Five Ways to Well-Being

posted: 07/04/2011

Taking the following five actions in our day-to-day lives boosts our well-being, evidence shows. On the day that the draft standards for better mental health support for people living with HIV are launched, here's some simple steps to feel better and enjoy more of life.

Connect
With the people around you. With family, friends, colleagues and neighbours: at home, work, school or in your local community. Think of these as the cornerstones of your life and invest time in developing them. Building these connections will support and enrich you every day.

Be active
Go for a walk or run. Step outside. Cycle. Play a game. Garden. Dance. Exercising makes you feel good. Most importantly, discover a physical activity you enjoy and that suits your level of mobility and fitness.

Take notice
Be curious. Catch sight of the beautiful. Remark on the unusual. Notice the changing seasons. Savour the moment, whether you are walking to work, eating lunch or talking to friends. Be aware of the world around you and what you are feeling. Reflecting on your experiences will help you appreciate what matters to you.

Keep Learning
Try something new. Rediscover an old interest. Sign up for a course. Take on a different responsibility at work. Fix a bike. Learn to play an instrument or how to cook your favourite food. Set yourself a challenge you will enjoy achieving. Learning new things will make you more confident, as well as being fun.

Give
Do something nice for a friend, or a stranger. Thank someone. Smile. Volunteer your time. Join a community group. Look outwards, as well as inside your head. Seeing yourself, and your happiness, linked to the wider community can be incredibly rewarding and it creates connections with the people around you.

Five Ways to Wellbeing, by the Centre for Wellbeing - slide show

draft Psychological Support Standards for adults living with HIV for comments and consultation 

Men - Get it Off Your Chest

posted: 27/05/2009

Men know what's just expected and usually perform too - He's  the strong and silent type, Be a man, Boys don’t cry.
But men are people not machines. Our upbringing as boys involves harsh 'toughening up' and we see a lot of abuse and mockery if any male 'weakens' and shows feelings. So it is no surprise at all that men often find it really difficult to talk about their feelings. But it's confusing - we are blamed for doing what's been demanded of us since we were babies in arms - Big Boys Don't Cry - but  now we are told we are 'emotionally stunted' or and unable to show any feelings. Men can show feelings just fine - watch the crowd at any soccer game.

But everyone can feel low sometimes, and anyone can have a mental health problem. That’s why Mind, the mental health charity, is now telling men to Get it off your chest .
 

Mind have launched important new research into men and mental health. The findings paint a troubling picture:

• 37 per cent of men are feeling worried or low
• men account for 75 per cent of suicides
• only 23 per cent of men would see their GP if they felt low for over a fortnight
• men were only half as likely to talk to friends about problems as women
• 31 per cent of men would feel embarrassed about seeking help for mental distress.

Mind put a spotlight on this important issue that has been hiding in plain sight for too long. Mind wants the government to develop the first mental health strategy for men – as a women’s strategy has already been published. This new men's mental health strategy must consider the different ways men experience mental distress, and the different ways men prefer to find help.

Click the image to download and read the report

You can read Derek's account of how he got out of his 3 year long depression, and other men telling their own stories.

You can also read a former Chelsea football player's story of the injury which ended his career at just 24 and his descent into depression, after heavy drug use and watching the death of his baby son.

HIV and mental health

Mental health problems among men are much more common than people realise - often we hide things too well because we are taught to be the strong and silent type - and with HIV, at least 1 in 3 men (and women) report depression and other mental health struggles. It's smart to recognise we will often need help and it's never weak to talk about feelings. It's just human.

There is a choice of help - and helpers, including George House Trust - call our support team 0161 274 4499 or email

We also have some useful links to outside websites you may find helpful 

Beating the Blues Online

posted: 14/05/2009

Most people with depression need some kind of therapy, but could a computer replace a counsellor? Tim Lott of The Guardian tried out the online Cognitive Behaviour Therapy website Beating the Blues. This is available from many Primary Care Trusts - check the list here for NW England.

Although I am not depressed - I am merely someone who has experienced a depressing amount of depression - I have just completed eight weekly sessions of a cognitive behavioural therapy course, which is available on the NHS.

Big deal, you might well remark. But this course is unusual because I didn't have to leave my desk or even talk to another human being. The therapy is administered entirely by a computer programme. Beating the Blues is an attempt by the NHS to meet the growing demand for mental health treatment without spending a fortune on face-to-face therapy.

My instincts were against it - I was insulted by the idea that my difficulties could be solved online. So I logged on to my first session with some trepidation. I was introduced by a honey-voiced computer to five other "co-sufferers" - Andrew, Elaine, Jean, Bob and Heather - who were going to share my journey.

They were played by quite convincing actors, although their characters all seemed a bit feeble. I unkindly branded them as - to use a non-clinical term - "losers". They couldn't get a grip on their lives, they blamed themselves for everything, they couldn't take on goals, and they thought they were failures.

For me, depression is like a toxic black cloud that manifests from nowhere and wrecks my rational thought processes. Andrew and his cheerless bunch of pals just seemed browned off rather than properly depressed - unhappy as opposed to "ill". One couldn't control his school class, another had lost her confidence in finding a boyfriend, a third had let the house go to rack and ruin since her husband died. They were all unmotivated and had terribly low self-esteem - which I don't suffer from, even when depressed (my specialities are guilt and fear, specifically fear of madness).

First session

But I tried to keep an open mind. The first 50-minute session examined the symptoms of depression and anxiety and gave a rough outline of cognitive behavioural therapy (CBT), which "rather than focusing on what happened in your past focuses on what is happening HERE and NOW ... It helps you to see the link between how you think and how you feel and behave."

The session explains how emotions are not simply results of events but of interpretations of events, which can, with proper training, be changed to be more helpful or realistic. It's not, it is emphasised, about "empty positive thinking", but about the distorted thoughts that depressed people tend to generate.

Session two

During the second session, I was taught to record my thoughts - in the hope that I could learn to change them - and also come up with some goals that were "positive, realistic, specific and measurable". The main thrust of the session, however, was to become conscious of "automatic thoughts", which "can become distorted and lead to anxiety and depression".

I tried to record these over the following week but found it difficult, mainly because a lot of my negative emotions don't seem to correlate with thoughts - at least, not thoughts that I am able to put into words. They are just moods, or reactions arising wordlessly out of the unconscious.

Third time

The third session focused on behaviour, suggesting that when you get upset you distract yourself through doing some physical activity - taking the dog for a walk, etc - or focusing on your breathing. It caught my attention properly for the first time in raising the topic of "Common Thinking Errors".

Common Thinking Errors included Black and White Thinking, in which you see everything in only two categories - all or nothing. If you think you haven't done something perfectly then you've failed, or if your clothes are less than immaculate you see yourself as a wreck. I recognised this tendency in myself - in some areas I am intractably perfectionist - and it came as a relief to have a label put on it as "distorted thinking" rather than "just me". It felt like the first step in getting it under control.

The other thinking errors - Jumping to Conclusions (negative conclusion when there is little or no evidence), Catastrophising (exaggerating your problems), Overgeneralising (thinking that if an unpleasant thing happened before it would happen again), and Should Statements (being a fierce task master who sets very high standards for themselves and others) - were less familiar in myself, but very familiar in some people I know.

Day the fourth

The fourth session offered tools to counter these thinking errors. I was asked to find evidence both for and against my negative automatic thoughts (NATs). Empty positive thinking was discouraged - any challenge to NATs has to be based on evidence.

Fifth time

In session five, it was suggested that much of what we think is not conscious. It then tries to offer tools for digging out these unconscious beliefs. In psychology this is known as laddering and is a complex and skilled job. But the computer program suggests it can be achieved by anyone simply by asking repeatedly what your problem "means".

In the example the computer gives, Bob is asked to examine the thought "I'm going to lose my job" and ask "what does that mean to me?". "I'll have to start looking for another job," says Bob. What does that mean to him? "It will be hard to get a job - I'm not particularly skilled." What does that mean to him? "I'll have to take not very nice work." What does that mean? "I'll feel ashamed." Thus Bob has uncovered his secret belief that, "unless I have a job, I'll be a second-rate person."

This is all dubious to my mind. Without proper guidance, laddering can lead to all sorts of inaccurate conclusions, and the idea that the unconscious can be so simply and reliably accessed is questionable. After I completed the ladder, I uncovered the "belief" that I was "possibly damaged in childhood to the extent of being rendered unlovable". It was easy for me to recognise it as a false belief - but I'm not confident that knowing that is any help when this irrational feeling strikes me down.

More practically, I was asked to start writing down my successes on a weekly basis. It was pointed out that people who are depressed "give away" their successes, crediting them to luck or outside sources. Being asked to keep a success record seemed like a good way of reclaiming a positive awareness of yourself.

Last sessions

It was the final sessions, however, that had the most resonance. I was taught about how to recognise my "attributional style". This is how you go about putting together your world view - to put it simply, whether you are a glass half-full or glass half-empty person.

It then asks you to train yourself to tailor your interpretations according to whether what is happening to you is negative or positive. So if you win a game of tennis, for instance (which is the example they use) it is because "my serve is strong, I play well on all types of courts" - whereas a depressed person might just say "I was lucky," or that they just had a "good day". The idea is that you acquire the (to me, slightly disingenuous) trick of laying claim to your successes, and mitigating (or perhaps just rationalising away) the reasons for your failures.

I doubt that every situation is so crudely open to re-interpretation, but I can see that when you are depressed you can get into negative habits of thought that reinforce your depression, and a tool like this could be useful in countering it.

How well did it do?

Obviously, being schooled by a computer has its drawbacks - you can't ask in the course of therapeutic conversation about anything you don't understand, and you often end up dealing with territory that isn't relevant to you. But it is not entirely impersonal - there is telephone backup if you require it.

I can't quite say that it "worked" - mainly because I wasn't depressed when I started it - but I have to concede that it is not as useless as I had imagined it would be.

It is no substitute for a real face-to-face session with a counsellor, but in the absence of the necessary resources - and with some 10 million people reporting mental health problems - Beating the Blues is not an entirely worthless stab at countering an intractable problem.
 

Can you get Beating the Blues?

In February 2006 the Government announced that people can use Beating the Blues free of charge on the NHS to help treat their depression. It is not yet available everywhere. More than 70% of Primary Care Trusts are now offering Beating the Blues as an option to help treat depression.

If your local PCT does not yet offer this treatment you can ask your GP for it. 

In NW England the availability of Beating the Blues is shown in this table

Other online therapies

Eating disorders

Sex therapy

Addiction

Young people (12 - 16 years)

Anger management

HIV Last Week 1 in 3 Think of Suicide

posted: 01/10/2008

A UK study of HIV patients at four clinics in London and one in Brighton has found that 31% reported having had suicidal thoughts over the previous week.

Twice the risk – straight men, ethnic minorities, non-disclosers

The study, published in the journal AIDS, found that heterosexual men, people of black ethnicity and people who had not disclosed their status to anyone were about twice as likely to have suicidal thoughts as other groups.

 A UK study of HIV patients at four clinics in London and one in Brighton has found that 31% reported having had suicidal thoughts over the previous week.

Twice the risk – straight men, ethnic minorities, non-disclosers

The study, published in the journal AIDS, found that heterosexual men, people of black ethnicity and people who had not disclosed their status to anyone were about twice as likely to have suicidal thoughts as other groups.

Risks higher if unemployed, single, having treatment problems or in poorer health

Other strong predictors of suicidal ideation were being unemployed, being single, and having stopped HIV treatment. Suicidal thoughts were also associated with poor treatment adherence and with having poorer physical and/or mental health, but were not associated with age, being on treatment, time on treatment, type of treatment or viral load.

Since 1990, 271 or nearly 2% of the 14,000 HIV positive people who have died in the UK took their own lives, and the proportion of deaths due to suicide has increased in the period since effective HIV treatment became available.

Studies haven’t worked out whether HIV infection is simply linked with suicidal thoughts or whether it is the kinds of people more vulnerable to HIV tending to have suicidal thoughts.

The UK study asked all 903 eligible patients attending the five clinics in a three-month period in 2005 and 2006 to fill in a confidential questionnaire asking then whether they had experienced suicidal thoughts over the previous week, and if so how frequently. There was a high response with 86% filling in the questionnaire.

Two-thirds were gay men, a quarter women, and 10% heterosexual men. Just over half had been born in the UK; 25% described themselves as black and 8% Asian or other, with the remainder describing themselves as white. Twenty-one per cent had never taken antiretroviral therapy, 66% were currently taking such treatment and 13% had anti-HIV drugs but had stopped. Fifty-three per cent were employed.

Dark thinkers
Of the 31% who had had suicidal thoughts over the last week, just over 10% said the thoughts were “frequent” and just over 5% ‘constant’. The rest said they were occasional.

The raw data show that the strongest predictors of suicidality were, in order:

• poor physical or mental heath
• unemployed
• poor treatment adherence
• not being in a stable relationship
• not having disclosed HIV status to anyone outside the clinic
• being of black ethnicity
• and being a heterosexual man.

Factors not associated with suicide included age, having had unsafe sex, number of sex partners, pessimism about treatment or being infectious, and type of treatment.

However suicidality was significantly higher in those who had stopped treatment (43%).

After multivariate analysis, sexuality, ethnicity, disclosure and state of physical and mental health remained the only independent predictors of suicidality.

Heterosexual men nearly twice as likely as gay men and 2.5 times more likely than women to feel suicidal; black people nearly twice as likely as white (most heterosexual men were black); and people in poor mental health, unsurprisingly, 2.3 times more likely. The association between suicidality and being a heterosexual man was even stronger in the patients on HIV treatment.

Fingered causes - HIV, stigma and shame, poor health, secrecy and isolation

The study appears to back the idea that HIV infection is an independent psychological stressor in its own right.

The authors point out that with 31% of people thinking of suicide in the last week is more than twice as high as that observed in gay men (13%), a group known for high suicide rates.

With 45% of heterosexual men recorded suicidal thinking in the study, as opposed to 30% of gay men, points to HIV infection and related factors such as stigma and shame, poor health and health pessimism, and what the authors call “the burden of secrecy and lack of community and social support” as being the most significant influences on suicidal thinking.

Reference
Sherr L et al. Suicidal ideation in UK HIV clinic attenders. AIDS 22(13):1651-1658. 2008.

George House Trust comment

Poor mental health has long been linked with HIV but it is not inevitable. Support is available.

Counselling, community support, meeting and talking with others at services and in groups, courses and more can all help people cope and feel better.

It is normal for people diagnosed with any long term serious condition to feel down and sometimes to think suicidal thoughts - but we can improve our mood and outlook with help and support from other people living with HIV and the health, community and social services that are available.