caffeine and screen use.

Connect. Speak to people you know and trust – this can be a phone call, email or text. Sharing your experience of stress can be very useful.

Use problem-solving strategies. These can make problems feel manageable (see problem solving sheet)

Try relaxation and calming techniques. Controlled breathing and progressive muscle relaxation can train your mind and body to become more relaxed. These techniques require practice, but can be very helpful (see calm breathing sheet below).

Ask for help. If you are unsure how you can manage or cope, ask for help from a trusted friend or family member. You can also ask for help from your GP, or from any NHS, mental health or support services that you access.

Managing Anxiety and Stress Relaxation Strategies - Calm Breathing

What is calm breathing?

Calm breathing is a technique that helps you slow down your breathing when feeling stressed or anxious.

Why is calm breathing important?

– Our breathing changes when we are feeling anxious. We tend to take short, quick, shallow breaths (called over-breathing). This makes us feel more anxious or makes anxiety last longer.

– Calm breathing changes your body’s response to anxiety and will help reduce symptoms.

– Calm breathing can be used anywhere, in any situation, whenever you feel, or are starting to feel, anxious.

How do I do it?

Calm breathing involves taking smooth, slow, and regular breaths. Sitting upright is usually better than lying down or slouching, because it can increase the capacity of your lungs to fill with air.

1. Take a slow breath in through the nose, breathing into your lower belly (for about 4 seconds)

2. Hold your breath for 1 or 2 seconds

3. Exhale slowly through the mouth (for about 4 seconds)

4. Wait a few seconds before taking another breath

Most who use this find about 6-8 breathing cycles per minute helpful to decrease anxiety, but find your own comfortable breathing rhythm.

Tips:

– It is important to pause for a few seconds after each breath.

– Try to breathe from your diaphragm or abdomen.

– Try to keep your shoulders and chest relaxed and still.

– If this is challenging at first, try this exercise by lying down on the floor with one hand on your heart, the other on your abdomen. Watch the hand on your abdomen rise as you fill your lungs with air. The hand over your heart should barely move, if at all.

When should I do it?

Try calm breathing for at least five minutes twice a day. You do not need to be feeling anxious to practice – at first you should practice while feeling relatively calm. You need to be comfortable breathing this way when feeling calm, before you can feel comfortable doing it when anxious. You’ll gradually master this skill and feel the benefits! Once you are comfortable with this technique, you can use it in situations that cause anxiety.

I’ve tried it and it didn’t work.

When we first use new strategies, they can feel unnatural or ineffective. Sometimes, we worry if we are not doing it right. Calm breathing requires some practice. Remember, this will not completely eliminate anxiety, but can be a helpful way of reducing symptoms, avoiding panic or calming more quickly.

Managing Stress Adapting routines and scheduling time

Why do I need problem solving strategies?

In the current situation, particularly when the government has asked us to practice strict social distancing measures, it can be very difficult for many, especially for autistic people, to cope with sudden unexpected changes and the interruption of normal schedules and routines.

You might be experiencing:

- Disruption of sleep patterns

- Not taking care of personal hygiene

- Changes in meal times, eating too much or not feeling like eating at all

- Not being able to carry out activities usually done outdoors, such as going to college or to work, etc.

It is normal to have an initial phase or transition period of ‘not knowing what to do’ to adapt to the new circumstances.

During this initial phase, you might feel a bit ‘out of control’ and you might notice unusual levels of stress and frustration. However, there are things that you can do to take control and recover your sense of comfort to some extent.

The best way to do this is to spend time re-designing a new routine and give structure to your week by planning and organising your daily activities and tasks.

Make a Monday to Sunday timetable. You can divide every day into morning and afternoon or do it by hours. Some people like a stricter schedule than others. Try to write one that is realistic and make you feel safe and secure. Stick it on a wall so that is clearly visible for you as a reference.

Balance your weekly routine. Make sure you have a good mix of work (activities that have to be done), rest and leisure. If you are worried about exercise, go for a walk around the park at a time when it is most quiet. But only once a day and stay away from other people.

It is important that you schedule both things that need to be done (i.e. essential tasks) and activities and hobbies that you enjoy and distract you. It is also important for you to include exercise if possible. Think about ways to adapt regular activities that you would normally do out of the home. For example, instead of an exercise class, following an online strength and balance routine?

These are some of the tasks/activities that you can include in your daily/weekly schedule (this is personal so make your own schedule):

Waking up and ‘going to bed’ times. This will help you maintain a good sleeping pattern.

Personal care activities. This includes showering and bathing.

Shopping days and times. Plan this ahead, as there might be queues due to social distancing measures. If you are currently unable to do your shopping see the ‘Resources/links to access support during the COVID-19 Pandemic’

Preparing food and having meals (at least 3 meals a day: breakfast, lunch and dinner). Try to have those meals around the same time every day.

Washing up

Taking the rubbish out on set up days, cleaning the house and tidying up. These will help you live in a more pleasant environment.

Going through mail and letters

Whenever you can, try to do at least half an hour of exercise outdoors or indoors. For example, you could go for a walk or follow a yoga session on YouTube.

Include your usual hobbies and interests as a way of distraction and because they are important to you as well. Depending on your interests, this can include reading, playing videogames, DIY, watching videos on the internet or anything else that helps you and motivates you.

Schedule a time to stay in touch with others. This can be either family members, friends, or people that you know online. Days and times to contact professionals like your GP or members at BASS can be also scheduled (although this might not be a regular thing).

Finally, some things for you to consider:

1. Schedule regular breaks every day!! It is important to rest your mind and body. It’s OK to do nothing.

2. Try to be realistic about your goals every day. Don’t plan to do too many things and re-visit the timetable. You might find that you didn’t achieve everything scheduled. It is OK if you need to make changes and lower your expectations.

Make practical plans and problem solve instead of worrying.

If you are spending too much time on your worries without taking any positive action, it will make you unhappy. Switch your brain to thinking more about positive things you can do that you enjoy or at least make you feel in control.

When you are stressed or anxious, it can be difficult to make decisions, think clearly, or know how to take action. Problems can seem big and unsolvable.

There are some strategies that can help you solve problems:

Step 1: Identify the problem

What is the problem? Identify specifically what it is that you want to change or sort out. Limit the scope of this – think about what the problem is for you or in your life. For instance, if you try to solve all of global warming, it may be overwhelming or feel hopeless, but if you try to think about how you can be more eco-friendly, it may feel manageable.

Step 2: Identify your options

What are the possible solutions as you see it? Make a list of every option you can think of, even those that seem unlikely. Consulting with others can be helpful here, as they might pick up on possibilities you haven’t considered.

Step 3: Weigh your options

Go through each option you’ve listed, and consider their potential benefits and consequences. Yep, do this for every option.

Step 4: Choose an option

After looking at the pros and cons of each option, one may jump out as the most likely for you. If not, just pick one! This is not about being right or wrong, it is about choosing the best available option for this particular problem and simply giving it a try.

Step 5: Put it into action

Whatever decision you’ve made about which option to take, go for it!

Step 6: Review

It is always worth taking time to review results. What have you learnt? What would you do differently if a similar problem presented itself? Would you do the same thing again, or are there other alternatives?

Problem solve your worries and ask others for help. Then you will be able to produce some practical solutions.

Using Helplines

When should I use a helpline or listening service?

If you're struggling with difficult feelings and need to talk to someone quickly, including if you're not ready or able to access other types of support.

How could they help me?

Helplines give you a chance to talk to someone about a problem, worry, or bad feelings. It can help to talk to someone, without being judged or told what to do. Many listening services let you talk through your problems for as long as you need.

Who would I speak to?

The people on helplines are trained to listen and help. They can also suggest resources and other sources of support.

What should I ask before calling a helpline?

What times are they open?

Is it free to call or is there a cost involved?

What will you do if the line is busy? It's often worth trying several times, or you might plan to call back later or try a different service.

When is it not confidential? Most services have a duty of care to protect you and those around you from harm, including if someone says they have attempted or are planning suicide. You might be able to find this information on the organisation's website, or you could ask the advisor to explain their policies during the call.

Who should I contact? There are different types of helplines that specialise in different types of problems. Some helplines specialise in helping certain groups of people, for instance young people, or those from the LGBTQ+ community.

I want help with my mental health, feelings, mood, thoughts or any other things that are upsetting:

Samaritans - Provides emotional support to anyone in emotional distress, struggling to cope, or at risk of suicide. Phone: 116 123 (free from any phone 24 hours a day, 365 days a year). Email jo@samaritans.org

SANEline - SANEline is a national out-of-hours mental health helpline offering specialist emotional support, guidance and information to anyone affected by mental illness. Phone: 0300 304 7000 (4.30pm–10.30pm every day).

I am under 25:

The Mix - Free information and support for under 25s in the UK. Get advice about sex, relationships, drugs, mental health and more. Phone: 0808 808 4994 (everyday, 4pm-11pm),

Crisis Messenger: Text THEMIX to 85258 For email support or a chat one-to-one online, visit The Mix website

Off The Record

Hubs are taking place digitally. You can find a weekly schedule that comes out on a Monday: https://www.instagram.com/p/B-olEs_gIGw/

As well as projects like Resilience Lab, Yoga, Book Club and some of our Therapeutic Groups (MindAid, Shameless and hARMED) running as closed groups that young people can sign up to. The sign up form (as well as the info about dates and times) is all here: https://otrbristol.typeform.com/to/XvWn5r

There's lots of things going out online that young people can browse through and watch in their own time: https://www.instagram.com/otrbristol/channel/

If you would like something offline that you don't have to tune into, there are lots of Zines and a Self-care plan on the Hubs page: https://www.otrbristol.org.uk/what-we-do/hubs/

I am under 35.

Papyrus HOPELINEUK – For support with those struggling with suicidal feelings, or for those supporting someone who is struggling with these feelings. Phone: 0800 068 4141 (weekdays 10am-10pm, weekends 2pm-10pm and bank holidays 2pm–10pm) Email: pat@papyrus-uk.org Text: 07786 209 697.

I am a student:

If you're a student, you can look on the Nightline website to see if your university or college offers a night-time listening service. Nightline phone operators are all students too.

I identify as LGBTQ+:

Switchboard: Provides a one-stop listening service for LGBT+ people on the phone, by email and through Instant Messaging. All phone operators identify as LGBT+. Phone: 0300 330 0630 (10am–10pm every day) Email: chris@switchboard.lgbt Webchat service: accessed from https://switchboard.lgbt

I identify as male:

Campaign Against Living Miserably (CALM)- Available to those who identify as male. This includes a web chat service which can be accessed from 5pm to midnight every day at https://www.thecalmzone.net/help/webchat/ Phone: 0800 58 58 58 (5pm–midnight every day)

I want help, but don’t feel comfortable speaking:

Shout - is the UK’s first 24/7 text service, free on all major mobile networks, for anyone in crisis anytime, anywhere. It’s a place to go if you’re struggling to cope and you need immediate help. Text: Shout to 85258 https://www.giveusashout.org/

I just want information:

Mind’s Infoline - Infoline provides an information and signposting service. Ask about: mental health problems, where to get help near you, treatment options and advocacy services. Phone: 0300 123 3393 Email: info@mind.org.uk Text: 86463 Post: Mind Infoline, PO Box 75225, London, E15 9FS

I want support with anxiety:

Anxiety UK - Charity providing support if you have been diagnosed with an anxiety condition. Phone: 03444 775 774 (Monday to Friday, 9.30am to 5.30pm) Website: www.anxietyuk.org.uk

I want support with panic or OCD:

No Panic - Voluntary charity offering support for sufferers of panic attacks and obsessive compulsive disorder (OCD). Phone: 0844 967 4848 (daily, 10am to 10pm). Calls cost 5p per minute plus your phone provider's Access Charge Website: www.nopanic.org.uk

I want support with OCD:

OCD Action - Support for people with OCD. Includes information on treatment and online resources. Phone: 0845 390 6232 (Monday to Friday, 9.30am to 5pm). Calls cost 5p per minute plus your phone provider's Access Charge Website: www.ocdaction.org.uk

Further resources

BASS Autism Service for Adults

If you have a question about something related to your general wellbeing or your autism, you can email BASS – awp.bass@nhs.net

Guide to Mental Health - BASS has produced a Guide to Mental Health which can be found at www.awp.nhs.uk/bass

BASS provides a number of useful guidebooks for autistic people. These include:

Stuff to do

Benefits

Money

Driving

Employment

Diverse UK (www.diverseuk.org) Diverse UK is a local charity that regularly hosts and run lots of social activities. These include: walking groups, Dungeons & Dragons, cinema groups, arts and crafts, gigs and pub meet ups. For more information, please contact: Email: hello@diverseuk.org; phone: 07795 490730

Mental health support

If you want to think about getting counselling or therapy around low mood or anxiety get advice from Bristol Autism Spectrum Service as we have staff who can meet with you and help you decide what kind of support you need. Book an appointment on 01275 796 204 or email awp.bass@nhs.net Or you can go direct to Vita Minds and book an initial assessment on 0333 200 1893 or online www.vitahealthgroup.co.uk

Online Resources

Northumberland, Tyne and Wear NHS Foundation Trust https://web.ntw.nhs.uk/selfhelp/

This website contains a number of excellent leaflets on wide range of topics including: Abuse, Depression, Obsessive Compulsive Disorder and Social Anxiety. The information is available as downloadable PDF leaflets (including Easy Read versions), Audio files and BSL videos.

Centre for Clinical Interventions https://www.cci.health.wa.gov.au/resources/looking-after-yourself. A website which contains useful information on many topics, including: Assertiveness, Health Anxiety, Perfectionism, Self-esteem & Worry and Rumination. There are Workbooks, Information Sheets and Worksheets for each topic.

Reading Well (www.reading-well.org.uk) Has great lists of recommended reading on anxiety, depression and self-esteem etc.

Books

Helen Dent (2018). Why Don’t I feel Good Enough? Using Attachment Theory to Find a Solution. A guide to how early emotional bonds affect our adult relationships and how psychological theory can help find the origin and solution to a number of life’s problems.

Matt Haig (2015) Reasons to Stay Alive. One man’s experience of overcoming crisis and depression.

David Burns (2005) Feeling Good. Written by a psychiatrist, outlining key concepts in cognitive behavioural therapy. Targeted at difficulties including anxiety, guilt, and low self-esteem.

Sue Gerhardt (2004). Why Love Matters: How Affection Shapes a Baby’s Brain. Outlines the links between our emotional experiences in infancy and early childhood and our strengths and difficulties later in life.

Maggy van Eijk (2018). Remember This When You’re Sad. A first-hand account of the author’s mental health difficulties in addition to useful self-care strategies.

TED Talks

All it takes is 10 mindful minutes (Andy Puddicombe) Outlines the links between mindfulness in relation to mood and wellbeing.

How childhood trauma affects health across a lifetime (Nadine Burke Harris) An overview of how the stress of abuse and neglect impacts the development of the brain and subsequent life events.

Apps

WellMind – Developed in conjunction with the NHS, providing self-help tools, mood tracking, education and information.

Headspace – Developed to help people learn to meditate. Contains short guided exercises tailored to a range of difficulties. Also provides information about the benefits of meditation and mindfulness to physical and mental health.

Distract Mobile Phone App - Concerned about self-harming? Feeling suicidal? Not sure what to do next? Then this is the app for you. The distract app provides easy, quick and discreet access to general health information and advice about self-harm. While the app is mainly aimed at young people in the UK, those living in other parts of the world may also find it useful.

You can download it here: www.expertselfcare.com/health-apps/distract.

Podcasts

Listen to a podcast by searching ‘anxiety’ or ‘stress management’. The quality of podcasts is variable but there may be some good tips you might like to use. The following is just one example:

www.anxietyslayer.com

Private therapists

You may like to make use of a private therapist or counsellor for the months whilst you are having to live indoors. Some therapists will use online communication such as Skype or Zoom to conduct therapy sessions.

Use these websites to locate trained therapists locally:

www.babcp.com

www.bps.org.uk

Advice for older people. The government has now advised that if you have an underlying health condition(s) or if you are aged 70 or older, you should be social distancing for up to 12 weeks. If you know of older people who need support, remind them of Age UK (https://www.ageuk.org.uk/) and Silverline (www.thesilverline.org.uk) who have people to speak to.

Crisis Support

In Bristol:

Bristol Crisis Service - 0300 555 0334 This line is open 24 hours a day, every day for those in Bristol. All callers speak to a specialist trained in responding to mental health crisis.

Bristol Sanctuary - 0117 9542952 or 07709 295661 1 New Street, St Jude’s. Bristol, BS2 9DX

www.bristolmentalhealth.org/services/bristol-sanctuary

All areas:

The Samaritans - 116 123 (Freephone) A free and confidential telephone support service for people of all ages who are feeling depressed or suicidal. Operates by phone 24 hours a day, 365 days a year.

Bristol: 7 St Nicholas Street Bristol, BS1 1TP www.samaritans.org/bristol

Bath: 25 Windsor Castle, Upper Bristol Road, Bath BA1 3DN

Weston Super Mare and North Somerset: 137A High Street, Weston Super Mare, BS23 1HN https://www.samaritans.org/branches/weston-super-mare/

Saneline - 0300 3047000 www.sane.org.uk

Saneline is a national out-of-hours telephone helpline offering emotional support and information for people affected by mental health problems. You can ring if you are worried about your own mental health, or you are concerned about someone else.

Mind Crisis Helpline: - 0808 808 0330 - Text: 86463 info@mind.org.uk https://www.mind.org.uk/

Mind provide mental health advice and support

Shout is the UK’s first 24/7 text service, free on all major mobile networks, for anyone in crisis anytime, anywhere. It’s a place to go if you’re struggling to cope and you need immediate help. Shout is powered by a team of volunteers, who are at the heart of the service. We take people from crisis to calm every single day.

Text: Shout to 85258 https://www.giveusashout.org/