What you need to know to stay mentally and emotionally healthy while at university

What you need to know in order to stay mentally and emotionally healthy while at university A Needs Led Approach to Mental Health & Wellbeing Created by in8.uk.com and NUA



What you need to know in order to stay mentally and emotionally healthy while at university A Needs Led Approach to Mental Health and Wellbeing By Alec Stansfield & Bindi Gauntlett with Illustrations by Laurie Stansfield

Publishing First published in Great Britain 2021 Copyright © Alec Stansfield and Bindi Gauntlett The right of Alec Stansfield and Bindi Gauntlett to be identified as the authors of this work has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. Published by in8 Publishing Trowbridge, Wiltshire, BA14 7BR ISBN: 978-0-9576232-5-5 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission of the publishers. in8.uk.com This book can be downloaded as a .pdf document - see the section on other student resources on page 49.

Contents Who is this for? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 3 The needs model of well-being . . . . . . . . . . . . . . . . . page 4 The basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 7 Our innate needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 7 Our innate resources . . . . . . . . . . . . . . . . . . . . . . . . . . page 9 How to stay healthy . . . . . . . . . . . . . . . . . . . . . . . . . page 12 Using all of your innate resources . . . . . . . . . . . . . . page 13 Barriers to getting needs met . . . . . . . . . . . . . . . . . . page 14 The symptoms of unmet needs . . . . . . . . . . . . . . . . page 14 What is anxiety? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 15 Symptoms of anxiety . . . . . . . . . . . . . . . . . . . . . . . . . page 16 Three sources of anxiety . . . . . . . . . . . . . . . . . . . . . . page 18 Anxiety versus Stress . . . . . . . . . . . . . . . . . . . . . . . . . page 19 Student life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 20 The importance of sleep . . . . . . . . . . . . . . . . . . . . . page 21 Techniques for improving sleep . . . . . . . . . . . . . . . . page 22 Submissions and hand-ins . . . . . . . . . . . . . . . . . . . . . page 23 Giving presentations . . . . . . . . . . . . . . . . . . . . . . . . . page 24 How to handle crits (critiques) . . . . . . . . . . . . . . . . . page 26 Living away from home . . . . . . . . . . . . . . . . . . . . . . page 26 Sharing accommodation . . . . . . . . . . . . . . . . . . . . . page 27 Concerns about friends . . . . . . . . . . . . . . . . . . . . . . page 28 Issues around eating . . . . . . . . . . . . . . . . . . . . . . . . . page 28 Trauma and phobias . . . . . . . . . . . . . . . . . . . . . . . . page 29 The risks of focusing on the negative . . . . . . . . . . page 30 When we are scared of future events . . . . . . . . . page 30 When to seek help . . . . . . . . . . . . . . . . . . . . . . . . . . page 31 Reference Diagnostic labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 32 Panic Attacks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 34 Depression - what it is . . . . . . . . . . . . . . . . . . . . . . . . page 34 Depression - how it works . . . . . . . . . . . . . . . . . . . . . page 35 Overcoming depression . . . . . . . . . . . . . . . . . . . . . . page 36 Post-Traumatic Stress Disorder (PTSD) . . . . . . . . . . . page 38 Obsessive Compulsive Disorder (OCD) . . . . . . . . . page 38 Bipolar Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 39 A Needs Led Approach to Mental Health & Wellbeing 1

Psychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 39 Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 40 Borderline Personality Disorder . . . . . . . . . . . . . . . . . page 40 Eating disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 40 Self harm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 41 Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 42 Resources and further information Techniques for managing stress and anxiety . . . . . page 43 Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 43 The 7-11 breathing technique . . . . . . . . . . . . . . . . . page 44 The STOP technique . . . . . . . . . . . . . . . . . . . . . . . . . page 45 The 1st thought / 2nd thought technique . . . . . . . page 45 The AWARE technique . . . . . . . . . . . . . . . . . . . . . . . page 46 The T-Cup technique . . . . . . . . . . . . . . . . . . . . . . . . page 47 The clench technique . . . . . . . . . . . . . . . . . . . . . . . . page 47 Choose your own metaphor . . . . . . . . . . . . . . . . . . page 48 Contact student support . . . . . . . . . . . . . . . . . . . . . page 49 Other student resources . . . . . . . . . . . . . . . . . . . . . . . page 49 Further reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 49 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . page 49 2 A Needs Led Approach to Mental Health & Wellbeing

Who is this for? This booklet is for you, your friends, your family, your colleagues, for anyone who wants to feel well and healthy. In other words it is for everyone! It contains a wealth of information that will help you to understand how to live well, study well, and cope with various forms of stress, anxiety and low mood. It will give you practical insights on how to thrive during your time at university and also after university. What it cannot do is replace individual, personalised advice or therapy from professionals who specialise in medicine, psychology and psychotherapy. If you are really struggling with living away from home, with life at university, with projects, with friendships, with eating, sleeping or coping with deadlines - then you should seriously consider seeking professional help. University life can present big challenges and there is no shame in asking for guidance. There are people who are looking out for you, but they won’t be able to help if they don’t know what is going on for you. The first place to ask for help is by contacting student support, further details on page 49. A Needs Led Approach to Mental Health & Wellbeing 3

The needs model of wellbeing This approach to understanding anxiety and stress is known as the needs model of well-being.1 My Environment (Needs & Motivators) External Food Movement Sleep Privacy Meaning & Myself Security Purpose My innate skills Attention (Resources & Community Capabilities) Internal Respect Emotional Achievement Connection Control Human beings, like all living entities, have innate skills (Resources / Capabilities) which they use to obtain those things that they require (Needs / Motivators) from their surrounding environment in order to remain healthy. Living organisms differ from non-living things in that they constantly need to obtain nourishment from their environment in order to survive and grow. A rock will continue to exist without any interaction with its immediate environment. However a plant will quickly die if it cannot obtain water and sunlight. 1 “Human Givens - A New Approach to Emotional Health and Clear Thinking” by Joe Griffin and Ivan Tyrrell - Published by HG Publishing 2004, revised edition 2013. 4 A Needs Led Approach to Mental Health & Wellbeing

Non-living things All living things need such as rocks to obtain nutrition from do not require their environment in anything from their order to survive. environment in order to continue to exist. All living things enter this world equipped with an internal guidance system which has evolved to help them to get their needs met. ‘Stress’ is always caused by one or more of our needs not being met or a resource being misused. Our Resources / Capabilities can be considered our human innate guidance system. Our innate Needs / Motivators are those forms of nourishment that are essential for human well-being. As long as we are able to obtain the things that we need from our environment (essential nutrients) we can survive and grow. If a plant is looking stressed and you want to look after it, you would ensure that its needs are met – water, light, the right soil, nutrition, etc. You would not have to ‘fix’ the plant! When its needs are met, it is in the nature of the plant to thrive. A Needs Led Approach to Mental Health & Wellbeing 5

A plant that cannot obtain what it needs will become stressed. A plant which has what it needs with thrive. Stressed plant Healthy plant Needs NOT met Needs WELL met Although humans are more complex than plants, the same applies. Whenever we feel stressed, it is generally because one or more of our innate needs is missing. We thrive when our innate needs are met in balance. This is why it is worth considering exactly what our essential needs are. One of the best questions in the world is: “What do you need right now?” Taking steps to get any innate need met will always have the effect of reducing stress and making you feel better. 6 A Needs Led Approach to Mental Health & Wellbeing

The basics Every one of us needs certain things in order to feel OK about ourselves and our life. We all have emotional and physical needs. “We thrive when we are using our innate skills to get our innate needs met in balance.” Getting our needs met in balance allows us to learn, grow and feel great about life. Stress is always caused by not being able to get our needs met. Understanding our innate needs and innate resources can help us deal with situations in which we feel anxious or stressed. Our innate needs We have both physical and emotional needs. Each of our innate Needs / Motivators is a form of nutrition something that we need from our environment in order to remain healthy. Although we can get by without them for a while, prolonged absence of any need will cause us anxiety - and if not addressed, eventually will cause us worry which can lead to us becoming stressed. Stress can be defined as what happens to us when one or more of these things are not available to us. Unresolved stress can lead to anxiety and depression. These needs are also the reason that we take actions in our lives. No matter what we feel motivated to do, whether we are consciously aware of it or not, underlying the motivation is always a desire to meet one or more of our innate needs. Our needs are as follows: A Needs Led Approach to Mental Health & Wellbeing 7

Oxygen We cannot live for more than a few minutes Food & Drink without being able to breathe. Movement Food and drink are essential for our physical Sleep health. Security We need to move to keep our body working Attention properly and our brain alert. Walking, running, swimming, dancing, the gym - it all Emotional counts! Connection Autonomy & Sleep provides essential rest and dreaming is Control important for keeping us sane. Achievement It is vital that we feel safe where we live and Respect study. When we don’t feel safe we become Community anxious and find it difficult to think clearly. Attention is a vital form of nutrition. We need to both give and receive attention in order to feel good about ourselves. We can get too little but also too much. It is important to have fun, and to have friendship(s) in which we are wholly accepted for who we really are. We feel good about ourselves when we have choices about how we live and how we spend our time. We get a sense of achievement whenever we are able to say “I’m glad I did that”. Learning and developing new skills helps our need for achievement. It is important to know that others recognise our strengths and abilities. We are social animals and need to be connected to groups who accept us - whether they are family, friends, peers or wider society. 8 A Needs Led Approach to Mental Health & Wellbeing

Meaning & We need to be stretched both mentally and Purpose physically in order to feel good about life. This may be through anything which focuses Privacy our attention outwards and away from just our own concerns. We need time away from distractions in order to have time for reflection and get a sense of perspective on life. Whenever you feel stressed, remember that stress can always be tracked back to one or more of our innate needs not being met. So look back through the list of our innate needs and figure out which need (or needs) are missing in your life. Then take some action to get that need (or needs) better met. Our innate resources We are born with a guidance system - a set of capabilities or resources that help us to make sense of the world and that used wisely can help us to get our innate needs met in balance. Each of our Resources / Capabilities is a key component of this guidance system. The better we know and use each of our innate resources, the stronger they become. You might think of each of them as your inner superheroes - characters that you can call upon to help you with any specific challenge or task. A Needs Led Approach to Mental Health & Wellbeing 9

Which are your friends? Which do you rarely use? And which would you benefit from getting to know better? Rational Our ability to think rationally helps us to make lists, Thinking to analyse situations, to prioritise actions, to look Imagination up things on Google and to figure things out. Memory Our imagination allows us to picture what we want from life. It is key to being creative and Pattern finding new approaches. Matching Memory is essential to the learning process. We can use it to learn from our mistakes and make better choices. When we have learned something and know it really well, rather than having to “think about it” we can rely on unconscious pattern matching. Rapport Pattern matching can also “trigger us” if we encounter anything that is similar to an earlier Dreaming unpleasant experience. Emotions We are born with an ability to connect with Observing others. Sometimes the answer can be found by Self calling a friend rather than trying to work it out yourself. Dreaming helps to consolidate learning and is vital for resolving emotional events from the day so that we can wake feeling refreshed. Emotions help to (e)motivate us since we generally do the things that we care about. But very strong emotions also stop us from being able to think clearly. This is the part of us that is simply aware of what is going on. When we are calm, we can stand back, reflect and see the bigger picture. We can access our observing self through meditation, mindfulness or anything that allows us to step back from our emotions. 10 A Needs Led Approach to Mental Health & Wellbeing

Think of your innate resources as a tool kit which you can use to improve your life and your learning skills. The key is knowing which tool to select and use in each situation. Like any tool, our innate resources can be both used and misused. For example, a common misuse of our imagination is to worry about things over which we have no control. We can also get stuck using our “go to” tool when another might be more suitable for the challenge we face. For example, we may sometimes get stuck trying to figure something out on our own (using our rational thinking) instead of asking for help (using our rapport skill). “Strong emotions severely impair our ability to think clearly and to learn.” A Needs Led Approach to Mental Health & Wellbeing 11

How to stay healthy The key to staying healthy is to make sure that we are using all of our internal resources to get all of our external needs met in balance. Take a moment to review how well your needs are met in your life right now. Score how well each of your needs is met on this circular chart. Then join up the individual points to create a profile shape. What shape do you see? Ideally you want to see a large circular wheel which will roll along smoothly through life. If you have dents 12 A Needs Led Approach to Mental Health & Wellbeing

or flat spots, consider what actions you might take (and which innate resources you might use!) to get this resolved. Using all of your innate resources Another aspect of keeping healthy is to ensure that we are making use of all of our innate resources on a regular basis. The following phrases can be used as a quick reminder to employ each of your innate resources. The innate A phrase which can encourage use of this innate resource resource for solving a problem we want to invoke Can you make a list, identify the item with the Rational highest priority and research that? Thinking Imagination Can you imagine a future situation in which this problem has already been overcome? Memory Have you ever solved a problem like this before? Pattern What did you learn? Matching Is this a familiar problem which keeps happening? Rapport When did the pattern start? Is it still relevant in the current situation? What needs to change? Dreaming Emotions Who could you call to get help with this? (Rapport is the “phone-a-friend” card) Observing Self Do you need to sleep on this? Are strong emotions getting in the way of solving this problem? Ask yourself: “How could you re- frame solving this problem in a way which gets you excited?” (i.e. how could you use emotion to motivate positive action) How would this problem look if you stepped back to see the bigger / longer term picture? A Needs Led Approach to Mental Health & Wellbeing 13

Barriers to getting needs met There are three factors that can prevent us from getting our innate needs met: The first is that the environment is toxic or does not contain those forms of nutrition that we need. Stigma around mental ill-health can be an environmental barrier to addressing unmet innate needs. The second is that we have not learned how to effectively operate our own innate guidance system. This can result in us either not using, or misusing vital resources. We have not yet learned the coping skills required in order to live healthy lives. The third possibility is that our internal guidance system is damaged in some way due to trauma or genetic damage. Damage can be caused by poor diet or not getting enough nutrition, genetic causes, poisoning from drugs or alcohol, physical accidents and psychological trauma including Post Traumatic Stress Disorder (PTSD). We may need to seek professional help to address such damage. The good news is that irrespective of any damage or physical or psychological disabilities, getting our needs met will always help us to operate at our optimum level. The symptoms of unmet needs Whenever one or more of our innate needs is not being met, we experience an emotion which draws our attention to that unmet need. If no action is taken, then in time, this lack can become a source of anxiety. If we spend time worrying rather than addressing the situation, then our sleep can become affected (since dreaming 14 A Needs Led Approach to Mental Health & Wellbeing

is the way we discharge worries from the day). And if our sleep becomes too disturbed, then we can wake feeling exhausted. This cycle can eventually lead to us feeling depressed, and can become a vicious circle, making us more anxious and less able to get anything done. The innate need which Some of the ways that we may is missing experience the lack of this need Oxygen Suffocation Food Hunger, Grumpiness Drink Thirst, Dehydration Movement Stagnation, Fatigue Sleep Tiredness, Exhaustion, Fuzzy head Security Fear, Anxiety Attention Feeling invisible or ignored Emotional Connection Loneliness, Numbness, Flatness Control Overwhelm, Overload Achievement Frustration, Low self esteem Respect Disrespect, Feeling unappreciated, Anger, Hatred Community Isolation, Disconnection, Alienation Meaning & Purpose Boredom Privacy Overcrowding, Feeling that our space is invaded What is anxiety? Anxiety is the way that our bodies tell us that we need to pay attention to something important. In its simplest form it is a useful, if not vital, automatic and emotional signal that tells us that we need to take some kind of action in order to stay safe. For example, when we walk across a normally busy road, it is anxiety which reminds us to check for traffic. Without this instinct A Needs Led Approach to Mental Health & Wellbeing 15

for self preservation we would not survive very long. Imagine being a passenger in a car being driven by someone who loves the rush of adrenaline associated with speed but has no knowledge or experience of anxiety. It would be terrifying. However, in our increasingly stressful world, anxiety can easily become a habit. And when it no longer informs our actions but becomes a way of life, it can quickly transform into a dangerous and destructive habit. It’s as if we keep worrying about the traffic even after we have successfully crossed the road, and then go on to worry about all the roads that we, and our loved ones may want to cross in the future. It would be foolish to expect to live without ever experiencing anxiety. The secret is to know the difference between anxiety which helps us and anxiety which limits our ability to live a full life. The symptoms of anxiety Over many thousands of years our bodies have developed a sophisticated response to fear that has been hugely successful in keeping our species alive. We respond to extreme danger with “fight, flight and freeze” response. We also respond to many forms anxiety in a similar way. The physical symptoms can include: Loss of appetite. Feeling sick. Sweating and hot flushes. Diarrhoea. A dry mouth. Shortness of breath. Shaking limbs. Tingling sensations. Numbness. Dizziness. The feeling of “butterflies” Pounding heartbeat. in the stomach. 16 A Needs Led Approach to Mental Health & Wellbeing

The mental and emotional symptoms of anxiety can include: Dissociation (feeling Confusion and inability to disconnected from think clearly. thoughts, feelings, memories or Forgetfulness. surroundings). Feeling faint. Time distortion. Fear of losing control, going crazy or dying. Every one of these symptoms is appropriate when the threat takes the form of immediate physical danger, and we need to do nothing else, or think of nothing else except find a way to escape. For example: our appetite diminishes as our body shuts down our digestive system since digesting food becomes low priority when we are facing danger. Hence the butterflies in the stomach feeling and the dry mouth. Our heart beats harder and faster in readiness for running away or fighting. Blood is sent to our limbs rather than our internal organs so that our muscles can work harder. We start to sweat in order to cool our body during the anticipated fleeing or fighting. Vomiting will help to empty our stomach and diarrhoea will empty our bowels, both of which make us lighter and also less attractive to anything trying to eat us! All of these symptoms are gearing us up to deal with an imminent physical threat. Our body reacts in a similar way regardless of whether we are being attacked or we are anxious about a forthcoming assessment. This is because for most of our time on earth, anxiety has been directly related to immediate physical danger. The way that our bodies respond to anxiety has not yet caught up with the way we live in this more complex modern world. We can feel ‘attacked’ by technology, crits / hand-ins and the sheer pace of life. Both the mental and the emotional symptoms can be intense. Strong emotions tend to polarise our thinking so that when feeling highly emotional we think in terms of absolutes: black and white rather than shades of grey. When we are angry we see things as either right or wrong. If we are fixing something and we become frustrated, then find we cannot fix it, we may destroy it. When we are in love, they either adore us or they hate us. “He loves me, he A Needs Led Approach to Mental Health & Wellbeing 17

loves me not”. Emotional thinking is sometimes called “black and white” thinking. Historically, when emotions run high, this style of thinking has been beneficial for our survival. The fight and flight state requires action, not analysis. When emotions are high we cannot think clearly. If we are not able to take appropriate action to address the causes of anxiety, then this can lead to us becoming depressed. Three sources of anxiety If we strip away the many and various ways that we experience anxiety to the most basic factors, we can distinguish between three distinct sources of anxiety. The Present Sometimes anxiety is a direct reaction to our current situation. For example, we may become fearful because we accurately perceive that we are in imminent danger. This is usually both appropriate and useful. Fight, flight or freeze is an appropriate reaction. Anxiety which occurs as a direct result of what is happening to us right now is usually beneficial to us since it focuses our attention on resolving the issue. Our observing self can help us to recognise whether the threat is imminently life threatening or needs a more considered response. Techniques that allow us to access our observing self (such as 7-11 breathing) will also help us to recover quickly to a state of calm once the threat has gone. The Past Sometimes we experience anxiety as a direct result of a previous experience. Something bad happened in the past which makes us unconsciously hyper-sensitive to anything that even slightly resembles that previous experience. Our instincts are attempting to help us to avoid a repeat of the previous bad experience (see Pattern Matching for further details). This is the mechanism that underpins most phobias and trauma. 18 A Needs Led Approach to Mental Health & Wellbeing

The Future It is natural to attempt to anticipate the future. But worrying about what has not yet happened is only beneficial when it helps us to take some positive action. If we are unable for any reason to take action then our concern can quickly become a habit that can lock us into a stress response which is serving no useful purpose. Our Imagination can be used to show how we can catastrophise and create a whole myriad of things to worry about that might never happen. Anxiety versus stress So far we have discussed anxiety primarily as a response to danger - a fearful response. But this is not the only type of anxiety that we may experience. Anxiety is the feeling that tells us that we are under stress. Let’s go back to the initial suggestion that anxiety is a signal that we need to pay attention to something important. The previous examples described the way that anxiety due to fear will prepare us for the fight, flight or freeze state due to the fact that our need for security is compromised. Fear is the name we give to our experience of not feeling secure, but our need to feel secure is only one of several innate needs. Imagine that you have not had anything to drink for two days and now you are feeling extremely thirsty. Thirst is the name we use for the specific feeling that our body needs water. In a similar way, hunger is the name we give to our experience of a lack of food. Both of these relate to our innate need for Food and Drink. Lack of water and lack of food are both conditions that we need to take seriously since they are stressful for our bodies. We cannot survive without food and water. In this sense we can consider that feelings of hunger and thirst are “stress responses”. We can extend this argument to cover other forms of nutrition. As social beings we depend upon connections with other people in order to feel good about our lives. We have a need for both emotional connection and community. A Needs Led Approach to Mental Health & Wellbeing 19

We can survive in isolation, but we tend to lose our sense of who we are if continually deprived of all human contact. Many people have struggled during lock down during the recent pandemic due to the effects of isolation. We can consider loneliness also to be a signal that we are missing the form of nutrition that is the giving and receiving of attention - a need often met through our parallel need to feel connected to others - our need for community. In this sense, we can consider that our needs for attention, emotional connection, friendship, a sense of autonomy and control, respect, achievement, being connected to others (community), a sense of meaning and purpose and our need for occasional privacy are all forms of nourishment for human beings. These forms of nutrition are similar to food and water in that we need to obtain them from our environment before we can really feel that we are thriving. When these needs are met then our stress levels will fall. When we cannot obtain any one or more of these forms of nourishment we experience stress. i.e. a signal that we need to pay attention and that something needs to be done to address the shortage. The relationship between these various forms of nutrition and the feelings associated with the lack of them can be summarised as: “Stress is a natural reaction to one or more of our innate human needs not being met.” We may feel anxious or stressed for many more reasons than simply fear. However, due to our evolutionary history, our bodies tend to respond the same way to stress as they do when we are in physical danger. Student life Student life brings many new opportunities and experiences. Although it can be a time of great excitement and personal 20 A Needs Led Approach to Mental Health & Wellbeing

growth, the many changes involved in moving away from home into university life can also sometimes cause some anxiety. Finding effective ways to tackle anxiety and stress is therefore important for ensuring that university life does not become overwhelming. Many people lose sleep when they are anxious and, in fact, the lack of sleep or too much sleep is often more significant than most people realise. Some people manage their feelings of anxiety by turning to comfort eating, alcohol or drugs. Others develop addictive or obsessive behaviour such as extreme shopping, internet addiction, or excessive gambling in an attempt either to blank out the feelings or distract themselves from the pain. Then there are others who may revert to frequent angry outbursts in an attempt to exert some control over their stressful situation. This toolkit is designed to help all or any of these situations. There are many different causes of anxiety, and many different approaches to overcoming it. The importance of sleep Sleep is vital for both our mental and physical health. Most adults require around 7 to 8 hours of sleep each night. Each time we sleep we usually go through several “sleep cycles” which include periods of both slow-wave, restful, deep sleep and more active REM (Rapid Eye Movement), dream sleep. Joe Griffin’s ground-breaking research into the role of sleep2 in mental health clearly demonstrates the relationship between sleep and depression. High levels of anxiety are likely to disturb our sleep. If our natural sleep cycle is sufficiently affected, anxiety can quickly lead to depression - a condition which brings its own fresh anxieties, completing a vicious circle which can trap us in misery for long periods of time. During deep sleep, human growth hormone is released and our body and brain rests. Toxins are flushed from our system. We 2 See “Why We Dream: The Definitive Answer” by Joe Griffin & Ivan Tyrrell (June 6, 2014) A Needs Led Approach to Mental Health & Wellbeing 21

need around four hours of deep sleep each night to maintain our physical health. During REM sleep we dream in order to discharge emotions from the previous waking day which have not been acted upon. This process takes place every night, regardless of whether we remember our dreams and has the effect of preserving our natural instincts and resetting our level of emotional arousal. While we are dreaming, our brain uses a similar amount of energy as when we are awake, about one fifth of our total waking energy use. The more anxious we are in the day, the more dreaming time is required in order to discharge the emotional arousal. This requires more energy and the extra REM sleep results in us having less restful sleep and we can wake feeling tired and lacking in motivation. Techniques for improving sleep Here are some ideas you can use to improve the quality of your sleep. We are creatures of habit. Going to bed and rising at the same time each day is less stressful than constantly asking your brain to adapt to new routines. Learn and practice relaxation exercises such as 7-11 Breathing (see page 44). Prioritise getting your innate needs met so that you have less to worry about. Make sure that your sleeping area is kept dark. Avoid stimulating drinks in the second half of the day. This includes caffeine (tea, coffee, energy drinks). Reduce sugar intake since sweets and foods with high sugar content provide us with a short term energy boost. Avoid excessive alcohol (one glass can aid sleep, too many will disrupt sleep). Avoid mental stimulation such as watching movies and internet surfing in the hours before sleep. Keep the place where you sleep free of technology. Do not use tablets, phones, laptops in bed. Seriously! 22 A Needs Led Approach to Mental Health & Wellbeing

If you have trouble getting to sleep, do not allow your unconscious mind to create an association between being in bed and being awake (remember that we are creatures of habit!) Break the association by getting up and doing something boring until you feel tired. Then go back to bed and try again. Do not spend more than 20 minutes in bed while awake. Keep repeating the process if necessary. Eventually you will get tired enough to fall asleep. If you have a habit of waking in the night and checking the time, set an alarm on your phone and place it somewhere you cannot see the clock. If it is dark, you do not need to know the time - it is sleep time! Your alarm will wake you when you need to get up and training yourself to be comfortable not knowing the time will lessen anxiety. Submissions and hand-ins Are you the kind of person who works best under pressure? Do you tend to leave things until the last minute? Or do you prefer to plan ahead and schedule your time? Whichever style works best for you, don’t allow the stress of the situation to overwhelm you. It can be tempting to try to work long hours in order to get a submission completed, but time spent sleeping, breathing, moving your body or taking a break is sometimes just as effective and often more healthy. Don’t fall into the trap of thinking that only long and sustained effort will get you where you need to be. The secret (as ever!) is to aim to get your needs met in balance during the process. Is it time to access your observing self in order to stand back and see the bigger picture? Do you need more sleep? If you feel under pressure, take a moment to consider how you are using your internal resources and figure out if you are getting stuck on just using one of them. Most of us have had the experience of thinking that we have learned something, then later, when we are under pressure (e.g. in the examination hall) suddenly our mind goes blank and we can’t remember anything at all! A Needs Led Approach to Mental Health & Wellbeing 23

This happens to all of us and, thankfully, the mechanism is well understood. It is called “emotional hijack”. “Strong emotions impair our ability to think clearly.” Worrying affects our ability to think, to remember things, to be creative and to learn. Extreme worry can lead to extreme mental impairment and can even cause us to shut down in the “freeze” state. So knowing your stuff is only half the challenge. The key to exam success is knowing how to stay calm when under pressure. One of the best ways to regain access to our rational thinking and memory is 7-11 Breathing (see page 44). Giving presentations Many people find speaking in front of a group a stressful experience. There is a very solid reason for this. Way back in history we lived in small groups and one of our biggest threats was physical danger from either wild animals or other tribes. We survived by gathering together in groups to drive off predators either by building a fire or making a big noise. Our strength was in numbers rather in having big teeth and claws. If our own tribe turned against us and excluded us from the group, it would often be a death sentence, for we would be unlikely so survive a night on our own. For many thousands of years our brains evolved with the knowledge that our very survival depended upon acceptance from our group. For this reason we have a deeply ingrained fear of making ourselves look foolish in front of our peers. Here are some things you can do to lower presentation anxiety. Prepare well and rehearse your presentation at least once before you give it. 24 A Needs Led Approach to Mental Health & Wellbeing

Use your rational thinking to make a list of everything you need to include and any resources you may need. Actively use your imagination to picture everything going really well. Focus on the idea that success is more about the value of what you have to share, than it is about you. Get your ego out of the way. Get a really good night’s sleep before the day of your presentation. Do at least 10 minutes of 7-11 Breathing (see page 44) just before you begin your presentation. Consider how you might use each of your inner “superheroes” to minimise presentation anxiety. Innate “superhero” How you can use each of your innate superheroes to prepare The Planner (Rational Thinking) Make a list of all the key points you want to The Visionary present and the resources you will need. (Imagination) Actively rehearse how you would feel if The Teacher everything went really well (even if you are (Memory) blatantly pretending!) The Storyteller (Pattern Matching) Commit to memory the main points that you The Friend want to make in your presentation. (Rapport) The Dreamer Remember a time when something you did (Dreaming) (anything!) went well and was appreciated. The Mover (Emotions) Rehearse your presentation in front of a friend or fellow student and ask for feedback. The Witness (Observing Self) Make sure you get a good night’s sleep before your presentation. Focus on the strong positive emotions that you could experience after a great success. e.g. sense of achievement “I did it!” Take a few minutes before the presentation to breathe deeply, centre and ground yourself. A Needs Led Approach to Mental Health & Wellbeing 25

How to handle crits (critiques) Being scrutinised and critiqued by others can feel uncomfortable. We all see things from our own unique standpoint and what matters to one person is sometimes unimportant to another. This is life. You are not responsible for how other people relate to our work and although we all like to feel appreciated, other people’s opinions are just that - opinions. We don’t have to take other people’s views personally. However, we can always learn from others. You will know whether you have done your best work, and critiques are a great opportunity to learn from other people’s perspectives. So don’t beat yourself up either before or after having your work scrutinised by others. Treat it as a valuable learning experience. Being able to stand back and evaluate your work takes courage and objectivity. Being at university is more about the journey than the destination. It feel great to succeed, but you are here to make progress, not to show off. Accept criticism as valuable input that you can think about privately to consolidate learning and experience. Living away from home Moving away from home can involve a lot of new challenges. As well as being exciting, it can also be a daunting experience. You will probably need to learn new skills such as: setting priorities; managing money; buying and preparing food; getting your clothes washed; making new friends; developing healthy routines for sleeping, working, eating and keeping in touch with people. There are many distractions competing for your attention, and it can be easy to feel overwhelmed. The key to surviving the new challenges is to draw upon your innate resources (be sure to familiarise yourself by reading page 9) and using them to get your needs (see page 7) met in balance. 26 A Needs Led Approach to Mental Health & Wellbeing

If you are struggling, don’t feel you have to solve everything yourself. Talk to others and ask for help when you need it. Sharing accommodation Sharing a living space with others always involves some degree of compromise. And because different people care about different things, disagreements are to be expected from time to time. Disagreements can occur over just about any subject, from use of shared resources, to noise levels, privacy and opinions. “A shared household works well when each person helps the others to get their innate needs met in balance.” Whenever there is any conflict, what matters more than who is right and who is wrong, is how you are going to resolve things in order to both move forward. The best way to resolve difficulties is to communicate. You were born with an ability to connect to others - rapport, so be sure to use it. If someone is expressing anger, then remember that although anger usually feels like an issue of “right versus wrong” (at least to the person who is angry), it is never quite that simple. Anger is always about “needs not met”. Be prepared to listen and talk about how each persons needs are affected. It helps to be clear about what matters to you and don’t be shy about letting people know your boundaries. But also be prepared to listen to what matters to others, communicate with them and be prepared to reach a shared understanding of what is important. If you are struggling as a household to find that shared understanding, contact student support who can work with you to find the way forward (see page 49). A Needs Led Approach to Mental Health & Wellbeing 27

Concerns about friends If you are concerned about someone else for any reason, be sure to build rapport with them before making any suggestions or trying to fix anything. Building rapport means making sure you are both on the same page. This is best done by listening carefully to their concerns and sharing with them exactly what you understand about their situation. Perhaps go for a walk with them. Rapport is built automatically when people share the same body postures, energy levels and movements. It is not your responsibility to rescue others and some situations need help from others who are more used to these things. It can be tempting to offer advice and solutions. You may have some excellent ideas and suggestions, but unless you are both in rapport, the other person is unlikely to even hear your advice, let alone take it. So rapport must come first. Whatever your concerns, if you feel that the situation needs some external input, let the other person know what action you would like to take and go and ask for help. Contact the student support team (see page 49). Issues around eating How we eat has a direct bearing on how we feel. If we want to do well, we should eat well. But what does eating well really mean? Our gut contains millions of bacteria that help us to digest our food and maintain our immune system. There is clear evidence that the health of our gut biome has a direct relationship to our physical and mental health. The key to having a healthy gut is to have a plenty of variety in the range of foods that we eat. Diets high in sugar, fat and carbohydrates do not generally provide this level of variety and you are more likely to experience low mood if you live on caffeine, burgers, sweet snacks, chips and beer. A diet high in sugar and fat can impair memory and cognitive functioning. 28 A Needs Led Approach to Mental Health & Wellbeing

Moderation and variety are the key, and a healthy diet will help you to improve your concentration, mood and memory as well as academic performance. It is important to eat regularly throughout the day. Any form of stress will reduce our ability to think clearly - and hunger is a form of stress since it is the emotion that draws our attention to the fact that our body requires refuelling. Trauma and phobias Anxiety which is the result of pattern-matching to past experiences can be useful for survival, but very often is more of a burden. When the initial experience is highly disturbing we can suffer automatic, unconscious and highly emotional reactions over which we have little or no control. The result can be that we suffer “emotional hijack” which can rapidly lock us in the fight, flight, freeze response, severely limiting our ability to think rationally or creatively or to deal with the situation effectively. We may experience nightmares, flashbacks and real feelings of panic from anything that ‘triggers’ these traumatic memories. If we recognise that our anxiety is unconsciously and automatically triggered, and also that it results in us having an “over the top” emotional reaction, then we can begin to take steps to deal with it. However this is beyond the scope for this booklet alone and it is important to realise that such automatic and unconscious triggers cannot usually be deactivated without skilled professional help. This is because it is very difficult for us to change unconscious processes using purely conscious thinking. The good news is that there are extremely effective techniques that can be used to diffuse such patterns (which are usually active in cases of both phobias and trauma). This booklet can certainly help with trauma and phobia, either to reduce anxiety until appropriate help is found or to maintain a sense of calm and a positive outlook on life once the underlying problem is resolved. A Needs Led Approach to Mental Health & Wellbeing 29

The risks of focusing on the negative “Telling our story” is important and, in the right setting, can be extremely therapeutic. However, obsessively and repeatedly recalling negative past events (misusing our Memory) can lock us into an unhelpful spiral of negative thoughts. Continual rumination on what went wrong, and overuse of words such as “always”, “never”, “must”, “mustn’t”, “should” and “shouldn’t” can also reinforce unhelpful negative thought patterns. The approach described in this booklet can help us to make sure that our needs are met in a balanced way. When done effectively, this will bring us to a state of calm and ease. Doing things that work for us and exploring which of our inner resources are most likely to help us get our needs met will have the effect of reducing stress and associated symptoms such as anxiety. When we are scared of future events Worrying about a future that has not yet happened is generally only beneficial when it informs a specific action - something that we do in response to the feeling. If you are using your imagination to picture a future disaster or catastrophe and not taking action, be aware you are ‘misusing’ your imagination and perhaps it is time to try another resource. Using your ability to think analytically (Rational Thinking) might help you make a list or a plan for a future event. Or using your skill to connect with other people (Rapport) might be what you need. This might be something as simple as phoning a friend to ask what they might do in a similar situation. We are genetically predisposed to prioritise the negative (it can keep us alive), but when this negativity becomes a habit, it becomes a problem. Living organisms, like the cells from which they are formed, tend to either be in “protection” mode or “growth” mode. Prolonged stress, worry and anxiety and the accompanying high levels of the stress hormone cortisol can prevent us from learning and growing, and cause damage to our bodies which were designed to recover quickly once the imminent danger had gone. Worrying about the future can 30 A Needs Led Approach to Mental Health & Wellbeing

become a dangerous habit. “What if something bad…” can be re-framed to “What if something good…” Working with this booklet can support you as you move into a habit of positive (yet realistic) thinking. When to seek help We have seen how anxiety can be a legitimate signal that something needs our attention. It may be that we do not feel safe, but it might also be that we feel lonely, frustrated, overloaded, disrespected, overcrowded, ignored or even terminally bored. Boredom can be considered to be the way we experience a lack of being motivated by something bigger than ourselves (a lack of meaning and purpose). It is also entirely possible that we might experience anxiety due to hunger and thirst (Food and Drink), though most of us can manage to satisfy this need within a few minutes or hours of recognising it. A definition of stress is that it is the way that we experience the lack of one or more of our innate needs. When we are using our innate resources to get our innate needs met in balance then we are operating optimally. We cannot stay stressed when all our innate needs are being met so looking to our needs is a great way to start addressing stress and anxiety. However, sometimes we need a few more tools to address the symptoms of anxiety and stress directly in order to cope in the moment. We have therefore included some techniques for coping with the symptoms of anxiety and stress on page 43. These can be very helpful even when the techniques do not wholly address the causes of the anxiety or stress. But it is also important to recognise when anxiety is being triggered by previous traumatic experiences since in these situations professional help is probably needed. This anxiety management resource alone is no substitute for a therapist skilled in the use of, for example, the Rewind technique (also known as Fast Phobia technique, VKD or Visual Kinaesthetic Dissociation technique) or EMDR (Eye Movement Desensitisation A Needs Led Approach to Mental Health & Wellbeing 31

and Reprocessing). Other therapeutic interventions can also be helpful. If you suspect that your anxiety is related to a previous traumatic experience, please contact student support (see page 49). Diagnostic labels Diagnostic labels can sometimes help us to make sense of people’s behaviour and emotional state. But it is important to be aware that no two people respond exactly the same way to anything in life and therefore all such labels are necessarily an approximation. There is no substitute to finding out about each person’s unique experience. It is always more relevant to ask “what has happened to you” rather than “what is wrong with you”. So although labelling someone as “depressed” or “bipolar” can sometimes be helpful, there are important limitations to what can be implied by any such labels. All mental health labels are based upon observed behaviour. There is not a single laboratory test that can reliably inform whether anyone is actually suffering from any of the common conditions. In the following section we aim to help you understand some of the commonly used terms in the field of mental health. Panic Attacks Panic attacks are frightening experiences which can sometimes happen for no obvious reason. They involve the body’s natural stress response and are related to either a conscious or unconscious sense that we are not safe - i.e. a lack of our innate need for a sense of security. During a panic attack the sufferer experiences overwhelming feelings of anxiety. The physical symptoms can include: Shortness of breath and / or choking sensations 32 A Needs Led Approach to Mental Health & Wellbeing

Dry mouth “Butterflies” in the stomach Irregular heart beat Sweating Shaking or trembling Chest pains Feeling sick Numbness or tingling sensations Panic attacks occur when our body perceives a threat to our security. This may be a real threat, but it can also be an imagined threat. In such a case, the fact that there is no immediate threat does not make the panic attack any less frightening. The mental symptoms of a panic attack may include: A fear that you are going to die. Fear that you are going to lose control and do something highly embarrassing or inappropriate. Fear that you will faint or pass out. Extreme confusion. A sense of dissociation - losing our sense of self. Panic attacks are caused when we pattern match to external events that we perceive to be threatening. This can be a conscious process, but it can also happen without us being consciously aware of the details. Pattern matching is often an unconscious process. When our needs for security and control are poorly met, we can become highly sensitive to subtle cues of danger. This is called becoming “hyper-vigilant”. In this state, we are on the lookout for any signs of threat or danger. Our body prepares to take action in case we need to move away from a source of danger. Our emotions are activated and we experience high levels of stress and anxiety. In order to protect us, our body automatically makes several internal changes which include the release of adrenaline, the speeding up of our heart rate, the redirection of blood away from A Needs Led Approach to Mental Health & Wellbeing 33

our digestion system towards our major muscles, as well as the shutting down of our digestion system. Regardless of the source of the threat, our body reacts as if we are preparing to run away from a tiger - which may or may not be appropriate, depending on the source of the threat. If you suffer from panic attacks, check out the “AWARE Technique” which you can find on page 48. You may also want to seek professional help. There are reliable techniques which work really well for preventing further panic attacks - but they rely upon the expertise of experienced professionals. Depression - what it is People suffering from depression tend to look as if they are shut down, withdrawn and feeling flat. But internally there is often a very high level of anxiety and frustration. It is a highly emotional state. As we have already learned, high levels of emotion tend to impair our ability to think clearly. This is why those suffering from depression find it hard to concentrate and make decisions. A depressed person often wakes up already feeling exhausted and therefore finds it extremely difficult to get motivated. These are the common symptoms of depression. If you experience four or more of these symptoms for most of each day, every day for more than two weeks you should seek help. Tiredness or lack of energy. Feelings of helplessness and lack of hope. Sadness that does not go away. Sleeping problems: difficulty getting to sleep Difficulty in concentrating. or waking during the night. No longer enjoying Finding it hard to function. things that used to feel pleasurable or interesting. Loss of appetite. Feeling anxious all or some The loss of a sense of of the time. meaning and purpose to life. Avoiding other people, sometimes even family Self-harm. and friends. 34 A Needs Led Approach to Mental Health & Wellbeing

Depression - how it works The good news is that the mechanism that underlies depression is now well understood. We may not remember our dreams, but they serve a vital purpose in maintaining our mental health. Dreams serve to “flush out” the emotional expectations of the previous day. When the system is working well it allows us to awake with a clear head and able to face the new day. The things we have worried about during the day (but which have not actually happened) will be acted out in our dreams, freeing our brain from those expectations. Basic needs do not Excessive get met or... worrying Bad stuff happens Things don’t Excessive get done dreaming Less able to DAY respond to NIGHT events Too much REM sleep! Brain gets tired Wake up exhausted Too little slow-wave sleep! Brain gets insufficient The Cycle rest & repair of Depression A Needs Led Approach to Mental Health & Wellbeing 35

However, sometimes the pressures of life mean that we are overloaded with worries. The more we worry, the more “work” needs to be done while we sleep. The dreaming process takes place mostly in the REM (Rapid Eye Movement) state of sleep. While we are dreaming our brain is about as busy as it is whilst we are awake. At this time our brain is using 20% (about one fifth) of the total energy of our body. If we have excessive worries during the day, we will have more REM sleep during the night. We may not be aware of it because we only tend to remember dreams which were happening at the time we awake. Excessive REM sleep leads to two effects. The first is that our brain gets tired from all the effort. The second is that we have less time for slow-wave sleep. This is the deep sleep during which the “repair and maintenance” of our body takes place. For two reasons we therefore wake feeling exhausted. Even if there was money on the floor we might not be bothered to pick it up because it is just too much effort. When our brain is exhausted we put things off. Things which need to be done (paying bills, seeing friends, going to uni, project work, eating) don’t get done. There is no pleasure in doing the things we used to enjoy - so we stop doing them. If we think about it, we say “we’ll do them when we feel a bit better”. When things don’t get done, some of our “needs” stop being met. This always causes us worry. So we have more to worry about. The cycle repeats and we spiral down into doing less, worrying more and getting more and more stuck. Overcoming depression The “Cycle of Depression” model provides us with some vital clues about how you can help someone overcome the debilitating effects of depression. Here are various things which are guaranteed to help: 1) Anything at all which reduces the amount of worrying (negative rumination) will take pressure off the REM dream state. This will allow night-time sleep to do its job more effectively. It can be difficult to get someone who is depressed 36 A Needs Led Approach to Mental Health & Wellbeing

to begin an activity which is pleasurable - they tend to think “I’ll do that when I feel better”. However, sometimes you have to act first in order to feel better. People are more likely to undertake this if they understand the cycle. 2) Getting any of our needs better met will reduce the amount of stress and hence will reduce worry. It is usually easy to identify needs which are not met for someone who is suffering from depression. 3) Anything at all which improves the quality of sleep will help. Exercise is known to be as effective as medication. It also tires the body, contributing to better quality sleep. Also, anything which reduces the excessive amount of REM activity will help. SSRI drugs (Selective Seratonin Re-uptake Inhibitors) do this and we believe that this is why they can sometimes help. 4) It is not possible to access your Observing Self and to be emotional (worry is a strong emotion) at the same time. Any practice which encourages access to, and strengthens the Observing Self will help to reduce worry - even if only for a short duration. Meditation, mindfulness practice, yoga, Tai chi, Qi-gong and other activities which promote self awareness without negative rumination can therefore be beneficial. 5) Nutritional supplements can be helpful - especially if our diet is poor. Foods or supplements rich in Omega 3 (specifically the EPA rather than the DHA component) can help with improving mental functioning. 6) The antidote to depression is hope. Anything at all that fosters a sense of hope can be the catalyst to exit the cycle. When you are at the very bottom, there is only one direction in which to go. The author J. K. Rowling said “rock bottom is the solid foundation on which I built the rest of my life.” It is quite possible for people overcome depression without having to engage in long and painful examinations of past emotional hurts. A Needs Led Approach to Mental Health & Wellbeing 37

Post Traumatic Stress Disorder (PTSD) Post-Traumatic Stress Disorder is caused by events which are perceived as life-threatening. The symptoms include: Upsetting memories of the event. Recurring dreams about the event. Strong reactions to anything that resembles certain aspects of the event (This is Pattern-Matching). Outbursts of anger when a Pattern Match is triggered. Reliving the event through flashbacks or hallucinations as if the event is happening in the present moment. Difficulty falling asleep or staying asleep. Irritability or sudden outbursts of uncontrollable anger. Difficulty in concentrating. Hyper-vigilance. An exaggerated startle response, for example jumping at sudden movements or noises. PTSD can often be resolved, but almost always requires professional help. Obsessive Compulsive Disorder (OCD) Obsessive Compulsive Disorder can cause sufferers to feel compelled to perform repetitive behaviours or routines that they feel will help to lower their stress levels. The trigger is usually experiencing troubling (often recurring) thoughts, impulses or mental images which are distressing. People suffering from OCD often believe that the routines and behaviours that they have adopted (for example repetitive hand- washing or carrying out a sequence of actions) will help to prevent unwanted events from occurring in the future. Because the symptoms of OCD are triggered by raised stress levels, ensuring that emotional needs are met in balance reduces the likelihood of symptoms being triggered. 38 A Needs Led Approach to Mental Health & Wellbeing

Bipolar Disorder There is debate about the causes and diagnosis of Bipolar Disorder. It used to be called manic depression and is characterised by extreme mood swings. Periods of over-active, excited behaviour (known as mania) are alternated with periods of deep depression. Between the periods of high and low mood, sufferers can experience a degree of stability. Some sufferers feel that the manic phase is a positive experience because they can become extremely productive as a result of the energy and creativity which is often stimulated. In some instances, bipolar sufferers may experience visual or auditory hallucinations, or may have strange beliefs or delusions. Management of symptoms includes a combination of prescribed medication, taking regular exercise, practising good sleep habits and a lifestyle in which innate needs are met in balance. Psychosis Psychosis can cause sufferers to hallucinate, hear voices and lose a sense of what is real and what is not. Losing a sense of reality can be a frightening experience. Psychotic episodes are usually triggered by an overload of stress combined with a combination of poor sleep, high levels of anxiety and much negative rumination. A possible explanation for psychosis is that high degrees of stress affect sleep to such an extent that the normal dreaming process is insufficient to discharge the high levels of emotion. As a result the high level of emotion shuts down clear thinking and the dreaming (REM state) process breaks through into waking reality. In this state, external inputs are processed via metaphorical, pattern-matching as is the case when dreaming. For example, someone who is in the habit of talking to them self may experience their internal chatter during a psychotic episode as hearing external voices. Many people who have experienced psychosis will describe it as a waking nightmare and relate to this description. A Needs Led Approach to Mental Health & Wellbeing 39

Schizophrenia Schizophrenia is a diagnosis sometimes given to people who have experienced psychosis. Views on schizophrenia have changed over the years and there is still much debate about its symptoms and causes. Although it has been claimed that there is a genetic component to schizophrenia, the inherited risk is far less than the effects of stress. Common myths about schizophrenia include the idea that people with schizophrenia suffer from multiple personalities and that they may be more likely to be aggressive or violent. Borderline Personality Disorder Borderline Personality Disorders can effect sufferers in the following ways: Being overwhelmed by strong emotions such as distress, anger, anxiety and feelings of low self-esteem. Avoiding other people and feeling a lack of emotional connection with others. Seeking control over strong emotions through activities such as self-harm (for example abusing drugs and alcohol, or taking overdoses) or, in rare cases, threatening other people. Difficulty with maintaining stable and close relationships and a rapport building style which is characterised by ‘pushing people away’ after becoming attached to them. Eating disorders Eating disorders are a form of unconscious self-harm and can be extremely overwhelming. Whether it is about how we feel about ourself, or what others may think of us, extreme worry about how our body looks and feels can prevent us from being objective about what we really need. Strong emotions impair clear thinking. Having a balanced diet is vital to our emotional and physical health and has a direct impact on our ability to study well. 40 A Needs Led Approach to Mental Health & Wellbeing

If we know that we are not eating well, then taking positive steps to lower anxiety, reduce stress and get our innate needs met in balance is a good way to begin. If things feel a little out of control, then please consider asking for help. The student support team will be happy to talk to you or look for local and national organisations such as BEAT for further information (see page 49). Self harm Self harm is when people deliberately hurt themselves in order to feel a sense of control over strong emotions, difficult feelings, intrusive memories or situations and experiences which are overwhelming. Physical harm to the body can trigger the release of adrenaline and endorphins, brain chemicals which give rise to pleasurable feelings. These feelings can become addictive if a person is feeling low and finding it hard to get their needs met in healthier ways. As well as meeting a need for control, the act of self-harm can also create an association (a Pattern Match) between the self harming, the release from painful emotions and experiencing pleasure as a substitute for emotional connection. Examples of self harm include: Cutting or burning skin. Poisoning or overdosing oneself. Over-eating and under-eating. Inserting sharp objects into the body. Hitting oneself or solid objects. Excessive exercise. Scratching or hair pulling. If you self-harm or are thinking about it talk to someone else or seek professional help. A Needs Led Approach to Mental Health & Wellbeing 41

Suicide Sometimes people reach a level of depression in which the distress is so great that ending their life seems preferable to carrying on living. This can happen when they feel little hope that things are likely to get better or that there is no longer any purpose to life. We should never make the assumption that someone who talks about ending their life is just seeking attention. There is evidence that most people who succeed in taking their own life have often told somebody of their intention before they do so. If someone you know expresses their intention to end their life, some useful questions to ask them are as follows: Encourage them to ring the Samaritans free on 116 123. They are open 24 hours per day, 365 days a year. Do they have a plan? If they do, this shows that they have thought things through and they therefore be at greater risk of acting on the plan. If they have a plan, can they be persuaded to delay acting upon the plan until they have exhausted every alternative action. Will they agree not to act until they have met with their doctor, mental health professional or another person in a support role. If you are worried that someone is at immediate risk of taking their own life, you should stay with them and take one of the following actions: Encourage them to ring the Samaritans on 08457 909090. They are open 24 hours per day and experienced at helping sufferers. Contact their doctor for an emergency appointment or out- of-hours service. Call 999 or the NHS direct service on 111. This is free from any land-line or mobile. Take them to the nearest A&E (Accident and Emergency) hospital department. 42 A Needs Led Approach to Mental Health & Wellbeing

Techniques for managing stress and anxiety The following techniques can help when you feel anxious. We are all different, so choose those which work best for you. All of them work best when they effectively send a message to your brain that despite how you are currently feeling, there is actually no tiger about to jump out and eat you. A panic attack will not kill you, even though it can feel like it might at the time. Medication Many people find medication helpful in managing their symptoms. However, there are several aspects of medication that it is helpful to know about before making any decision regarding whether to start a course of medication. The old idea that mental ill-health (including depression) is caused by a chemical imbalance in the brain has now been thoroughly discredited. It is true that there are correlations between the levels of various neurotransmitters in our brains (such as seratonin and dopamine) and our mood. In fact, our brains have the capacity to manufacture a wide range of powerful chemicals ranging from those that can induce relaxation and reduce pain such as endorphins to stimulants such as dopamine. We should not be surprised that the chemicals within our brain are affected by our behaviour and our mood. There is also plenty of evidence that there can be other factors in mental ill-health including trauma, environmental factors and various sources of stress such as needs not being met and no pill, however capable, is capable of addressing such underlying factors. If you believe medication may be helpful, you should speak to your doctor or mental health professional. Medications can have side effects and many are known to cause withdrawal effects when you stop taking them. It is therefore vitally important that you consult your doctor before making any changes to medication. A Needs Led Approach to Mental Health & Wellbeing 43

The 7 - 11 breathing technique If you are going to learn just one anxiety / stress management technique, learn this one! This simple technique3 should be practiced regularly before you get into an anxious situation so that your body is already familiar with it and you can then use it easily in the heat of the moment. Breathe using your diaphragm (your belly should move in and out, rather than your shoulders moving up and down). Count from one to seven during each in-breath (at a speed which suits your lungs!) Count from one to eleven during each out-breath (at the same speed that you used for counting in). Keep this up for 10 to 15 minutes without stopping the counting. Details on 7/11 breathing are available in a handy wallet sized card. Ask student support or pick one up next time you’re in the library. There is also a more detailed description of 7-11 breathing which you can download (see page 49). 3 See https://www.in8.uk.com/information-resources/7-11-breathing/ 44 A Needs Led Approach to Mental Health & Wellbeing

The STOP technique Whenever you spot a negative thought sneaking into your thoughts, imagine putting out your arm and saying: “Stop! I recognise this as a negative thought. It is real & I’m not going to deny it but…” Then imagine moving your hand to the side saying: “I’m going to place it to the side so I can deal with it later if I can be bothered. Right now, I’ve got more important things to get on with!” The 1st / 2nd thought technique You don’t get to choose the first thought that comes into your head. It is often an automatic and emotional response to an external stimulus. But you can choose the second thought... An important aspect of handling anxiety is to learn to control where you place your attention. A Needs Led Approach to Mental Health & Wellbeing 45

The AWARE technique This simple technique can help reduce the symptoms of anxiety and panic attacks. Commit the five letters and each associated step to memory. Go through the following steps whenever you start to feel anxious. Accept The first step is to accept whatever is happening to you. Don’t fight the panic. Your body is telling Watch you that it is anxious - big deal! It doesn’t mean Act that you are going to have a panic attack, faint, Repeat die or embarrass yourself. Breathe calmly. Expect Watch your emotional state. Try to stand outside the anxiety and observe it. Scale it from 1 to 10. Notice what makes the feelings rise, and also notice when the intensity falls. Act normally. Don’t try to escape. That will only bring temporary relief. Pretend that everything is going to be OK - even if you don’t really believe it yet. Slow things down a bit if you need to. Repeat the first three stages as required. Accept the situation, Watch your emotional state and Act normally. Expect the best! Your body is trying to help, but it has developed a habit of overreacting. Your job now is to retrain it to act appropriately. A summary of the AWARE technique is available as a handy wallet-sized card. Ask student support (see page 49) or pick one up next time you’re at the library. 46 A Needs Led Approach to Mental Health & Wellbeing