Take Control of Your Wellbeing

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Depression and Anxiety

Lesson 1
About Depression and Anxiety
Welcome!

Congratulations on having the courage to tackle your symptoms of Depression and Anxiety.

This program involves six lessons to be completed over twelve weeks:

Lesson 1 Learning about your symptoms and tackling physical symptoms
Lesson 2 Learning about thoughts and tackling low activity
Lesson 3 Tackling unhelpful thoughts
Lesson 4 Tackling avoidance by facing your fears
Lesson 5 Mastering your skills at tackling avoidance
Lesson 6 Staying well in the long term and getting even better

We have prepared a lesson summary for each lesson which includes key information and
exercises to practise your new skills. There’s also additional information in the extra resources
section on topics like assertiveness and sleep, as well as frequently asked questions (FAQs) and
personal recovery stories from others who have completed a THIS WAY UP course.

Our team is committed to helping you. We hope you find this program useful and interesting.

Don’t hesitate to contact us if you have any questions at any stage of this program, by email at
[email protected].

Good luck!

The THIS WAY UP Team

www.thiswayup.org.au

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1. The Consequences of Depression and Anxiety for You

What areas of your life does Depression and Anxiety interfere with?

Tick the boxes that apply to you:

 It interferes with my personal life

 It interferes with my employment/education/career
 It affects how I get on with others
 It affects how I feel about myself
 It affects how I feel about other people
 It affects my health

Note down other areas here:

2. What Do You Want to Achieve in this Program?

Treatment is more likely to be effective if it is goal-oriented. Goals make it easier for you to
know what you’re working toward and stay motivated (especially during challenging times), and
give you a sense of achievement when you have mastered them. It is important that your goals
are meaningful to you.

We have listed some common general goals below. Tick the boxes that apply to you:

 Understand what causes my symptoms  Have better control over my thoughts

 Learn how to manage my symptoms  Feel better about myself
 Feel more secure in myself  Feel more physically relaxed
 Feel in control without feeling too worried  Be more independent/less dependent
and depressed on others

Now we’d encourage you to set your own SMART goals.

SMART goals are as specific as possible, measurable, achievable (by being broken down into
steps), realistic in terms of what you are willing and able to do, and have a time frame. For
example, rather than ‘to be happy’, a SMART goal might be expressed more specifically as ‘to
arrange to catch up with a friend within the next 2 weeks’.

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My SMART goals:

3. Depression and Anxiety Explained Happy

Afraid Sad
Everyone feels anxious and depressed sometimes.

Normal
For many people these feelings are temporary. Upset
Emotions
Anxious

However, for some people, symptoms of depression

and anxiety turn into a problem because their
Angry Excited
symptoms become (tick the boxes that apply to you):
Guilty

 Excessive and severe  Too intense

 Difficult to control  Interfere with day-to-day functioning
 Pervasive (occur in many situations)  Long-lasting

In clinical practice, Depression is sometimes called Major Depression, Dysthymia or Clinical

Depression. Depression is characterised by:
• Feelings of sadness, numbness or low mood that last for most of the day for at least 2
weeks
• Lack of interest or difficulty experiencing pleasure or enjoyment for at least 2 weeks
• Low energy, feelings of fatigue and exhaustion
• Sleeping problems (either sleeping too much or too little)
• Feelings of worthlessness, and hopelessness about the future
• Suicidal thoughts (if you experience thoughts of suicide, please read our extra resource
called ‘In Case of Emergency’ and the section on ‘Staying Safe’ at the end of the Lesson
Summary).
There are also different types of anxiety that people experience. We have provided a list for you
to explain what these labels mean.

Generalised Anxiety Disorder (GAD): People with GAD experience excessive worry that is
persistent, usually out of proportion (or about lots of everyday things), and difficult to control.
They also experience irritability, fatigue, muscle tension, insomnia and other problems.

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Social Anxiety Disorder: People with social anxiety fear social situations (e.g., being the
centre of attention, public speaking, meeting new people) because they are afraid that they will
be judged negatively. This leads to avoidance or high levels of anxiety in social situations.

Panic Disorder: People with panic disorder fear having panic attacks. They often develop
agoraphobia, which is the avoidance of situations where they believe they will be unable to
escape, should a panic attack occur.

Post-Traumatic Stress Disorder (PTSD): People with PTSD usually experience recurrent and
distressing memories, flashbacks and/or nightmares of traumatic events that they have
witnessed or experienced. They often avoid reminders of the traumatic event, and experience
other problems (e.g., irritability, numbness, insomnia).

Obsessive Compulsive Disorder (OCD): People with OCD experience distressing intrusive
thoughts or images, and also experience compulsive behaviours (e.g., checking).

Did You Know?

Depression and Anxiety have been linked to:

• Genes – Often Depression and Anxiety run in families. You might find that other people
in your family have experienced similar symptoms to you.
• Temperament/Personality - Genes partly determine your temperament and personality.
If you have a tendency to be sensitive, inhibited or introverted, it can make you more
vulnerable to developing depression and anxiety.

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 • Life Stress – Episodes of Depression and Anxiety are often triggered during times of life
stress (e.g., moving house, changing jobs, experiencing illness, when a loved one dies or
when there is conflict in your relationships).
• Early Learning Environment – You may have had a stressful upbringing, experienced
negative life events when you were young, learnt the tendency to view situations as
threatening from the people around you, or learnt certain thinking styles and ways of
responding to stress from others in your environment (e.g., family members or friends).

4. The Three Parts of Depression and Anxiety Explained

People with Depression and Anxiety usually have three types of symptoms which interact with
each other.

What you think to yourself

What you do or What you feel in

don’t do your body

These three parts reinforce each other and keep depression and anxiety going.

Liz’s example: “I can’t cope”

“I’ve got too much to do”

Stay in bed and rest, Feel tired and

avoid going out. exhausted

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Rob’s example:

“I’m having a heart

attack!”

Avoid activities (like

Heart racing
exercise) that would
make my heart beat fast

Depression and anxiety involve a vicious cycle that can be hard to break. The good news is that
if you make small changes in any one of these symptoms, it will have a positive impact on the
other symptoms. That is why Cognitive Behavioural Therapy (CBT; the treatment in this
program) is so important. CBT helps you to dismantle the cycle.

5. Identifying Your Symptoms of Depression and Anxiety

Here are some common symptoms. Tick the ones that apply to you:

1. Common Physical Symptoms (what I feel in my body)

 Heart palpitations, pounding heart  Dry mouth

 Feeling short of breath  Chest pressure, discomfort or pain
 Blushing  Muscle tension
 Sweating  Jelly legs
 Clammy hands  Nausea, stomach problems, diarrhoea
 Trembling or shaking  Numbness
 Feeling dizzy, light-headed, or faint  Feeling “out of body” or detached
 Difficulty sleeping  Fatigue, exhaustion
 Loss of appetite  Difficulty making decisions
 Reduced interest in sex  Other:
 Difficult concentrating

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2. Common Unhelpful Behaviours (what I do or don’t do)

 Over-planning  Seeking approval from others

 Excessive list making, rigid routines  Deferring decisions to others
 Procrastination  Cutting activities short/leaving early
 Avoiding exercise  Avoiding offering your opinion
 Drinking alcohol or taking drugs to cope  Avoiding confrontation
 Spending more time in bed during the day  Being unable to say “no”
 Ignoring mail and phone calls  Always taking on other people’s
 Withdrawing from people responsibilities
 Avoiding people or situations that are
 Talking too much to avoid silences
anxiety-provoking
 Reassurance seeking
 Perfectionism: making things feel ‘just
 Comfort eating right’
 Excessive checking  Other:

3. Common Unhelpful Thoughts (what I think to myself)

 Everyone will know I am not coping  This is hopeless

 I’m always going to be anxious  I’m worthless
 I can never cope  There is something wrong with me
 My worry keeps everything together  This treatment won’t work
 I can never be too prepared  It’s all my fault
 I have to do everything 100%  I’m a loser
 I will never be able to do this right  I’m a failure
 I will never be normal  I’m going crazy
 I have nothing interesting to say  Other people think I’m stupid
 People will judge me for being anxious  I’ll be paralysed by anxiety
 The world is a dangerous place  If I don’t plan ahead I’ll fail
 There’s no point trying  I’m not good enough
 I can’t concentrate and it’s ruining my whole  Other:
life

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About Rumination and Worry (Repetitive Thinking)
People with Depression and Anxiety are prone to getting stuck in their thoughts – a process
called ‘repetitive thinking’. When you experience repetitive thinking, you have lots of thoughts
about situations or problems that you keep going over and over again in your mind. It might feel
like these thoughts are uncontrollable or like your mind is racing, going in circles, or stewing
over things.

There are two types of repetitive thinking: rumination and worry. Although everyone ruminates
and worries sometimes, excessive rumination and worry are two key ‘thought symptoms’ of
Depression and Anxiety.

Rumination (focused on the past): Thinking over and over about past negative
experiences, failures, and regrets, and your perceived shortcomings. For example, dwelling on a
conversation you had with a colleague – how badly you came across, what they must have
thought of you, what else you should have said. Rumination might also involve brooding about
how badly you feel and trying to understand why you feel this way.

Worry (focused on the future): Repeatedly thinking about negative things that might
happen in the future. For example, you might worry about your health, finances, career, or how
others perceive you in social situations. Worries can be verbal thoughts, like “I might get cancer”
or images, such as imagining a doctor telling you that you have cancer.

6. What Is Cognitive Behavioural Therapy (CBT)?

Cognitive Behavioural Therapy (CBT) involves learning skills to manage your symptoms. CBT
teaches you new ways of thinking and behaving that can help you break the vicious cycle of
Depression and Anxiety. There are a few things you should know about CBT:

CBT focuses on the here and now. CBT deals with the present rather than analysing your
past. CBT aims to give you the practical skills you need to make changes to your life now and in
the future.

CBT involves practice tasks. A key component of CBT is skills practice, so that you can
transfer the skills you learn into your day-to-day life. There are 168 hours in a week. One hour
of therapy a week will not make much difference if you don’t make any changes in the other
167 hours. Practice tasks impact on those 167 hours – if you don’t practise the skills, this
treatment will not be very effective.

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CBT is not a quick fix. To get the most out of this course, allocate about 4 hours a week to
read the lesson slides, summaries, and extra resources, and practise the skills shown throughout
the program. No one expects you to be an expert overnight.

The road to recovery is filled with ups and downs. Many people with Depression and
Anxiety have very high expectations of themselves. It is important that you have realistic
expectations about treatment. During treatment, it is common to experience ups and downs.
Indeed, setbacks are to be expected. However, improvement during treatment generally heads
in the right direction with more and more improvement being seen over time.

You are taking very brave steps in completing this program, so it is important that you
acknowledge this and reward yourself at each step.

Tick the boxes below to remind yourself to have realistic expectations about treatment. If you
feel like you are not progressing quickly enough, please come back to this list to help keep your
expectations in check.
 The path of treatment has ups and downs – it’s not a straight line
 I am learning new skills – no one expects me to be an expert overnight
 Ups and downs are to be expected
 My symptoms did not come overnight so they will not go away overnight
 Learning new skills means making mistakes, and making mistakes is OK
 I will put in 4hrs of work on the program each week
 I will reward myself for my hard work
 Other reminders:

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7. Managing Fatigue and Exhaustion Using Exercise
Engaging in physical activity is a very effective way of relieving the common physical symptoms
of Depression and Anxiety.

Why increase your activity?

Activity makes you feel better and less tired
• Light aerobic exercise (e.g., walking or swimming) is an
effective way of tackling mild depression, because it helps
release the body’s own “feel good chemicals” that
counteract anxiety and low mood.
• When you are physically active, it helps take your mind off
your worries.
• Exercise gives you the sense that you are taking control
over your life, and doing something worthwhile.
• It can give you the opportunity to do things you enjoy, which you may have stopped
because of your symptoms.
• Normally, when you are tired, you need rest. When you are depressed, doing nothing
will only make you feel more lethargic and exhausted. Exercise helps increase energy.

Activity motivates you to do more

The less you do, the less motivated you become. However, the good news is that the opposite is
also true: the more you do, the more you feel like doing.

Activity improves your ability to think

Exercise improves focus and attention. Once you get started increasing your activity levels,
problems which you thought you could do nothing about come into perspective.

…And if nothing else, it is good for your health!

We recommend that you do light cardio exercise at least half an hour a day, three days a week –
the type that makes you huff and puff! Have a look at the tips below to help you get started. If
you continue to stay inactive, you’ll end up feeling more tired, miss out on positive
opportunities that could make you feel better, and you’ll stay stuck in the vicious cycle of
Depression and Anxiety.

Here are some tips to help you exercise more:

• Don’t wait to feel motivated – just do it even if it’s the last thing you feel like
doing.

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 • Pick a realistic goal and stick to it!
• Pick exercises you will enjoy, not just one you feel you ‘should’ do.
• Exercise regularly and consistently, and plan a time in your week to exercise.
Write it in your diary or calendar, and leave yourself reminders.
• Pick a number of different tasks that can suit a variety of times and conditions.
Don’t miss your exercise target just because it is raining, or too hot, or a venue is
booked out.
• See your GP if you have any health complaints. GPs and physiotherapists can
often recommend exercise you can do even if you have a health complaint.
• If you stop – just start again! Don’t beat yourself up about stopping. Think about
what you have done and can do, and turn this into what you will do and start
again!
• Reward yourself for your hard work.
• Exercise with friends if you can. It’s more fun, and you won’t want to let them
down.
• Start small and build up from there.

8. The Fight-or-Flight Response Explained

When our brain detects possible danger or threat, our body reacts with an automatic biological
response called the fight-or-flight reaction. These normal biological reactions are designed to
keep you physically safe in the face of possible danger. They include:

1. Our breathing rate and heart rate increases, to get more oxygen to our muscles
2. Blood is diverted from non-essential organs (e.g. stomach) to more essential muscles
3. Our muscles tense up in preparation for activity
4. Our bodies start to sweat to cool us down
5. Our brain focuses on any potential dangers (making it hard to concentrate)

The fight-or-flight response:

The fight-or-flight response is a normal survival mechanism, and is usually a helpful response.
If there is real danger, it is useful, because it prepares us to fight or to flee (escape) the
dangerous situation. Without it, humans would not have survived.

However, for many people, the fight-or-flight response it is triggered when they perceive
danger or threat. In this case, it can be unhelpful because it can be triggered too easily and is
triggered by situations or circumstances which don’t actually threaten our safety. If it is
experienced too often, you can also start to feel tired, tense, and anxious.

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The changes associated with the fight-or-flight response often produce distressing symptoms.
Tick the boxes that apply to you:
 Light headedness or faintness  Increased heart rate
 Dizziness or confusion  Tingling sensations or numbness
 Breathlessness  Cold or clammy hands
 Feelings of unreality  Muscle tension
 Blurred vision  Heart racing/ heart pounding
 Nausea/feeling sick  Dry mouth

Many people become frightened of these symptoms, but you need to know;
1. Although these symptoms are uncomfortable, they are not harmful to you.
2. The more you become afraid of experiencing these symptoms, the more anxious you will
feel.
3. The symptoms usually return to normal after a few minutes.
4. If you stay in the situation that triggers the fight-or-flight response for long enough, the
physical symptoms will fade away.
5. Often people start to avoid places and situations which trigger the fight-or-flight
response. However, avoidance will only increase the problem, because it stops you from
learning that you will be able to cope with these symptoms (and that they will eventually
fade away).

9. Controlled Breathing
Controlled breathing can be useful to soothe the symptoms caused by the
fight-or-flight response. At first you may need to find a quiet, relaxing
place to practise the skill. With practice, it becomes easier and you can use
it whenever and wherever you would like to. It takes time to master this
skill, so don’t give up! We recommend that you practise this technique at
least 3 times per day every day.

STEP 1
A normal resting breathing rate is 10 – 12 breaths per minute. What is yours now? Use a watch
with a second hand (or timer) and count the number of breaths you take over one minute.

breaths per minute

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 STEP 2
Sit comfortably in a chair. Breathe in and out gently through your nose. Rest your hands on your
tummy to check that you are using your stomach muscles (and therefore, your diaphragm) to
drive your breathing, rather than your upper chest.

STEP 3
Now, breathe in for 3 seconds, and out for 3 seconds. As you breathe out, relax your body (and
say the word ‘relax’ to yourself). Do this for 3 minutes and notice the difference in your tension
or anxiety.

Record your breathing rate after this exercise. Did it change?

breaths per minute.

We recommend practising this technique at least 3 times per day every day.

10. Staying Safe

As mentioned earlier, sometimes people experience thoughts of suicide or self-harm when they
are depressed or anxious. If you are feeling this way, it is important you talk to someone about
it. There are several people who you can talk to including family, friends, your GP, or your
therapist if you have one. Suicidal thoughts and feelings are horrible, but they do pass and they
are easier to deal with when you talk to someone.

If you are in Australia and you feel that you are at risk of suicide, you should contact one of the
following immediately:

Your GP – Where possible, your GP should be your first point Phone:

of contact during a crisis. GPs are well equipped and _________________
experienced in helping to find the most appropriate services.

The Police or Ambulance – Emergency Assistance Phone: 000

Lifeline Australia – Free 24-hour telephone crisis support

Phone: 13 11 14
www.lifeline.org.au

Suicide Call Back Service – Free 24-hour telephone crisis Phone: 1300 659 467
support – www.suicidecallbackservice.org.au

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 State Crisis Numbers
NSW – 1800 011 511 – Mental Health Line
VIC – 1300 651 251 – Suicide Help Line
QLD – 13 43 25 84 – 13 HEALTH
TAS – 1800 332 388 – Mental Health Services Helpline
SA – 13 14 65 – Mental Health Assessment and Crisis Intervention Service
WA – 1800 676 822 – Mental Health Emergency Response Line
NT – 08 8999 4988 – Top End Mental Health Service
ACT – 1800 629 354 – Mental Health Triage Service

If you live outside of Australia, please contact your supervising therapist as soon as possible.
You can also consult the International Associated for Suicide Prevention (IASP) to find
international crisis centres: https://www.iasp.info/resources/Crisis_Centres/

11. Action Plan

Congratulations on finishing your first lesson! Below is your action plan for the coming week
Remember to make time for each step in your plan and tick things off as you go.

LESSON 1: MY ACTION PLAN

 Set some SMART goals for this Program
 Put together my own anxiety and depression cycle, which includes identifying:
o Worrisome or unhelpful thoughts,
o Unpleasant physical sensations and feelings,
o What I do or don’t do in response to anxiety and depression.
 Exercise at least 30 minutes per day 3 times per week
 Practise Controlled Breathing 2 to 3 times per day.

Please schedule a time to complete Lesson 2 in your diary once you have completed all the
exercises outlined in this lesson summary. It is important that you read this lesson
summary and complete the exercises before you go onto the next lesson.

Good luck!
The Team from THIS WAY UP
www.thiswayup.org.au

1.

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