Mental Health First Aid Skills -

DEPRESSION

Approximately 1 in 4 people in the UK will experience a mental health problem each year. In England, 1 in 6 people report experiencing a common mental health problem (such as anxiety and depression) in any given week. According to the 2013 Global Burden of Disease study, the predominant mental health problem worldwide is depression, followed by anxiety, schizophrenia and bipolar disorder. In 2013, depression was the second leading cause of years lived with disability worldwide, behind lower back pain. In 26 countries, depression was the primary driver of disability. Depressive disorders also contribute to the burden of suicide and heart disease on mortality and disability; they have both a direct and an indirect impact on the length and quality of life.

WHAT IS DEPRESSION?

Depression is a common mental health problem that causes people to experience low mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. Everyone can feel sad or low when things happened in their lives. However, feeling sad or down does not mean that you have depression. The vast majority of periods of low mood will eventually lift and most people can learn to cope with negative feelings and manage their mood. Depression is often used as a blanket term for feeling sad however in this course we will be talking about differences between clinical depression and the short term situational depression.

SITUATIONAL AND CLINICAL DEPRESSION. WHAT ARE THE DIFFERENCES?

Situational and Clinical Depression. What are the differences? A disappointing event or devastating news can lead to short-term symptoms of depression. Some key differences between situational and clinical depression will determine the type of treatment the person needs and the severity of the condition. No type of depression is more “real” than another. Both can present significant challenges and threats to wellbeing. However, knowing which type of depression is at the root of a persistent negative mood can support recovery.

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WHAT IS ANXIETY?

The origin of feelings of anxiety and stress are an instinctive response to pressure. The more intolerable or persistent a person may perceive this pressure to be, the more heightened the anxiety. Anxiety is a survival tool, left over from human evolution. At one time anxiety would make us aware of danger and keep us alert. The problem is we are not in the jungle anymore and feelings of anxiety manifest themselves in everyday situations were a life or death survival instinct is not required. Everyone experiences anxiety at some point in life.

Now in our society, feeling anxious before something like public speaking is perfectly normal. The feeling in the pit of your stomach before you stand up to do that speech is the same feeling that was developed in evolution to tell us we are in danger and should run away! Unfortunately, sometimes that feeling (known as ‘the fight or flight instinct’) can manifest themselves in everyday situations, were they do not belong. This is an anxiety disorder.

In the UK, women are almost twice as likely as men to be diagnosed with anxiety disorders.’ Anxiety can vary in severity, ranging from a low level feeling of being alert to a possible threat all the way up to a crippling panic attack. Anxiety disorder is an umbrella term that includes different conditions:

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BIPOLAR DISORDER

Bipolar disorder is a mental health condition that affects your moods, which can swing from one extreme to another. It used to be known as manic depression. People with bipolar disorder experience varying episodes of:

• Depression – feeling very low and lethargic.

• Mania – feeling very high and overactive.

DEPRESSION

Symptoms of bipolar disorder depend on which mood a person is experiencing. Unlike simple mood swings, each extreme episode of bipolar disorder can last for several weeks (or even longer), and some people may not experience a “normal” mood very often. A person may initially be diagnosed with clinical depression before they have a manic episode (sometimes years later), after which they may be diagnosed with bipolar disorder. During an episode of depression, you may have overwhelming feelings of worthlessness, which can potentially lead to thoughts of suicide.

MANIA

During a manic phase of bipolar disorder, a person may:

• Feel very happy.

• Have lots of energy, ambitious plans and ideas.

• Spend large amounts of money on things you cannot afford and would not normally want. It’s also common to:

• Not feel like eating or sleeping.

• Talk quickly.

• Become annoyed easily.

A person may feel very creative and view the manic phase of bipolar as a positive experience. However they may also experience symptoms of psychosis, where they see or hear things that are not there or become convinced of things that are not true.

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CHRONIC STRESS

WHAT IS CHRONIC STRESS?

Short-lived feelings of stress are a regular part of daily life. When these feelings become chronic, or long lasting, they can severely impact a person’s health. In this section we look at what chronic stress is, how to identify it, and the medical consequences it can have. We also describe ways to manage stress, including medical treatments, and when to see a doctor. ‘The physical effects of stress usually do not last long. However, some people find themselves in a nearly constant state of heightened alertness. This is chronic stress.

Signs of chronic stress can include a range of red flags such as headaches, fatigue, and low self-esteem. Stress is a biological response to demanding situations. It causes the body to release hormones, such as cortisol and adrenaline. These hormones help prepare the body to take action, for example by increasing the heart and breathing rates. When this occurs, a doctor might describe a person as being in a state of heightened alertness or anxiety.

Many factors can trigger a stress response, including dangerous situations and psychological pressures, such as work deadlines, exams and sporting events. The physical effects of stress usually do not last long. However, some people find themselves in a nearly constant state of heightened alertness. This is chronic stress. Some potential causes of chronic stress include:

• High-Pressure Jobs

• Financial Difficulties

• Challenging Relationships

Chronic stress puts pressure on the body for an extended period. This can cause a range of symptoms and increase the risk of developing certain illnesses.

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OBSESSIVE COMPULSIVE DISORDER (OCD)

Obsessive-Compulsive Disorder presents itself in many guises, and certainly goes far beyond the common misconception that OCD is merely a little hand washing or checking light switches, although these are still valid OCD compulsions. Perceptions can fail to acknowledge the distressing thoughts that occur prior to such behaviours and also fails to highlight the utter devastation that constant compulsions (no matter what they are) can cause.

Although there are infinite forms of OCD, it has been traditionally considered that a person’s OCD will fall into one of these five main categories, with themes often overlapping between categories too.

• Checking

• Contamination / Mental Contamination

• Symmetry And Ordering

• Ruminations / Intrusive Thoughts

• Hoarding There are infinite types of OCD, it can impact on any thought, on any subject, on any person, on any fear, and frequently fixates on what’s important in a person’s life. For example, if religion is important to someone, OCD fixates on unwanted intrusive thoughts around religion, perhaps making the sufferer believe their actions/thoughts will offend their God.

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WHAT IS PTSD?

Post-traumatic stress disorder (PTSD) is a type of anxiety disorder which you may develop after being involved in, or witnessing, traumatic events. The condition was first recognised in war veterans and has been known by a variety of names, such as ‘shell shock’. But it’s not only diagnosed in soldiers – a wide range of traumatic experiences can cause PTSD such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault.

However, exposure could be indirect rather than first hand. For example, PTSD could occur in an individual learning about the violent death of a close family. It can also occur as a result of repeated exposure to horrible details of trauma such as police officers exposed to details of child abuse cases. People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended.

They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.

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WHAT IS POSTNATAL DEPRESSION?

All parents go through a period of adjustment as they try to handle the huge changes a baby brings. For most people, this time of adjustment will be temporary and will not be overly distressing. Many women experience what’s known as the ‘baby blues’ in the first few days after having a baby. The baby blues usually only last 2 to 3 days and new mothers might feel upset, anxious and moody during that time. The support of a partner, family and friends is usually enough to help a person get through it.

When these feelings last beyond these early days and continue to get worse, it may be a sign of developing depression. Postnatal depression is the name given to depression that develops between one month and up to one year after the birth of a baby. It affects about 1 in every 7 women who give birth each year.

However, it’s not just new mothers who experience postnatal depression. Many new fathers also experience postnatal mental health issues.

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WHAT IS PSYCHOSIS AND SCHIZOPHRENIA?

PSYCHOSIS

Psychosis is a syndrome or group of symptoms. Someone experiencing an episode of psychosis is having a ‘break’ with reality. Major symptoms of psychosis are hallucinations and delusions. Hallucinations are sensations that are not real, such as hearing voices or sounds that aren’t real. Hearing voices is a common hallucination, but hallucinations can be experiences with any sense—hearing, sight, smell, taste, or touch.

Delusions are strong beliefs that can’t possibly be true. Common delusions include the belief that someone is following or monitoring you, or the belief that you have extraordinary powers or abilities. Other symptoms of psychosis include difficulties concentrating, completing tasks, or making decisions. Thoughts may feel ‘jumbled’ or confused. Some people have a hard time following conversations or speaking clearly. Psychosis can even affect the way people move or express their emotions.

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SIGNS OF DEPRESSION

Most mental health symptoms have traditionally been divided into groups called either ‘neurotic’ or ‘psychotic’ symptoms. ‘Neurotic’ covers those symptoms which can be regarded as severe forms of ‘normal’ emotional experiences such as depression, anxiety or panic.

Conditions formerly referred to as ‘neuroses’ are now more frequently called ‘common mental health problems.’ Less common are ‘psychotic’ symptoms, which interfere with a person’s perception of reality, and may include hallucinations such as seeing, hearing, smelling or feeling things that no one else can. These symptoms affect the way you think, feel and behave. They are problems that must be discussed with a doctor.

The following are red flags of depressive disorder that should help you spot when help is needed. A person should seek help if these symptoms have persisted for a period of two weeks or longer:

• Irritability, agitation, and moodiness - Not everyone who snaps at you is depressed, but another red flag of depression is heightened irritability, agitation, and moodiness. Little things set you off – like a loud conversation next to you on the bus, or an itchy tag on your sweater. That anger can surface as thoughts of self-harm or the desire to harm someone else. Anyone experiencing some of those feelings should seek help.

• Developing unexplained aches and pains - Depression has clearly physical manifestations. In a study published in Dialogues in Clinical Neuroscience, 69% of people who met the criteria for depression consulted a doctor for aches and pains. Mood disorders can show up in surprising symptoms — like bloating, backaches, or joint pain.

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ANXIETY AND PANIC ATTACKS

A massive red flag of an anxiety disorder is when someone begins to have anxiety attacks. Commonly known as a “panic attacks” these are the abrupt onset of intense feeling of fear or discomfort that reaches a peak within minutes and includes at least four of the following symptoms:

• Pounding heart, or accelerated heart rate

• Shortness of breath or Hyperventilation

• Sweating

• Trembling or shaking

• Tightening of the chest

• Nausea or abdominal distress

• Dizziness, unsteady, light-headed, or faint

• Chills or heat sensations

• Fear of dying

• Paresthesia (numbness or tingling sensations)

• Derealisation (feelings of unreality) or depersonalization (being detached from oneself) Some people can experience what is known as “limited-symptom panic attacks”. These are similar to full-blown panic attacks but have less than four symptoms.

Although anxiety is often accompanied by physical symptoms, such as a racing heart or knots in your stomach, what differentiates a panic attack from other anxiety symptoms is the intensity and duration of the symptoms. Panic attacks typically reach their peak level of intensity in 10 minutes or less and then begin to subside.

Due to the intensity of the symptoms and their tendency to mimic those of heart disease, thyroid problems, breathing disorders, and other illnesses, people with panic disorder often visit A&E departments or doctor’s surgeries, convinced they have a life-threatening issue.

SOCIAL ANXIETY

Social Anxiety can be a red flag of anxiety disorder characterised by extreme fear or anxiety in one or more social settings. Going to a party or even having a one-on-one conversation with a new person can result in increased heart rate, sweating, and racing thoughts for someone with social anxiety. When social anxiety gets significant, it’s common for individuals to isolate and feel very alone, making recovery harder.

Ultimately, it can make it difficult for a person to live the life they want: the excessive fear of humiliation and rejection can limit them in work, school, and relationships. While most people have concerns about acceptance and embarrassment, the extreme anxiety and dread that accompany social anxiety disorder are so overwhelming that a person may find it hard to function in daily life and may avoid the anxiety-inducing situations altogether.

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SELF HARM

Self-harm occurs when someone intentionally and repeatedly harms herself/himself in a way that is impulsive and not intended to be lethal. The most common methods are: • Skin cutting (70-90%), • Head banging or hitting (21%-44%), and • Burning (15%-35%). Other forms of self-harm include excessive scratching to the point of drawing blood, punching self or objects or even infecting oneself. Most individuals who engage in non suicidal self-harm (NSSI) hurt themselves in more than one way.

HOW COMMON IS SELF HARM?

Research indicates that self-harm occurs in approximately as many as 4% of adults in European countries. Rates are higher among adolescents, who seem to be at an increased risk for self-harm, with approximately 15% of teens reporting some form of self-harm. Studies show an even higher risk for self-harm among college students, with rates ranging from 17%-35%.

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EATING DISORDERS

Eating disorders such as anorexia, bulimia, binge eating disorder are serious red flags of complex mental illness that can have devastating consequences for health, productivity and relationships. People struggling with an eating disorder often become obsessed with food, body image and/or weight. These disorders can be life-threatening if not recognised and treated appropriately. The earlier a person receives treatment, the greater the likelihood of full recovery.

WHO HAS EATING DISORDERS?

Eating disorders-- such as anorexia, bulimia, and binge eating disorder-- include extreme emotions, attitudes and behaviours surrounding weight and food issues. Eating disorders are serious emotional and physical problems that can have life-threatening consequences for both females and males. Anyone can develop an eating disorder regardless of their gender, age, race, ethnicity, culture, size, socioeconomic status or sexual orientation.

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SUBSTANCE & ALCOHOL MISUSE

16.6% of adults in England report drinking to hazardous levels, while 1.2% report levels which indicate probable dependence on alcohol. 3.1% of adults in England show signs of drug dependence and men (4.3%) are more likely to be dependent on illegal drugs than women (1.9%). 50% of people with drug dependence were receiving mental health treatment in 2016 and adults with drug dependence are twice as likely as the general population to be using psychological therapy.

There’s clearly a connection between substance abuse and mental health disorders, and any number of combinations can develop, each with its own set of unique causes and symptoms, as well as its own appropriate intervention and treatment methods.

SELF-MEDICATION

By far the most common issue connecting mental illness and substance abuse is the intention of patients to medicate the mental health symptoms that they find disruptive or uncomfortable by using alcohol and drugs. Some examples include:

• The depressed patient who uses marijuana to numb the pain.

• The person suffering from social anxiety who drinks to feel more comfortable in social situations

• The person who struggles with panic attacks and takes benzodiazepines Valium in order to calm the symptoms or stop the attacks before they start.

• The person with low energy and lack of motivation who takes cocaine to increase their drive to get things done

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MANIC BEHAVIOUR

The mania phase of bipolar disorder involves an unusually high level of energy and activity. It is common for people in this phase to experience racing thoughts, a lower need for sleep, and difficulty concentrating. Bipolar disorder is a condition that causes extreme changes in mood. There are different forms of the disorder, some of which involve shifts from mania to depression.

The classification of bipolar disorder depends on the severity of manic symptoms and how long they last. Doctors classify bipolar disorder into one of the following categories: Bipolar I: The individual has had at least one manic episode that lasted 7 days or longer or was severe enough to result in hospitalisation. The manic episode may precede or follow a major depressive episode, but this is not necessary for a diagnosis of bipolar I.

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BIOLOGICAL FACTORS AFFECTING MENTAL HEALTH ISSUES

Some mental illnesses have been linked to abnormal functioning of nerve cell circuits or pathways that connect particular brain regions. Nerve cells within these brain circuits communicate through chemicals called neurotransmitters. “Tweaking” these chemicals -- through medicines, psychotherapy or other medical procedures -- can help brain circuits run more efficiently. In addition, defects in or injury to certain areas of the brain have also been linked to some mental conditions.

Other biological factors that may be involved in the development or triggering of mental illness include:

• Genetics (heredity): Mental illnesses sometimes run in families, suggesting that people who have a family member with a mental illness may be somewhat more likely to develop one themselves. Susceptibility is passed on in families through genes. Experts believe many mental illnesses are linked to abnormalities in many genes rather than just one or a few and that how these genes interact with the environment is unique for every person (even identical twins). That is why a person inherits a susceptibility to a mental illness and doesn’t necessarily develop the illness. Mental illness itself occurs from the interaction of multiple genes and other factors -- such as stress, abuse, or a traumatic event -- which can influence, or trigger, an illness in a person who has an inherited susceptibility to it.

• Infections: Certain infections have been linked to brain damage and the development of mental illness or the worsening of its symptoms. For example, a condition known as paediatric autoimmune neuropsychiatric disorder (PANDA) associated with the Streptococcus bacteria has been linked to the development of obsessive compulsive disorder and other mental illnesses in children.

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OBSESSIVE COMPULSION DISORDER (OCD)

For many people, the term “obsessive-compulsive disorder (OCD)” conjures up images of cleanliness and organisation. Maybe you think of hand-washing, organising things by colour and having a spotless house. And while these behaviours may be a part of some people’s experience with OCD, it’s important to remember it’s not every person’s experience.

Furthermore, these compulsions are so much more than “quirkiness” and can cause real psychological distress to the person experiencing them. Because it can be easy to view these habits as “quirks,” how are we supposed to know when certain behaviours are the result of a struggle with OCD?

What’s important to remember about OCD is that it’s not just the behaviours themselves, but the thoughts and beliefs behind them that drive the disorder. Many of these compulsions are motivated by fear, which makes them much different than somebody who likes to keep their room clean.

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TRAUMATIC EXPERIENCE

When a person experiences a traumatic event, the body’s natural defences take effect and create a stress response, which may make someone feel a variety of physical symptoms, behave differently and experience more intense emotions. This fight or flight response (as discussed in the Unit 1 Anxiety Module) in which the body produces chemicals that prepare the body for an emergency can lead to symptoms such as:

• Raised blood pressure

• Increased heart rate

• Increased sweating

• Loss of appetite

This is normal, as it’s your body’s evolutionary way of responding to an emergency, making it easier for you to fight or run away.

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SUICIDAL TENDENCIES

The World Health Organisation estimates that approximately 800,000 people die each year from suicide. To those who are not in the grips of suicidal depression and despair, it’s difficult to understand what drives so many individuals to take their own lives. But a suicidal person is in so much pain that he or she can see no other option.

For every suicide there are many more people who attempt suicide every year. A prior suicide attempt is the single most important risk factor for suicide in the general population. Suicide is the second leading cause of death among 15–29 year olds. Most suicidal individuals display red flags or warning signals of their intentions.

The best way to prevent suicide is to recognise these red flags and know how to respond if you spot them. If you believe that a friend or family member is suicidal, you can play a role in suicide prevention by pointing out the alternatives, showing that you care, and getting a doctor or psychologist involved.

Suicide prevention starts with recognising the warning signs and red flags then taking them seriously. If you think a friend or family member is considering suicide, you might be afraid to bring up the subject. But talking openly about suicidal thoughts and feelings can save a life.

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SOCIAL MEDIA

Our reliance on social media can have a detrimental effect on our mental health, with the average British person checking their phone as much 28 times a day. While social media platforms can have their benefits, using them too frequently can make you feel increasingly unhappy and isolated in the long run. The constant barrage of perfectly filtered photos that appear on Instagram are bound to knock many people’s self-esteem, while obsessively checking your Twitter feed just before bed could be contributing towards poor quality of sleep. Here are six ways that social media could be negatively affecting your mental health (and potentially triggering a mental health issue) without you even realising.

SELF-ESTEEM

We all have our fair share of insecurities, some that we speak about openly and others that we prefer to keep to ourselves. However, comparing yourself to others on social media by stalking their aesthetically perfect Instagram photos or staying up to date with their relationship status on Facebook could do little to assuage your feelings of self doubt. A study conducted by the University of Copenhagen found that many people suffer from “Facebook envy”, with those who abstained from using the popular site reporting that they felt more satisfied with their lives.

When we derive a sense of worth based on how we are doing relative to others, we place our happiness in a variable that is completely beyond our control. Becoming more conscious of the amount of time you spend scrolling through other people’s online profiles could help you focus more on yourself and boost your self-confidence.

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COGNITIVE DISTORTIONS

Cognitive functioning is a term referring to the ability of an individual to perform the various mental activities most closely associated with learning and problem solving. Cognitive distortions are simply ways that our mind convinces us of something that isn’t really true. These inaccurate thoughts are usually used to reinforce negative thinking or emotions — telling ourselves things that sound rational and accurate, but really only serve to keep us feeling bad about ourselves.

For instance, a person might tell themselves; “I always fail when I try to do something new; I therefore fail at everything I try.” This is an example of “black or white” (or polarised) thinking. The person is only seeing things in absolutes — that if they fail at one thing, they must fail at all things. If they added, “I must be a complete loser and failure” to their thinking, that would also be an example of an overgeneralisation — taking a failure at one specific task and generalising it to their self and identity.

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ACTIVE LISTENING

Active Listening is a vital skill for any mental health first aider. ‘Active listening’ means, as its name suggests, actively listening. That is fully concentrating on what is being said rather than just passively ‘hearing’ the message of the speaker. Active listening involves listening with all senses. As well as giving full attention to the speaker, it is important that the ‘active listener’ is also ‘seen’ to be listening - otherwise the speaker may conclude that what they are talking about is uninteresting to the listener.

Interest can be conveyed to the speaker by using both verbal and non-verbal messages such as maintaining eye contact, nodding your head and smiling, agreeing by saying ‘Yes’ or simply ‘Mmm hmm’ to encourage them to continue. By providing this ‘feedback’ the person speaking will usually feel more at ease and therefore communicate more easily, openly and honestly. It’s important for people who may be experiencing mental health issues to feel like they are being heard if they have decided to take the difficult step of talking about how they feel.

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INITIAL RESPONSE ACTIONS IN MENTAL HEALTH FIRST AID

As a mental health first aider you will often be the one of the first people to notice is someone is beginning to experience a mental health crisis. A mental health crisis often means that a person will no longer feel able to cope or be in control of their situation. Someone may feel great emotional distress, may experience anxiety attacks, and often lose the ability to cope with day-to-day life or work. They may think more about suicide or self-harm, or experience hallucinations and hear voices.

Whether experiencing a sudden deterioration of an existing mental health problem or experiencing problems for the first time, a person will need immediate expert assessment to identify the best course of action and stop the situation getting worse. A mental health first aider can facilitate this by delicately approaching the sufferer and letting them know you are available to discuss any difficulties confidentially and without judgement.

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BECOMING MORE RESILIENT

Building resilience is crucial for maintaining balance and mental wellbeing when life tests us. Resilience is our ability to adapt and bounce back when things don’t go as planned. Resilient people don’t wallow or dwell on failures (or perceived failures); they acknowledge the situation, learn from their mistakes, and then move forward. There are three elements that are essential to resilience:

CHALLENGE - Resilient people view a difficulty as a challenge, not as a paralyzing event. They look at their failures and mistakes as lessons to be learned from, and as opportunities for growth. They don’t view them as a negative reflection on their abilities or self-worth.

COMMITMENT - Resilient people are committed to their lives and their goals, and they have a compelling reason to get out of bed in the morning. Commitment isn’t just restricted to their work – they commit to their relationships, their friendships, the causes they care about, and their religious or spiritual beliefs.

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SUICIDE PREVENTION

Suicide prevention starts with recognising warning signs and treating them seriously. Someone who is thinking about suicide may display some clues also known as suicide warning signs to those around them that show they are troubled.

RESPONDING TO SUICIDE WARNING SIGNS

Speak up if you are worried. Talking to a friend or family member about their suicidal thoughts and feelings can be extremely difficult. But if you’re unsure whether someone is suicidal, the best way to find out is to ask. You might be worried that you might ‘put the idea of suicide into the person’s head’ if you ask about suicide. You can’t make a person suicidal by showing your concern. In fact, giving a suicidal person the opportunity to express his or her feelings can give relief from isolation and pent-up negative feelings, and may reduce the risk of a suicide attempt.

HOW TO START A CONVERSATION ABOUT SUICIDE

“I am worried about you because you haven’t seemed yourself lately” “I have noticed that you have been doing (state behaviour), is everything ok?”

QUESTIONS YOU CAN ASK

“What can I do to help you?”

“What support have you called on so far?”

WHAT YOU CAN SAY THAT HELPS

“I want to help you and I am here for your when you want to talk”

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CBT (COGNITIVE BEHAVIOURAL THERAPY)

Cognitive therapy is based on the theory that much of how we feel is determined by what we think. Disorders, such as depression, are believed to be the result of faulty thoughts and beliefs. By correcting these inaccurate beliefs, the person’s perceptions of events and emotional state improve.

Research on depression has shown that people with depression often have inaccurate beliefs about themselves, their situation and the world. Common cognitive errors and real life examples are:

• Personalisation — relating negative events to oneself when there is no basis.

Example — When walking down the hallway at work, John says hello to the company CEO. The CEO does not respond and keeps walking. John interprets this as the CEO’s lack of respect for him. He gets demoralised and feels rejected. However, the CEO’s behaviour may have nothing to do with John. He may have been preoccupied about an upcoming meeting, or had a fight with his wife that morning. If John considered that the CEO’s behaviour may not be related to him personally, he is likely to avoid this negative mood.

• Dichotomous Thinking — seeing things as black and white, all or none. This is usually detected when a person can generate only two choices in a situation.

Example — Mary is having a problem at work with one of her supervisors who she believes is treating her badly. She convinces herself that she has only two options: tell her boss off or quit. She is unable to consider a host of other possibilities such as talking to her boss in a constructive way, seeking guidance from a higher supervisor, contacting employee relations, etc.

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MINDFULNESS WHAT IS MINDFULNESS?

An extremely valuable tool in Mental Health First Aid. Mindfulness is a way of paying attention to the present moment, using techniques like meditation, breathing and yoga. It helps us become more aware of our thoughts and feelings so that, instead of being overwhelmed by them, we’re better able to manage them.

Mindfulness is recommended as a treatment for some people who experience common mental health problems, such as stress, anxiety and depression. It’s also for those who simply want to improve their mental health and wellbeing. Depending on what applies best for the situation, there are various mindfulness practices, which can help people in different ways. Anyone can learn and practice mindfulness: children, young people and adults can all benefit.

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