Managing anxiety, worry and uncertainty

Managing anxiety, worry and uncertainty

Many people are feeling worried or anxious, at times, at the moment. You may have had difficulties with anxiety in the past, and you may be feeling that the current situation has made coping with this more difficult. On the other hand, difficulties with anxiety may be new for you, and it may be that it feels quite scary for you to feel like this. The good news is that there is lots you can do to help manage your worry and anxiety at this time. 

If you’ve got five minutes…

Dr Russ Harris (author of the Happiness Trap) has developed a five-minute video on coping with anxiety and fear during the Covid-19 crisis. There are some really useful tips for managing some of the difficult feelings that you may be experiencing.

Oxford Health NHS Foundation Trust have developed a short booklet on coping with worry and uncertainty at this time. It has some great ideas for tackling worry.

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust have developed a brief leaflet on managing anxiety, with some helpful tips on managing symptoms.

For a four-minute video on dealing with anxiety at this time, with advice from an NHS clinical psychologist, please see this YouTube video. She recommends six top tips: limiting the news, routine, separate workspace, social connection, goals and projects, and self-care.

Psychology Tools have developed a brief guide on managing worry in uncertain times. You’ll find some tips on managing worry thoughts, including a useful technique in which you separate ‘real worries’ and ‘hypothetical worries’.

If you’ve got 10-20 minutes…

The Wellness Society have developed a comprehensive anxiety workbook with some really useful suggestions on managing anxiety at this time. You’ll find out about how to think about the things you can control, and also that you cannot control. In addition, you’ll learn about how to manage uncertainty and tips on challenging worrying thoughts. 

Managing health anxiety

Health anxiety is when worrying about your health starts to have a major effect on your life. At the moment, many of us are feeling more anxious about our health, and this is perfectly normal. 

For some people, health anxiety will be making day-to-day life feel very difficult. For some, the current situation will be increasing the problems that they had before with their health anxiety. If you would like information on health anxiety, and how to deal with it, the resources below may help. 

To understand more about health anxiety, visit the NHS website which outlines some common experiences of people with health anxiety. These include frequent checking, worrying that medical tests have missed something, and frequently seeking reassurance that they are not ill.

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust have developed a brief leaflet on managing health anxiety, with some helpful tips for coping with these difficulties. 

Get Self-help have produced a four-minute video which helps us understand health anxiety, and how to break the cycle that maintains it.

Get Self-help have also described a cognitive behavioural approach for addressing health anxiety using the STOPP technique:

  • STOP - just pause for a moment
  • Take a breath - one slow, deep breath
  • Observe - there's that health worry again. My body and mind is reacting to that body sensation and I feel anxious
  • Pull back - this is just the health anxiety - my thoughts are reacting to the super scanner. Don't believe everything you think! Let’s stick with the facts - these thoughts are just opinions. I don't have to react right now. There's another explanation for this... (normal body sensation, anxiety sensation). What's the bigger picture?
  • Practise / proceed - what can I do right now? I don't need to check or seek reassurance. I could practice my mindful breathing, or other things that help me.

Are you living with a long-term condition, and interested in learning more about how to cope?

The Living with Long Term Conditions course is now online. It’s a free course, and it’s a great way to meet others living with long term conditions and to learn some self-care techniques.

Click below on the documents to find out more about the course and how to apply.

Long terms conditions leaflet

Long terms conditions dates

Long terms conditions form

OCD

For those of you who live with and manage OCD this is may be a difficult time. You may have learnt to manage your condition well, but may be finding it increasingly hard to do so given your current work situation as well as well as what you might be hearing and reading in the news.

Oxford Health NHS have developed a short booklet on coping with OCD during the Coronavirus pandemic. There is information in the booklet about signs of OCD, and some information on what you can do if you are having some of these difficulties.

OCD UK have developed a set of tips for managing during this period. They include:

  • Washing your hands for 20 seconds and not a second longer
  • Be kind to yourself when things don’t go as planned (there may be times when 20 seconds becomes 30 seconds or a minute)
  • Limit your time on social media and be prepared to mute, unfollow or block
  • Remember what you can still do – not what you can’t – try making a list
  • Visit the OCD UK website for a full list of helpful tips.

I’ve got 10-20 minutes….

Mood Juice have also developed a self-help guide for managing symptoms of OCD effectively. The guide helps you understand what keeps obsessional thoughts going and how to overcome them.

Managing low mood and depression

Managing low mood and depression

Depression might be familiar to you or it might be that you are feeling very low and uncertain right now and concerned that you might be feeling depressed. Having ups and downs in mood are normal, especially during the current Covid-19 situation when life is more restricted. However, there is a difference between this and actual depression. 

Depression is low mood that lasts for a long time and affects your everyday life. In its mildest form, depression can mean just feeling as though you are in low spirits. It doesn't stop you leading your normal life but everything can seem harder to do and may not give you any satisfaction. At its most severe, depression can make you feel suicidal. 

Whatever the severity of the depression though, there are things that you can do to help yourself, and people you can speak to for support.  

In this section you will find some self-help guides, and some places you can ring for tips and support at this time.

Self-help guides

Oxford Health NHS have developed a leaflet on managing depression during the pandemic. The leaflet tells you more about depression, and what it is. It will also tell you about things that can help at this time.

For a simple self-help leaflet on managing symptoms of depression, please see the booklet developed by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.

This video created by the team at www.getselfhelp.co.uk explains the main ways depression can affect you along with some simple tips for combatting it.

NHS Inform have produced a self-help guide based on cognitive behavioural therapy (CBT) for managing mild to moderate symptoms of depression.

The MIND website has lots of information on managing low mood at this time, and links for helpful sources of support at this time. 

Speak to someone for further support for managing how you are feeling

If you are feeling down or depressed there are people there you can talk to, right now. 

Local support 

There is support there for you at this time. 

You can call the Derbyshire Mental Health Support line on 0800 028 0077 (24/7 freephone). You will be able to speak to a mental health professional, who will be able to speak to you about your situation and things that may help.

You can also make urgent appointment to speak to your GP, who may be operating a call-back service. They will be able to talk to you about a range of things that may help you at this time, including medication options.

National helplines 

Some people find it helpful to speak to someone they don’t know. We have a list of helplines below you can call, and are there to help when you're feeling down or desperate. Unless it says otherwise, they’re open 24 hours a day, every day.

If you, or someone you know, is in immediate distress there are people you can talk to. You can:

Speak to a friend, family member or someone you trust

Call the Derbyshire Mental Health Support line on 0800 028 0077 (24/7 freephone)

Call the Samaritans 24-hour support service phone: 116 123 (free phone) or contact Samaritans online

Use the Staying Safe website for support, information and making your own safety plan

Make an urgent appointment to see your GP, who may be operating a call-back service. Contact NHS 111, though be aware of delays in accessing this service

In medical emergency and life-threatening situations only (where a person has taken an overdose or needs urgent medical attention) please dial 999 or attend your nearest hospital emergency department.

Sleeping better and managing fatigue

Sleeping better

It is common for sleep to be disrupted at times such as these, as most of our routines have been changed. 

The NHS website has some great tips on getting a better night’s sleep.

For 10 tips to beat insomnia please see the NHS website - they include regular sleep hours, creating a restful sleep environment and writing away your worries.

Age UK have also published some information on getting a good night’s sleep. They suggest trying not to lie in, and avoiding eating a heavy meal at night. 

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust have produced a comprehensive booklet on managing sleep problems.

NHS Professionals have published a range of tips for dealing with night shifts. This might be particularly helpful if this is something you are not used to. Their tips include short periods of rest (30 minutes before the shift), 10-20 minutes during the shift, staying hydrated, sleeping well in the day, and limiting your caffeine intake.

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Managing fatigue

Many people are experiencing difficulties with fatigue at this time. It may be following illness, including Coronavirus. It may be something you’ve had difficulties with in the past.

For some people fatigue can feel quite scary, if it is very different for you to feel this way. It can also feel frustrating, if you can’t do the things you used to be able to do. The good news is that there are ways you can learn to manage fatigue more effectively. 

For information on coping with chronic fatigue at this time please see this NHS leaflet. You’ll learn about helpful and unhelpful ways of managing fatigue.

For a useful self-help course on dealing with fatigue, based on Cognitive Behavioural Therapy, visit this Nottinghamshire Healthcare NHS website.

Recovery after Covid-19

Recovery from Covid-19

Recovery from Coronavirus will often take time. Recovery time will vary from person to person. We have provided some information for you in this section on some of the common things you may be experiencing, and things that may help your recovery.

Information and support to manage your recovery

We are all different, so we have provided a range of tools and resources to support your recovery from Covid-19. There is an online course you may be interested in, or a booklet you can print off. Many people find peer support very helpful when recovering from critical illness, and at the bottom of the page you’ll find some trustworthy peer support links.

The NHS has created a resource hub to support your recovery from Covid-19. You’ll find a range of helpful resources on tips such as eating well, sleeping well and physical activity.

Information from your local hospitals

Chesterfield Royal Hospital have put together some really helpful information on their website to help you cope after you have had Coronavirus.

University Hospitals of Derby and Burton have a webpage to support your recovery from Coronavirus, with some useful information on common things you may be experiencing, and things that may help you manage your recovery.

Clinical psychologists in Derbyshire have developed two leaflets called ‘Life after Covid-19’, to support your emotional and psychological recovery from Covid-19.

Both leaflets will provide you with information about common issues you may experience, and helpful tips for managing them. You’ll also find where to get more support, if you need it.

Life after Covid-19 - for individuals who were at home, in a care home or on a general hospital ward.

Life after Covid-19 - for individuals who were cared for on a High Dependency Unit (HDU) or Critical Care Unit (CCU)

An online course to support your recovery from Covid-19

Lancashire Teaching Hospitals have developed a useful online course that you may find helpful.

A recovery information pack

A London NHS hospital has developed a comprehensive post-Covid-19 support pack with a range of tips on managing concerns such as breathlessness.

National information guides for managing your recovery from Covid-19

The Royal College of Occupational Therapists has published some excellent detailed guidance around the specifics of recovery if you are recovering from a bout of Covid-19 and you were able to stay at home throughout as well as if you needed hospital treatment.

Looking after your energy, as you recover from Covid-19

For some practical tips on conserving your energy, visit the Royal College of Occupational Therapists website.

Top tips include the ‘three Ps’ principle – learning to pace, plan and prioritise:

  • Pacing means to take your time and break tasks down. For example, washing the plates, taking a break, and then putting them away
  • Planning means to think ahead about the day or the week, spread out tiring activities. For example, building in time for rest
  • Prioritising means working out what’s important and what activities you can leave, or do another day. For example, if seeing people makes you feel better you might want to save your energy for this, rather than using it up on housework.

Sepsis UK have developed a helpful booklet on recovering after a critical illness that you might find useful at this time.

Support from others who have experienced Covid-19

If you have breathing difficulties after Covid-19, Asthma UK and the British Lung Foundation have set up a Post-Covid Hub to support you. On the website there is tailored information and support for you if you were in intensive care, and if you were not. There is also a phone number you can call for support.

It can be helpful to connect with others who have been through similar experiences. For further information and peer support groups, visit the ICUsteps website.

Support and resources for people from Black, Asian and ethnic minority communities

Support and resources for people from Black, Asian and ethnic minority communities

We know that Covid-19 has been affecting different communities in different ways. In particular, those who come from Black, Asian and ethnic minorities. The following links are a collection of websites, organisations and resources that specifically support these communities during the Covid-19 pandemic. It includes information for different age ranges, ethnic groups and backgrounds given that we are all different and experience and respond to the challenges of this pandemic in different ways. 

National information and resources

Muslim communities

Resources and information and guidance for Muslim communities regarding Covid-19, including mental health support and guidance.

South Asian communities

Resources and information and guidance related to Covid 19 which is translated into different south Asian languages.

Black communities

Black Girls Hike is a non-profit organisation which aims to make the UK countryside more inclusive and provide a safe space for Black women to explore the outdoors with like-minded individuals. Their regular hiking events also place emphasis on wellbeing and sisterhood. 

Chinese mental health

Information and resources around mental health difficulties for those who are part of the Chinese communities.

People from Black, Asian and ethnic minority communities

The Ubele initiative is a resources hub for people from Black, Asian and ethnic minority communities. Signing up to the newsletter will provide up to date information on Covid-19-related issues or wider community projects.

Mental health

Information for peer support in your communities. Resources and ways to sign up to offer peer support in the local area.

Rethink have various links with organisations for further support and help regarding mental health difficulties. 

Anxiety

A number of coping strategies to help with feelings of anxiety, this was produced by Bristol traumatic stress service and has been translated in to a number of different languages.

NHS staff from Black, Asian and ethnic minority communities

30-minute discussion with UNISON health group who lead a conversation with Yvonne Coghill, director of WRES implementation, NHS England, Kebba Manneh, chair of UNISON national Black members committee, and Margaret Greer, UNISON national race equality officer.

Older adults

Dr Elizabeth Webb provides an update on how Covid-19 is impacting black older people. There is more guidance and resources of supporting older adults with health and wellbeing on the Age UK website.

Children

50 humanitarian organisations have produced a storybook which supports and help explain Covid-19 to children aged 6-11.

Equality

National organisation which supports victims, witnesses and third parties who have experienced hate crimes. The websiteprovides links to different service you can access and to gain further information.

Covid-related information

Guidance about Covid-19 which has been translated in to a number of different languages. The information has been produced by the government, British Red Cross, Migrant Help and Clear Voice.

Support and resources on a range of topics 

Community led support platform for those disproportionately affected by the Covid-19 crisis. You can access a number of different support organisations via the website https://sparkandco.co.uk/

Coping with bereavement and loss

Bereavement and loss

During this period we know some of you will be experiencing loss, under very difficult circumstances. You may be reading this because you know someone who has experienced loss in this period, and you are wondering what might be helpful for them.

For information on coping with grief during this period please visit Cruse for lots of support and suggestions for coping at this difficult time.

Derbyshire County Council have provided some information on coping with loss at this time.

Oxford Health have provided information on managing bereavement during the pandemic, with common reactions, and suggestions of things that may help you or others to cope at this time.

There are a number of organisations providing support and guidance at this time. We have provided some of these below, including support for adults and children.

Support for adults

There are a number of organisations providing support for those experiencing bereavement, terminal and or life-limiting illness and their families, including:   

  • South Derbyshire only – Tree Tops Hospice - offering support to people affected by a terminal illness or affected by bereavement call 0115 949 6944. 
  • Cruse Bereavement Care - a national charity providing bereavement support for both adults and children (see children’s section for more information). The Cruse Bereavement Care freephone national helpline is staffed by trained bereavement volunteers, who offer emotional support to anyone affected by bereavement. The number is 0808 808 1677​. The helpline is open Monday-Friday 9.30-5pm (excluding bank holidays), with extended hours on Tuesday, Wednesday and Thursday evenings, when they’re open until 8pm.
  • Griefchat - is a safe space for grieving or bereaved people to be able to share their story, explore their feelings and be supported by a qualified bereavement counsellor. In addition to this, GriefChat can help bereaved people to consider if they need additional support and where to get this from. Using GriefChat is free of charge and is open Monday-Friday, 9am - 9pm, to grieving or bereaved people.
  • What’s Your Grief – is an organisation providing support and information to those experiencing grief and loss. They have recently added advice and support around what you can do when you can’t be with someone who is sick or dying. This may be particularly useful given the current restrictions to visiting friends and family in hospitals, hospices and other care settings. 
  • Macmillan Support Line - offers confidential support to people living with cancer and their loved ones. Telephone helpline Monday to Friday 9am - 5pm on 0808 808 00 00. Online chat, Monday to Friday, 9am - 5pm.
  • Sue Ryder Online Community - a national charity providing palliative, neurological and bereavement support. If someone you love is dying or has died, the online community is a place to share experiences, get things off your chest, ask questions and chat to people who understand.
  • Marie Curie – provide care and support for people living with any terminal illness, and their families. They offer a wide range of support. Telephone support: 0800 090 2309
  • Nelson’s Journey - is an organisation which provides support for bereaved children. They have put this information together based on recent announcements from the Government and advice from the National Association of Funeral Directors. Please bear in mind that funeral arrangements may have to change again in the future as the Government’s response to Covid-19 develops. This guidance is aimed at parents/carers of children and young people who have experienced a recent death and who may need some support in helping their child at this very challenging time.

Support for older children and young people

There are a number of organisations providing support for children experiencing bereavement, or with family members who have a terminal and or life limiting illness, including:  

  • Winston’s Wish – a national charity providing support to children and young people after the death of a parent or sibling. Also advice to supporting adults. Winston’s Wish have a freephone national helpline - 08088 020 021. They also have an online chat facility open Monday to Friday, 10am - 1pm. 
  • Cruse Bereavement Care: Hope - website, helpline and other support for young people aged 12-18 following a bereavement 0808 808 1677. Also provide email and online support.
  • Childhood bereavement network - is the hub for those working with bereaved children, young people and their families across the UK.

There are also a number of organisations providing support and advice to children and young people around a range of issues, including anxiety and depression and more recently the impact of Covid-19.

  • Childline - is a national organisation supporting children and young people around a range of issues. If you're under 19 you can confidentially call, email or chat online about any problem big or small. Freephone 24h helpline: 0800 1111. Sign up for a childline account on the website to be able to message a counsellor anytime without using your email address.
  • The calm zone section of the Childline website offers advice, tips and activities to help reduce anxiety and improve emotional wellbeing.
  • Young Minds - website offering resources and support for young people (and their parents/carers)  – around anxiety, mental health issues, grief and bereavement.
  • Young Minds Crisis Messenger provides free, 24/7 crisis support across the UK if you are experiencing a mental health crisis - just text YM to 85258. All texts are answered by trained volunteers, with support from experienced clinical supervisors. Texts are free from EE, O2, Vodafone, 3, Virgin Mobile, BT Mobile, GiffGaff, Tesco Mobile and Telecom Plus. 
  • The Mix - is a UK support service for young people under 25. Range of services from mental health to money, from homelessness to finding a job, from break-ups to drugs. Online, social or free, confidential helpline 0808 808 4994 (1pm to 11pm daily).

Something difficult has happened

You may have experienced some really difficult things over this period. We have provided you information in this section about some of the normal things you may be experiencing after a difficult event, and things you can do that may help you to cope. We have also provided you information on when it can be helpful to ask for a bit more support. It is important to let you know there is support there for you, if you need it.

Common psychological responses to a crisis or traumatic event/s

  • Disbelief
  • Emotional numbness
  • Nightmares and other sleep disturbances
  • Anger, moodiness and irritability
  • Forgetfulness
  • Denial
  • Guilt
  • Panic
  • Catastrophic thinking
  • A shaky emotional foundation.

These experiences can continue for a few weeks following a trauma or crisis, typically once the event has ended. It would be usual to struggle with memories, nightmares, increased worry and hypervigilance for around a month or so.

What can we do in the midst of a difficult situation or in the immediate aftermath?

Creating a sense of safety for ourselves is hugely important, we can do this in all sorts of ways:

  • Stick to a routine
  • Take time to breathe and be mindful (focus on your immediate task and surroundings)
  • Open up about your thoughts and feelings to a trusted person/people
  • Exercise (gently)
  • Try not to push negative thoughts away, rather let them come and go
  • Be kind to yourself; speak to yourself in an encouraging and soothing way - don’t beat yourself up if you are struggling
  • Rest, eat well and laugh at things you enjoy. Focus on hope and the idea that things will improve.

Dealing with trauma or diffcult events

There are a number of self-help guides which can help you, or others, understand some of the things you may be experiencing and how to cope with them.

Oxford Health NHS Trust have developed a leaflet for dealing with trauma, during the Coronavirus pandemic. 

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust have developed a booklet on understanding what post-traumatic stress disorder is, and things that may help if you are experiencing symptoms. 

When you, or others, have experienced something difficult it can be hard to create a feeling of safety. Something called ‘stabilisation’ can be really helpful, and there are things that you can do yourself to help you feel more able to cope with some of the things you are experiencing. 

For a range of self-help guides written to help people who have experienced trauma, please click on this link.

When to ask for further support

Mental health professionals agree that if the common psychological reactions that are listed above continue for around four-to-six weeks after the event/s has settled then it would be helpful to speak with a medical professional, like your GP. 

At this appointment, your GP may talk to you about assessing you for Post-Traumatic Stress Disorder (PTSD). The reassuring thing is that PTSD is a very common and treatable condition. There are good, solid, effective methods for resolving this issue. It mainly involves speaking to a therapist in a safe place to work through the events and the problems that you are left with (for example, nightmares, flashbacks, memories and difficult emotions) in order that you can ‘file them away’ more neatly in your brain so that they no longer cause you so much distress. It is possible to make a full recovery from PTSD.