Cognitive Behavioural Therapy (CBT) Bundle (312 pages)

WHAT IS ADHD?

WHAT IS ADHD?

WHAT IT CAN LOOK LIKE

Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder which first shows in childhood, with symptoms also continuing in to adulthood. ADHD looks different in different individuals, however there are three common types seen. This is where the symptoms are predominately in the inattentive space, versus symptoms of a hyperactive/impulsive type. Many individuals also show a combination of the two categories of symptoms.

Difficulties staying focused on a task. Being forgetful & frequently loosing track of time. Difficulties with sitting still for longer periods. Being inattentive when completing tasks that are “boring”, while hyper focusing when tasks are “interesting”. Difficulties with taking turns in conversations. Constantly moving and “on the go”. Difficulties with “quiet” tasks. Intensely talkative.

MANAGING ADHD SYMPTOMS

There are a number of ways to help stay on top of ADHD symptoms, including:

Structured therapy (for example CBT therapy). Medication. Regular physical activity. Creating structured habits for healthy eating, time management and using tools such as reminders, focus plans, breaking up tasks etc.

ADHD SYMPTOMS CHECKLIST

INATTENTION

Difficulties staying focused on tasks

Forgetful of tasks & appointments

Misses small details

Makes careless mistakes

Avoids mentally demanding tasks

Take a moment to read through some common

May seem to not listen when spoken to

symptoms of ADHD. You may recognise yourself in some and not others. This is normal, and it is not unusual that ADHD looks very different from person to person. Knowing your symptoms and 'warning signs' can help you better understand them and allow you to put actions in place sooner to manage your symptoms where needed.

Often looses or misplaces things

HYPERACTIVITY & IMPULSIVITY

Constantly moving or 'on the go'

Has difficulty sitting still

Excessively talkative

Struggles with 'quiet' tasks

Often speaks out of turn/interrupts

THE ADHD BRAIN

There are a few distinct areas of the brain that are affected in individuals with ADHD. Read on below to learn more about the ADHD brain.

FRONTAL CORTEX

LIMBIC SYSTEM

BASAL GANGLIA

FRONTAL CORTEX: The frontal cortex controls high level functions such as attention, executive function and organisation. In individuals with ADHD we often see a weaker function and structure of the frontal cortex, which in turn can impact on these functions. The limbic system regulates things such as emotions, attention and motivation. As such, ADHD-related changes to this area of the brain may contribute to hyperactivity, inattention, and poor decision-making. The basal ganglia is a small area deep in the centre of our brain responsible for motor learning (the act of learning a particular skill through practice or experience). It also plays a role in regulating emotions, focus and behaviours. This is another area that may be impaired in individuals with ADHD. LIMBIC SYSTEM: BASAL GANGLIA:

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NEURODIVERSITY

WHAT IS NEURODIVERSITY?

The term “neurodivergent” describes individuals whose different brain functions affect how their brain works. This means that they have different strengths, as well as face different challenges when compared to individuals whose brains do not have these differences (often referred to as “neurotypical”). These differences can be a result of medical disorders, learning disabilities and other conditions.

THE MOVE FROM DEFICITS TO DIFFERENCE

The movement towards the inclusive label of neurodiverse has gotten stronger in the past few years. There is however still a lot of bias against individuals with diagnoses such as ADHD, autism, down syndrome and others. Historically the focus has been on barriers and challenges experienced by these individuals, and with this, strengths and capabilities have been ignored. It is important to view the neurodiverse individual as a whole, rather than only focusing on symptoms and challenges. This is why the move from only seeing “deficits” in these individuals, to “differences” has been so important.

CONDITIONS UNDER THE NEURODIVERSE UMBRELLA

There are a number of medical diagnoses, psychological conditions, and learning disabilities that a neurodiverse individual may present with. Some of these include:

Autism Spectrum Disorder (ASD) Attention-Deficit Hyperactivity

Dyslexia Dyspraxia Intellectual disabilities Sensory processing disorders

Disorder (ADHD) Down Syndrome

Dyscalculia Dysgraphia

Tourette syndrome Williams syndrome

MYTHS ABOUT NEURODIVERSITY

Unfortunately, there are far too many myths gaining traction in relation to neurodiversity. Let’s take a moment to bust some of the most common myths.

“NEURODIVERGENT INDIVIDUALS ARE UNINTELLIGENT” Not at all! Many neurodivergent individuals are highly intelligent and can be extremely gifted individuals.

“NEURODIVERGENT INDIVIDUALS CANNOT BE SUCCESSFUL” There are many neurodivergent individuals who are incredibly successful, some famous examples include oscar-winning actor Sir Anthony Hopkins, olympian Simone Biles, and animal scientist and author Temple Grandin.

“NEURODIVERGENT INDIVIDUALS CANNOT HAVE HEALTHY RELATIONSHIPS” While some conditions included under the neurodivergent umbrella affect the ability to understand social cues, impact on communication and may become a barrier to developing relationships, with the right support any neurodivergent individual can build and maintain healthy and long-standing relationships. “NEURODIVERGENT INDIVIDUALS ARE ONLY SUITED TO REPETITIVE JOBS ” Just as for any other human being, there is no one job that fits all. Some neurodivergent individuals may enjoy more repetitive tasks at work, however many others thrive in jobs where they can be more creative and flexible in their role. “NEURODIVERSITY IS A DISORDER“ One of the most common and problematic misconceptions surrounding neurodiversity is that it is a disorder that needs to be cured. Neurodiversity is not a disorder but a natural variation in the human brain. It is no different from variations in physical characteristics or abilities.

HOW DOES THE ADHD BRAIN DIFFER?

ADHD looks different in different individuals. This is particularly evident as there are three different “types” of ADHD presentations that come under the ADHD umbrella. Read on to learn more about the three different presentations listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

INATTENTIVE

HYPERACTIVE-IMPULSIVE

COMBINED

Often:

Often:

Often:

Struggles to give close attention to details or makes careless mistakes. May appear to not listen when spoken to. Has difficulties sustaining attention. Struggle with organization of tasks. Often misplaces or looses things. Can be forgetful.

Frequently fidgets with hands or feet or squirms in chair. Has difficulties sitting still. Can be extremely restless. Constantly “on the go”. Talks excessively. Difficulties taking turns in conversation. Frequently interrupts

Has a combination of both inattentive and hyperactive-impulsive symptoms. There does not need to be an equal amount of symptoms from each category, however for a diagnosis of combined ADHD, the individual would meet criteria for both previously listed types.

in conversation. Often blurts out answers.

Gets easily distracted.

THE STRENGTHS OF THE ADHD BRAIN

While individuals with ADHD may face a lot of challenges as a result of their symptoms, there are also a lot of strengths that can come as a result of ADHD. To borrow a great analogy from ADHD expert Dr Edward Hallowell:

“Your brain is like a Ferrari race-car engine. It is very powerful. But there is one problem. You have bicycle brakes. Your brakes are not strong enough to control the powerful brain you’ve got”.

What this analogy points to is that when nurtured and supported appropriately the ADHD brain has some wonderful strengths. Particularly when you learn to control it in a positive way.

Here are just a few of the many wonderful traits and abilities seen in individuals with ADHD:

HYPER-FOCUS

SOCIAL CONNECTION

EMPATHY

The ability to channel all your energy and attention in to work that you enjoy or find interesting.

The ability to connect with others through warmth and often humour.

The ability to be empathetic and practice kindness and generosity towards others.

CREATIVITY

WILLINGNESS TO TAKE RISKS The willingness to step outside of your comfort-zone and try something new.

PERSISTENCE

The ability to “think outside the box” and come up with wonderful and creative solutions.

The ability to continue to persist towards a goal, regardless of challenges, when you set your mind to something.

PASSION

SPONTANEITY

HUMOUR

The ability to be driven and passionate in situations and work you care about.

The ability to be driven by energy and impulses to be spontaneous.

The ability to be silly, laugh at yourself and situations, and not take life to seriously.

WHAT IS COGNITIVE BEHAVIOURAL THERAPY (CBT)?

Cognitive Behavioural Therapy (CBT) is one of the leading approaches to psychotherapy due to its strong research basis and clear treatment path and timeline. CBT is a semi-structured therapy approach which provides a clear understanding for how situations, thoughts, emotions and behaviours interact and influence each other. It then provides clear exercises and strategies that can be utilised to manage and treat symptoms of psychological conditions such as ADHD, anxiety, and depression, along with many other conditions. CBT is based on the idea that our thoughts, feelings, and behaviours are constantly interacting with and influencing one another. How we interpret or think about a situation determines how we feel about it, which then determines how we'll react.

SITUATION

THOUGHTS

BEHAVIOURS

EMOTIONS

WHAT IS COGNITIVE BEHAVIOURAL THERAPY (CBT)?

How will CBT be helpful to me?

Have you ever watched a movie or show that really made you feel something? Maybe you’ve felt fear while the main character slowly walks into a dark space, sadness when your favourite character gets hurt, or joy and relief when everything turns out okay in the end. We know that movies and shows can make us feel very deeply... but why?

The answer is actually very simple. Walking into a dark space does not cause the emotion of fear. It’s what you think about being in a dark space that causes fear. Simply put, your thoughts have the power to influence and control your emotions.

This is partly where CBT comes in. Through using the CBT based information and exercises in these worksheets, you will learn to identify thought patterns in your everyday life that are causing stress, overwhelm, anxiety and other painful emotions or problems. By then replacing old thought patterns, and behaviours we can impact the ability to think and act differently when facing stressors or triggers causing anxious symptoms to appear. In addition to this, CBT provides many wonderful and practical strategies to address behaviours we want to change, such as for example avoidance or procrastination. It also gives us a good understanding of how we can use strategies and skills to manage and regulate our emotions and physical sensations related to stress, anxiety or overwhelm, and through that became calmer and more confident in our approach to life.

ADHD SYMPTOMS CHECK IN

INATTENTION

Difficulties staying focused on tasks

Forgetful of tasks & appointments

Misses small details

Makes careless misstakes

Avoids mentally demanding tasks

Take a moment to read through some common

May seem to not listen when spoken to

symptoms of ADHD. You may recognise yourself in some and not others. This is normal, and it is not unusual that ADHD looks very different from person to person. Knowing your symptoms and 'warning signs' can help you better understand them and allow you to put actions in place sooner to manage your symptoms where needed.

Often looses or misplaces things

HYPERACTIVITY & IMPULSIVITY

Constantly moving or 'on the go'

Has difficulty sitting still

Excessively talkative

Struggles with 'quiet' tasks

Often speaks out of turn/interupts

SETTING YOUR GOALS

Take a moment to reflect on any goals you may have. Perhaps you want to decrease worry and feel more confidence at school or work? Or maybe you'd like to overcome anxiety to be able to try out new activities or meet new people? No matter the size or importance of your goal, writing it out using the 'SMART' method can help you in setting your intentions for the work you're about to undertake on your mental wellbeing journey.

S M A R T

SPECIFIC

WHAT DO I WANT TO ACCOMPLISH?

MEASURABLE

HOW WILL I KNOW WHEN IT IS ACCOMPLISHED?

ACHIEVABLE

HOW CAN THE GOAL BE ACCOMPLISHED?

RELEVANT

DOES THIS GOAL SEEM WORTHWHILE TO ME?

TIME BOUND

WHEN CAN I ACCOMPLISH THIS GOAL?

MANAGING ADHD Cheat Sheet

CREATE STRUCTURE

STRUCTURE IS KEY

BREAK DOWN GOALS

USE REMINDERS

USE A TIMER

Big goals and tasks can feel very overwhelming. Get in to a habit of breaking tasks and goals in to smaller 'chunks' or steps. This helps the brain stay focused and the smaller tasks are experienced as more achievable.

Our modern society is distracting. So there is absolutely nothing wrong with needing reminders to keep yourself on track. Make it a habit to use lists or the reminder function on your phone to stay organised.

Similarly as breaking goals in to smaller tasks can be helpful, so can limiting tasks to a set time period. For example, instead of just saying 'I need to clean my house', set yourself a timer for 30 minutes and do as much cleaning as you can in that time.

The ADHD brain is by its nature easily distracted and 'on the go'. Many people with ADHD find that having a clear routine and structure in their day helps with budgeting energy and focus for the tasks that are important to them.

ENVIRONMENT

STAY ORGANISED

When it comes to ADHD some people find that they are very sensitive to noise and stimulation, while others find that they function best when there is a lot of sensory input and stimulation. Read on below for some tips on how to alter your environment to suit your needs.

Create to do lists. Lists can be your best friend for staying organised and remembering important tasks and goals.

Keep your space clean. Take 5 minutes each day to keep your main living and working areas clear from clutter.

Downsize. Do regular clean outs of your space. Having a lot of distractions, clothes, papers etc laying around can be overwhelming. Having a regular clean up can help you feel more organised. Do small tasks straight away. If a task comes up that is small and isn't expected to take more than 30 seconds to a minute, and you aren't doing anything important, do it straight away.

NEED NOISE AND ACTIVITY?

NEED PEACE AND QUIET? Listen to music. Turn on the TV to low volume for background noise. Update your environment by adding plants, photos, and colourful textures. Schedule regular breaks to go for a walk. Spend some time walking around in nature, or hit up a busy shopping street and do some window shopping. Use headphones. Either noise cancelling for complete quiet, or with some non-intrusive music or white noise. Designate an area in your home where you remove all distractions. Keep it clean and simple. Perhaps a cozy chair with a warm light and a green plant to use as a quiet space. Turn off your phone, turn off notifications on your email, and close the door to your room.

HEALTHY LIFESTYLE

Prioritise your sleep. For optimal mental health, focus and energy sleep is crucial. Aim for between 7-9 hours per night. Anything more or less than that may result in reduced focus, low energy, irritability and poor impulse control. Move your body. Exercise and physical activity has been found to be particularly helpful for individuals with ADHD as it boosts mood, increases mental focus, improves impulse control, enhances working memory, and improves the brains executive functions needed for planning and organising tasks. Eat right. Eating a balanced diet is not only important for your physical health, but can also have a big impact on our mental health. How much and what we need to eat often differs from person to person, however as a general rule of thumb eating regular meals, having good servings of protein, and minimising sugar/caffeine/alcohol is key to optimising your mental health and executive functions of the brain.

MANAGING SYMPTOMS Progressive Musle relaxation One method of reducing muscle tension and relieving physical symptoms of stress or overwhelm is a technique called Progressive Muscle Relaxation (PMR). Follow the steps below to complete the exercise. Start by applying muscle tension to a specific part of the body. This step is essentially the same regardless of which muscle group you are targeting. First, focus on the target muscle group. Next, take a slow, deep breath and squeeze the muscles as hard as you can for about 5 seconds. It is important to really feel the tension in the muscles. After about 5 seconds, let all the tightness flow out of the tensed muscles. Breathe out as you do this step. You should feel the muscles become loose and limp, as the tension flows out. Deliberately focus on and notice the difference between the tension and relaxation. Remain in this relaxed state for about 15 seconds, then move on to the next muscle group. Repeat the tension-relaxation steps. After completing all of the muscle groups, take some time to enjoy the deep state of relaxation. Find a quiet, comfortable place to sit, then close your eyes and let your body go loose. Take about 5 slow, deep breaths before you begin.

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RECOMMENDED MUSCLE GROUP SEQUENCE

Right foot Right lower leg and foot Entire right leg Left foot Left lower leg and foot Entire left leg Right hand Right forearm and hand

Entire right arm Left hand Left forearm and hand Entire left arm Abdomen Chest Neck and shoulders Face

Take care not to hurt yourself while tensing your muscles. You should never feel intense or shooting pain while completing this exercise.

MANAGING PHYSICAL SYMPTOMS

Why addressing the physical symptoms of anxiety is crucial

One of the body’s reactions to fear and stress is a change in breathing patterns, along with muscle tension. This can result in feeling “tense”, and can often lead to muscle aches and pains, as well as leaving some people feeling exhausted. Additionally, fast and shallow breathing can increase a persons sense of panic and may further reinforce the feeling of anxiety and fear when experienced for extended periods. Think about how you respond to stress. Do you “tense up” when feeling anxious or stressed? Perhaps you get frequent headaches or end up with pain in your neck, shoulders or back. The reality is that although we consider anxiety to be a psychological condition, it simultaneously manifests very much physically in the body for most people. It is not unusual to actually have the experience that stress and anxiety is more physical in nature rather than psychological. With this in mind, it is important to have strategies in place to manage the physical symptoms of stress and anxiety. This is often even more important while we are working through worry as strong physical experiences often cause us to feel like we want to run away from and avoid the uncomfortable situation due to the difficult nature of sitting through these types of sensations. As part of any good mental health management routine, I would recommend getting in to the habit of practicing controlled breathing and muscle relaxation exercises as these can be particularly helpful when addressing feelings of being on edge, anxious, stressed or overwhelmed. This following two pages will guide you through a simple, controlled breathing exercise, along with a common form of relaxation designed to reduce muscle tension.

MANAGING SYMPTOMS Controlled Breathing Exercise During periods of stress and overwhelm, the body triggers symptoms known as the stress response. In this state our breathing becomes shallow and rapid, our heart rate increases, and our muscles tense up. The opposite state to the stress response is the body's relaxation response. Here our breathing slows down and becomes deeper, our heart rate decreases and returns to a steady state, and most of our anxious or stress based symptoms quickly start to subside.

To achieve a relaxation state through our breathing we want to slow down , and control our breathing by getting it in to a steady rhythm .

One of the quickest and most effective exercises to achieve this is by using a steady rhythm formula such as the 4 - 2 - 6 rhythm. Follow the steps below to practice this exercise.

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If possible, practice this while in a safe and calm environment. Seated and relaxed is preferred (at least during the initial practice).

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Take a breath in for 4 seconds (through the nose if possible).

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Hold the breath for 2 seconds.

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Breathe our for 6 seconds (through the nose if possible), then pause slightly before repeating for 10 to 20 breaths or as needed.

Practice this regularly (preferably a couple of times a day initially). When you have mastered the controlled breathing technique this can then be utilised any time you notice your anxious symptoms coming on.

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UNCOVERING UNHELPFUL THOUGHTS

We know that the way we think affect how we feel. If you are feeling happy and excited, chances are, you have been thinking positive thoughts and about positive things. On the other hand, if you are feeling anxious, depressed, or upset, it is likely that you have been thinking negative thoughts. We call these unhelpful thoughts (simply because they lead to the experience of unpleasant feelings or unhelpful behaviours). All of us, at times, think things that make us feel sad or anxious, or that stops us from trying new things because we don't think we could handle it. This is a normal part of life, however, if you often feel distressed or anxious, you might need to examine your thinking to work on ways to improve how you feel. If unhelpful thoughts lead to distressing emotions, then it might be quite reasonable to say that the most effective thing to do is to change those unhelpful thoughts to more helpful ones. So, how can you do that? To start influencing the way you feel, and to work on more productive and helpful behaviours you need to learn to be aware of those unhelpful thoughts and beliefs, with the ultimate aim of challenging and balancing them. To do that, let’s start with doing an ABC analysis.

The ABC model describes how emotions and behaviour are a direct consequence of our thinking.

A - Activating event/situation

B - Thoughts and Beliefs

C - Consequences

A : The activating event can be anything - something that happens to us, something that somebody says or does, even something internal - an idea or memory that is triggered.

B : Can be beliefs or attitudes such as a ‘real men don't get emotional’, or they can be brief automatic thoughts such as ‘I’m a failure’ or 'I can't do this'. This also includes the constant chatter of negative self-talk that goes on in our head.

C : This includes anything that follows as a consequence of A and B (e.g. feelings, behaviours, and sensations). Examples include low mood, anxiety, anger and avoidant behaviour.

PRACTICING YOUR ABC'S

Doing the ABC analysis is taking the first step toward learning how to understand your thought cycle and learning the skills to manage your thoughts/emotions/behaviours.

Below is an example of an ABC analysis recorded in a Thought Diary:

A - SITUATION

B - THOUGHTS/BELIEFS

List all statements that link A to C. Ask yourself: “What was I thinking?” “What was I saying to myself?” “What was going through my head at the time?” Find the most distressing (hot) thought and underline it 1. 2.

This may be either: An actual event or a situation, a thought, a mental picture or recollection.

E.g. "What if I say something wrong" "Everyone will judge me"

E.g. Walking into a party

E.g. - Heart pounding, lightheaded, dry mouth, fast breathing - Stopped for water

C - CONSEQUENCES

E.g. Panic (90) Stressed (60)

1. Write down words describing how you feel. 2. Underline the one that is most associated with the activating event. 3. Rate the intensity of those feelings (0 to 100).

4. Jot down any physical sensations you experienced or actions carried out.

Now it's your time to practice! Follow the steps and examples listed above and practice identifying any recent situations that have caused you to experience for example stress, overwhelm, or anxiety. Take your time to outline the situation, any thoughts or beliefs that you noticed running through your mind in response to this, and the consequent feelings and sensations that occurred as a result.

A - SITUATION

B - THOUGHTS/BELIEFS

C - CONSEQUENCES

PRACTICING YOUR ABC'S

A - SITUATION

B - THOUGHTS/BELIEFS

C - CONSEQUENCES

A - SITUATION

B - THOUGHTS/BELIEFS

C - CONSEQUENCES

A - SITUATION

B - THOUGHTS/BELIEFS

C - CONSEQUENCES

PRACTICING YOUR ABC'S

A - SITUATION

B - THOUGHTS/BELIEFS

C - CONSEQUENCES

A - SITUATION

B - THOUGHTS/BELIEFS

C - CONSEQUENCES

A - SITUATION

B - THOUGHTS/BELIEFS

C - CONSEQUENCES

BALANCING UNHELPFUL THOUGHTS

So, now that you have been practicing the ABC thought monitor using the previous exercise, we move on to practicing what we can do to manage these thoughts.

Just to recap, when you challenge your thinking by using the thought diary, you describe an activating event/situation and you identify your automatic and unhelpful beliefs and thoughts that have contributed to your experiencing distressing emotions (consequences). The next step from here is to use disputation to practice challenging your unhelpful thought. This process helps you to start balancing how you think with the intention to improve how you feel. Take some time to review the evidence for and against your unhelpful thought. Just a quick note here, changing your thinking to improve how you feel is not just thinking the opposite of negative thoughts. Swinging the pendulum to the opposite extreme and being overly positive can sometimes be just as unhelpful. Instead, it is important to create a balanced thought process. Balanced thinking means evaluating your thoughts and including the positives and the negatives – both of which are a part of our everyday lives. We would treat this as if it would be handled in a courtroom, trying to balance up the facts of a case, taking into consideration all of the available evidence and trying to take all emotion out of it. Once you have completed step D, we would move on to the final step. Here I want you to create a balanced thought by asking yourself, “How can I rewrite my unhelpful thought to take into account all the evidence I have listed?” Write down your answer to this question. This becomes your new, balanced thought. A balanced and helpful thought or belief is one that takes into consideration all the evidence, objective information, and alternative viewpoints. We may not be able to completely take the emotion out of it fully by balancing the thought, however with practice it is likely that you can bring the emotion level down significantly to a level where you can feel comfortable in managing the situation moving forward.

When you feel ready go to the next page, start by practicing the full ABCDE model, using the example below as a guide.

PRACTICING YOUR ABCDE'S

A - SITUATION

B - THOUGHTS/BELIEFS

List all statements that link A to C. Ask yourself: “What was I thinking?” “What was I saying to myself?” “What was going through my head at the time?” Find the most distressing (hot) thought and underline it 1. 2. E.g. "What if I say something wrong" "Everyone will judge me"

This may be either: An actual event or a situation, a thought, a mental picture or recollection.

E.g. Walking in to a party

C - CONSEQUENCES

D - DISPUTING THOUGHTS

E.g. "Sometimes when I am anxious I go quiet and feel uncomfortable". Perhaps others are also feeling nervous being in a space with new people. Maybe others are caught up with their own thoughts and would likely not notice anything I said or did "wrong" even if it was to happen" Take some time to consider evidence for and against your thought.

1. Write down words describing how you feel. 2. Underline the one that is most associated with the activating event. 3. Rate the intensity of those feelings (0 to 100).

4. Jot down any physical sensations you experienced or actions carried out. E.g. - Heart pounding, lightheaded, dry mouth, fast breathing - Stopped for water E.g. Panic (90) Stressed (60)

E - EVALUATION/END RESULT

After looking at all the evidence for and against your hot thought, and having considered the disputation questions, replace the unhelpful thought with helpful, balanced thought/s. Finally, rerate the emotions felt after establishing the balanced thoughts when thinking about the situation.

E.g. ""I might feel a bit uncomfortable when first arriving at the party, but this is completely normal and most people probably feel similar feelings. I know I have been to parties before and this has ended up going well and been nothing to worry about. As such I am likely to be more than capable to handle any tricky situations that may come up.

E.g. Panic (25)

A - SITUATION

B - THOUGHTS/BELIEFS

C - CONSEQUENCES

D - DISPUTING THOUGHTS

E - EVALUATION/END RESULT

PRACTICING YOUR ABCDE'S

A - SITUATION

B - THOUGHTS/BELIEFS

C - CONSEQUENCES

D - DISPUTING THOUGHTS

E - EVALUATION/END RESULT

A - SITUATION

B - THOUGHTS/BELIEFS

C - CONSEQUENCES

D - DISPUTING THOUGHTS

E - EVALUATION/END RESULT

PRACTICING YOUR ABCDE'S

A - SITUATION

B - THOUGHTS/BELIEFS

A - SITUATION

D - DISPUTING THOUGHTS

E - EVALUATION/END RESULT

A - SITUATION

B - THOUGHTS/BELIEFS

C - CONSEQUENCES

D - DISPUTING THOUGHTS

E - EVALUATION/END RESULT

CHALLENGING THOUGHTS TIPS & TRICKS

The idea of changing your thinking may initially seem overwhelming. In fact, it may take some time to challenge and correct your old thinking habits, but be patient and you will master this skill. There are however a few tips and tricks to get started in practicing challenging your unhelpful, automatic thoughts. Read on for four ways to evaluate your unhelpful or anxious thought and then practice balancing it.

LOOK AT THE EVIDENCE

ALTERNATIVE EXPLANATIONS

You can ask yourself four things

Looking for evidence relies on facts rather than opinions. Do you have any objective

Are my thoughts/beliefs helping me to achieve my goals? Are my thoughts/beliefs helping me to get on with others whom I care about? Is my thinking helping me to feel good about myself and my life? Do the advantages of thinking this way outweigh the disadvantages?

proof that your thinking is correct? Approach this from a court of law

perspective. We are looking for cold hard facts not maybe’s, ifs, or possibles. Feelings are not counted as facts just like they wouldn’t be in a court of law.

ADVANTAGES AND DISADVANTAGES OF THINKING THIS WAY

DECATASTROPHISING

‘What if’ statements are usually based on an expectation that the worst will happen. A lot of the anxiety produced by ‘what if’ statements comes from the underlying assumption that you won’t be able to cope or change with whatever happens. Remind yourself that dealing with the unexpected provides opportunities for growth and learning. Instead of being scared of change and looking for the worst, approach it as an exciting new change or adventure.

Consider the advantages of adopting an alternative view point. a. What other explanations could there be for my assumptions or conclusions b. Is there a more positive way I could look at this which will help me to deal with the problem and feel better? c. What might someone else whose views I trust think about this? d. What other explanations would I offer to another person who came to me with this problem?

GRADED EXPOSURE

GRADED EXPOSURE

We have previously looked at how we can 'test out' our negative predictions and thoughts through behavioural experiments. But what happens when we have very specific fears or anxieties that feel way to overwhelming to test out this way right now? Here we turn to an exercise called graded exposure. The concept of this is the same. We want to desensitise the brain to the stress experienced in these situations, and give our brain a chance to see that it actually can cope with these situations safely, and in the instance of graded exposure, we do this in a gradual way. The first thing to do is to think about a situation that you fear and try to avoid. For example, some people might fear and avoid going to social places, or being assertive with others. Start by identifying the situation. From there you would break the situation down in to steps and list them. Once you have made the list, you note down how much distress you feel around each step by giving them each a rating on a scale of 0 to 100. Finally, we would organise the list in order of distress experienced. HOW DOES IT WORK?

FEAR HIERARCHY

Now that you have what we refer to as a fear hierarchy list with your steps ready you can start working step-by-step towards your major goal. Of course, goals with high distress (eg a rating of 80+) will need more steps than a medium distress goal (eg a rating of 40+). You can break your goal into smaller steps by changing WHO is there, WHAT you do, WHEN you do it, WHERE you do it, and HOW long you do it for. The goal is to get you to work on each item, starting from the bottom and moving up the steps as you start to feel more comfortable.

FEAR HIERARCHY

Start by constructing a ladder with the overarching goal on top (the situation you've identified that makes you anxious or stressed). Below this, you list each step towards that goal in order of distress. Give each item a rating from 0-100% according to how strongly you would feel the emotion if you had to be in that situation.

Check out the example below, and then jump in to creating your own ladder on the next page.

SITUATION

EMOTION (0-100%)

To go to the gym on a weekend by myself at peak hour and complete a full workout.

80%

GOAL:

Go to the gym on a weekend at peak hour with a close friend and complete a full workout. Go to the gym on a weekend by myself at a more quiet time and complete a full workout. Go to the gym on a weekend at a more quiet time with a close friend and complete a full workout. Go to the gym on a weekday by myself and complete a full workout. Go to the gym on a weekday with a close friend and complete a full workout. Go to the gym later at night when few people are there and complete a workout. Go to the gym later at night and spend some time checking where all the machines are and test them out. Meet with the receptionist at the gym for a walk through of the facilities. Look up the gym online to orient myself to the layout of the gym.

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FEAR HIERARCHY EXERCISE

When starting to gradually expose yourself to each step of the ladder (starting from the bottom), it is important to be aware that you may need to repeat some of the steps several times to get the anxiety, stress or worry down to a manageable level, where you feel confident in moving on to the next step. There are no right or wrong amount of steps, or times needed to complete each step. Make sure to utilise the thought balancing exercise to prepare you for each step and practice the relaxation and breathing strategies as needed.

SITUATION

EMOTION (0-100%)

GOAL:

PHYSICAL ACTIVITY

Few things are as all round positive for our health as physical activity. Not only is it incredibly beneficial for our physical health, but it is also plays an important role in mental health management.

HOW CAN EXERCISE HELP MY MENTAL HEALT?

Research has found that regular exercise can help ease symptoms of anxiety, depression and stress by releasing feel-good endorphins and other natural brain chemicals that can enhance your sense of well-being. Exercise has also been found to be particularly helpful for individuals with ADHD as it increases mental focus, improves impulse control, enhances working memory, and improves the brains executive functions needed for planning and organising tasks.

HOW MUCH EXERCISE DO I NEED TO DO?

To improve physical and mental health, the World Health Organization recommends that a person should exercise at least 30 min per day, 5 days per week to achieve health benefits. There is some evidence that higher intensity exercise is more effective than lower intensity exercise, but it can also be harder to stick with, so the most important thing is that you exercise in a way that you find enjoyable and that can be maintained over time.

HOW TO GET STARTED

By making the decision to exercise more, you’ve already taken a big step towards your health and wellbeing. Decide what activity interests you most (perhaps walking, weight lifting or a dance class), then take the steps required to get started. Action often needs to come before motivation – once you start moving it will be easier to continue.

Need a boost to get started? Perhaps make a walking date with a friend or sign up to a class for some accountability to help get the momentum going.

SLEEP HYGIENE

Sleep is a crucial part of good mental health. Everyone needs different amounts of sleep, however a common recommendation is 7-9 hours. Not getting enough sleep can increase anxiety and low mood over time, and can often result in irritability, poor concentration and poor judgement. Not getting enough quality sleep? Check out the ideas below for some simple ways to improve your sleep.

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Get regular. One of the best ways to train your body to sleep well is to go to bed and get up around the same time every day, even on weekends and days off. Sleep when sleepy. Only try to sleep when you actually feel tired or sleepy, rather than spending too much time awake in the bed. Get up & try again. If you haven’t been able to get to sleep after about 20 minutes, get up and do something calming or relaxing until you feel sleepy, then return to bed and try again. Use a sleep diary. Keeping a diary around sleep for a few days or a week can help you identify good and bad habits that may help or interrupt sleep. Bed is for sleeping. Try not to use your bed for anything other than sleeping so that your body comes to associate bed with sleep. If you use bed as a place to watch TV, work, eat, and other things, this will interrupt the association between the bed and sleep.

Avoid naps. It is best to avoid taking naps during the day, to make sure that you are tired at bedtime and to reinforce a clear routine around sleep. Sleep rituals. You can develop your own bedtime routine to remind your body that it is time to sleep - some people find it useful to do relaxing stretches or breathing exercises before bed each night, having a warm shower or bath, or to have a cup of caffeine-free tea. No clock-watching. Many people who struggle with sleep tend to watch the clock too much. Frequently checking the time during the night can wake you up and reinforces negative thoughts. A calm space. It is very important that your bed and bedroom are quiet and comfortable for sleeping. A cooler room with enough blankets to stay warm is best, and make sure you have curtains or an eye mask to block out early morning light and earplugs if there is disturbing noise outside your room.

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PROCRASTINATION

At the centre of procrastination is often a desire to want to avoid any form of anticipated discomfort. This may be avoidance of fear, anger, resentment, boredom, anxiety or exhaustion. Learning how to sit through discomfort, as well as putting some simple strategies in place to avoid high levels of discomfort in relation to a task can help us overcome our desire to procrastinate a task.

Read on below for some simple tips to start working on and overcoming procrastination.

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Pick your timing. Work out what time of the day you are at your most productive and energised. Plan any challenging tasks for this time when you are at your best.

Worst first. Start with the hardest task first. Once you've overcome that task, all other tasks will feel easy in comparison.

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Use the momentum. Opposite to the above, it can also be helpful starting with a more enjoyable task. When the brain detects positive emotions associated with a task it is more likely to maintain motivation and momentum for several tasks following this. Give me 5 (minutes). Set a timer on your phone or watch for 5 minutes. Then allow yourself to only spend those 5 minutes on the task. Breaking it down in to shorter intervals often feels more achievable for the brain, and by the time the 5 minutes are up you have probably built up momentum to keep the work going for longer. And if not thats okay too! In that case you are still 5 minutes closer to completing the task then you were before. Set time limits. Similar to the example above you can benefit from setting other time limits on tasks (e.g. spending 30 minutes on your assignment). Having a set amount of time planned for a task often feels more achievable and less overwhelming.

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Pick your place. Pay attention to what type of environment you are at your most focused and least distracted (maybe this is your office, at the dining room table or at a coffee shop). Then use these settings when trying to complete tricky or boring tasks. Reminders. Use visual reminders and lists to keep yourself on track. This can be a written list, a coloured post it note or the reminder app on your phone. Practice mindfulness. Before starting a tricky task, take a few minutes to practice mindfulness to get your brain in an optimal state of focus. There are plenty of 1-2 minute exercises and audio apps you can use to get you started in this area. Reward yourself. Plan small rewards for yourself when something has been achieved or as a well earned break to keep yourself motivated and to increase your sense of enjoyment with the tasks.

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STUDY TIPS

Establish a routine. Create a consistent routine where you study for a set period of time, at a certain time of day each day.

Create a dedicated study area. Wherever possible make sure to study in the same place each time. Pick a comfortable place with minimal distractions.

Quality over quantity. It is better to break your study sessions up in shorter time periods with regular breaks in between. Here quality really beats quantity.

Treat it like your job. Commitment is key with study. If you've got a study plan in place, stick to it! You wouldn't just skip work on a whim, so don't to it with study.

Set specific goals. When starting a study session set specific goals with what you want to achieve during that time (e.g. read one chapter, or write 3 paragraphs).

Write down what you learn. When reading a chapter or watching a lecture, make a point of writing down the key takeaways that you have learnt.

Quiz yourself. A really good way to make sure that what you are learning stick is to regularly quiz yourself on the content you've read/watched.

Take a break. Regular shorter breaks and a change of scenery is a great way to keep yourself energised and your brain focused.

Self care is key. When studying, don't forget to look after yourself! Make sure to get adequate sleep, eat regularly and engage in some physical activity.

BEHAVIOURAL EXPERIMENTS

Negative predictions

Many people who suffer from anxiety, depression or unhelpful thought patterns tend to make negative predictions about how certain situations will turn out. For example, they may tend to overestimate the likelihood that bad things will happen or that something will go wrong, or exaggerate how bad things will be. It is also not unusual to underestimate your ability to deal with things if they don’t go well. When jumping to negative conclusions like these, it is more likely that you will tend to engage in unhelpful behaviours. Perhaps you avoid the situation completely, try the situation out but escape when things feel too difficult, or be overly cautious and engage in safety behaviours. The problem with these strategies is that they prevent you from actually testing out your predictions and proving your worry wrong. This makes it very hard for you to ever have a different experience from what you expected, so you continue to expect the worst. As mentioned earlier, when we experience worry one of the most common things that happens is that we simply avoid facing the anxiety or stress provoking situation all together. This may help you reduce your discomfort in the short term, but it also contributes to the continuation of your negative predictions and anxieties.

Testing the predictions

What we can do instead of engaging in avoidance, is to test out our negative predictions. We would do this almost as if we are designing a scientific experiment. We would identify the situation, plan how we are going to approach it, prepare by engaging in positive coping strategies such as through relaxation and thought balancing, and then finally try out the new behaviour. By testing our predictions and engaging in "behavioural experiments" we can help reinforce the balanced thoughts practiced, reinforce our strengths and capacities, as well as prove the brain 'wrong' when it comes to the unhelpful thoughts.

On the next page you can read further about how to plan and evaluate a behavioural experiment, and then jump in to designing and practicing one yourself.

BEHAVIOURAL EXPERIMENTS

Behavioural experiments step by step

Be clear about the purpose of the experiment - the point is to test out your negative predictions and help you to develop more realistic and/or balanced predictions.

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Identify what the thought or belief is that you are trying to test. Rate how strongly you believe this prediction (0-100).

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What is an alternative prediction or belief? Rate how strongly you believe this alternative (0-100).

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Design the actual experiment. Decide what you will do to test your prediction, when you will do it, how long it will take, and with whom. Try to be as specific as possible. There are no boundaries to how creative you can be, and it is ok to ask for help. Make sure you set your experiment at an appropriate level. It is best to start with smaller and less anxiety or stress inducing behaviours and situations, and then increase the challenge step-by-step. Make sure to identify likely problems you may come up against and how to deal with them.

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Carry out the experiment as planned. Remember to take notice of your thoughts, feelings and behaviours.

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Write down what happened. What did you observe? Consider the evidence for and against your original prediction. What did this say about your negative prediction?

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Identify what you have learnt from the experiment.

Rate how strongly you now believe in your original prediction and the alternative prediction (0-100).

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BEHAVIOURAL EXPERIMENTS

BEHAVIOURAL EXPERIMENTS WORKSHEET

Using the steps listed above take a moment to complete the behavioural experiment worksheet. Pick a situation that feels achievable to test out, and leave the 'big ticket' items for later. Follow the steps you've outlined when ready, and then return to the worksheet to complete the last two boxes when you have tested out your prediction.

Prediction Specifically what are you afraid will happen?

Experiment How will you test your prediction?

Evidence to Look For What will I/others observe if prediction is true?

Actual Outcome (stick to facts)

What Have I Learned?

SELF CARE GRID

Just like a battery we often encounter situations that either fill us up with charge or zaps us of all our energy. Take a moment to reflect at the end of each day this week on what activities/people/places made you feel energised/good about yourself, and what drained your energy or contributed to putting yourself down.

WHAT DID I DO TODAY THAT MADE ME FEEL ENERGISED OR INCREASED POSITIVE EMOTIONS?

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WHAT DID I DO TODAY THAT DRAINED MY ENERGY OR INCREASED NEGATIVE EMOTIONS?

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