What is Depression?

The word depression is used to describe various and sometimes overlapping experiences. To many people being depressed means feeling sad, ‘blue’, downhearted, disappointed, detached or upset. However, a person can feel all these emotions without being ‘clinically’ depressed. Feelings of sadness or the ‘blues’ are generally brief and have slight effects on normal functioning.

Clinical depression is an emotional, physical and cognitive (thinking) state that is intense and long-lasting and has more negative effects on a person’s day-to-day life. Approximately one in five people will experience an episode of clinical depression in their lifetime.

It is also important to distinguish depression from the sadness we naturally experience after loss, such as during bereavement. Although the grief associated with loss is often intense and long lasting, such emotions are a healthy response to loss and allow people to adjust to their new life circumstances. Depression on the other hand, can have significant and detrimental effects on many aspects of a person’s life. It is generally important to consider what is causing and maintaining the depression for improvement to take place. This may involve a person approaching life stresses or relationships differently, making lifestyle changes, regaining selfesteem or reconnecting with his or her values.

Finally, it is helpful for depressed people to understand what depression is and isn’t. It is not something to be ashamed of or to feel guilty about. It is not a character flaw or a sign of weakness, or a lack in discipline or personal strength. It is not just a ‘mood’ that someone can snap out of’. Most importantly, depression is not permanent – that is, the chances for recovery are very good. A number of psychological and pharmacological treatments (antidepressant medication) are effective, affordable and readily available.

What are the causes of depression?

The causes of depression are often not due to one factor but are likely to be the result of a number of inter-related factors. Factors that may play a role in the development of depression are listed below.

Hereditary
There is evidence that some people have a genetic predisposition to developing depression. Having a family history of depression does not mean that a person will necessarily develop depression, but it does mean that the risk of developing depression can be higher than if there is no family history. There are usually other situational factors involved such as a stressful life event or chronic illness that may act as a trigger for the onset of a depressive episode.

Biochemical
People who are depressed demonstrate abnormal functioning of some chemicals in the brain. Neurotransmitters are naturally occurring chemicals that send signals from one part of the brain to the next. In people who are depressed the mood-regulating neurotransmitters do not function normally, which interferes with signals sent to the brain and causes mood to be affected.

Stress
Stressful life events can act as a trigger for depression. While most people will experience some level of depressed mood following a stressful event such as a relationship break-up, this often reduces over time. However, for some people the depressed mood will persist and lead to clinical depression. There is evidence that life events that put a person at a higher risk for depression are those that impact on the person’s self-esteem, such as experiencing a relationship breakdown or a financial or job loss.

Personality
Some personality types are more likely to develop depression. There is evidence that people who experience high anxiety levels, are very sensitive to criticism, or have a perfectionist personality have a higher risk of developing depression.

What are the symptoms of depression?

Loss of interest in pleasurable activities and daily routine
People who experience depression are often unable to complete daily tasks and do not enjoy activities they previously took pleasure in. They miss out on positive experiences associated with a sense of achievement and on the pleasure derived from completing daily tasks. The people around them may also suffer as a result.

Worrying and negative thinking
People with depression often worry about the future and have negative thoughts about themselves and their circumstances. These thinking patterns are very unhelpful in that they reduce a person’s ability to focus on recovery and tend to increase their vulnerability to other unhealthy emotions and behaviours.

Irritability, agitation and fatigue
People with depression often experience irritability and agitation, and may complain of exhaustion. Sometimes they feel frustrated with their rate of recovery or the level of support available and annoyed that they don’t have the energy to do anything. They may become more easily upset with those around them. Irritability, agitation and fatigue are often made worse by changes in sleeping patterns and other symptoms associated with depression, such as negative thinking.

Changes in sleeping patterns
Changes in sleeping patterns (either sleeping too much or having trouble sleeping) are common in individuals experiencing depression. Disruptive sleeping patterns can make a person feel worse and make routine communication and activities seem overly difficult and frustrating.

Hopelessness
People who are depressed usually feel trapped or hopeless about their situation, and suicidal thoughts and feelings are commonly experienced. When their mood lifts these feelings are replaced with a more positive perspective and options for the future.

How is depression treated?

There are two major forms of treatment for depression that may be used individually or in combination, depending on the type of depression.

Psychological treatments
Psychological treatments for depression provide a supportive environment for a person to work through difficulties. Psychologists help by providing skills and strategies to change negative thinking patterns and behaviours that contribute to depression and to lessen underlying sensitivity to future episodes of depression. There are a number of psychological treatments that have research evidence supporting their effectiveness.

Antidepressant medications
One defining aspect of clinical depression is a change in the balance of chemicals in the brain that impact on mood. When some specific chemicals in the brain are very low or lacking, this can contribute to feelings of low mood, sadness and fatigue. Antidepressant medications are drugs that help restore the brain’s chemical balance to improve mood.

Combination treatments
For some types of depression, particularly more severe depression, a combination of both antidepressant medication and psychological treatment has been shown to be most helpful. Antidepressant medication helps change a person’s mood and increases their responsiveness to psychological treatment. The psychological treatment provides support and strategies to change depressed thinking and behaviour, and improves long-term coping skills to minimise future relapse. Your general practitioner will be able to provide you with more information on these treatment options.

Tips to manage symptoms of depression

Loss of interest in pleasurable activities and daily routine

There is evidence to show that increasing activity levels and participating in pleasurable experiences can help reduce depressive symptoms. The following points provide guidelines for increasing pleasurable activities and the sense of accomplishment you experience.

· Make a list of activities you need to complete as well as some that you find (or used to find) enjoyable. Make sure you write down as many activities as you can. Remember to also list activities that are only marginally enjoyable.
· Plan to take part in an activity each day. Activities should be achievable and should provide a sense of accomplishment when completed. Include enjoyable activities and try to increase the amount of time each day available for these.
· Think about what you have accomplished once you have completed a daily task. When participating in pleasurable activities, think about their enjoyable aspects. Talk to others about activities they enjoy and reflect on positive experiences.
· Remember that during a depressive episode you often lack motivation to work through daily routines and things you enjoyed previously may not seem as enjoyable. Focus on the positive, no matter how small, and remember that as you recover, the enjoyment you experience will increase.

Worrying and negative thinking

Changing negative thinking patterns and reducing worry is not as easy as it may seem. This is an area where people often require the assistance of a psychologist or other mental health professional. Below are some suggestions for learning to control worry and reduce negative thinking.

· Take time to think about how realistic your negative thoughts are. Try to find some different and more helpful thoughts and explanations for circumstances. Write down some of these more helpful ways of thinking.
· Avoid excessively discussing negative thoughts and feelings with colleagues, family or friends. Instead, try to focus on positive aspects of situations. Negative thinking and dwelling on negative topics will not help you feel better.
· Keep yourself busy and your mind focused on tasks. Avoid unstructured time where you have nothing planned, as your mind may wander and dwell on negative themes.
· Try to think positively. There are many things you can do to address the cognitive (thinking) component of depression. These include: making a list of your skills,
talents, and achievements; identifying the three most beautiful things in your environment; reminiscing about a time when you were really happy, successful or content.
· Set aside a daily “worry time” of 15 minutes when you do nothing but ruminate about your problems. Once this time is finished, leave all your concerns behind and begin working on thinking more positive thoughts. If during the day you begin to focus on your worries, remind yourself that there is a designated time for this and move your thoughts away from your problems. After some time of practising this, people often complain that they have difficulty filling 15 minutes with their worries.
· Keep a journal of your thoughts. Identify negative and unhelpful thoughts and try to correct them.
· Do not make any major life decisions, such as quitting your job or breaking up a relationship, while depressed. Remember, you may not be seeing yourself, the world, or the future in a clear way when you are depressed.

Irritability, agitation and fatigue

Being irritable or agitated is a normal part of depression. It is important that people close to you are aware of this so that they can be more patient and understanding, rather than annoyed and unsupportive. Below are some tips to help you deal with irritability and agitation.

· Make sure you take the time to educate and advise key support people, such as close friends, family and colleagues, of what you are going through. Help them to understand that if you appear irritable or agitated it is not because you are unhappy with them, but rather because you are recovering from depression. Thank them for
their support and provide feedback on how they can best continue to support you.
· When you are feeling irritable or agitated, stop and settle yourself down. Ask yourself what is driving your emotions. If it is negative thinking, then use strategies outlined previously to tackle negative thoughts. If you are tired, pace out your workload to allow for this. If you feel unmotivated, try and incorporate some enjoyable activities into your schedule.
· Practise regular relaxation and meditation activities and organise regular times to talk with a support person about how you are coping and implementing new coping skills. By taking time out to relax regularly and to communicate with supportive people, you greatly reduce the impact of potentially irritating and frustrating experiences.
· Be as active as possible despite fatigue. Try to schedule activities to fill up the spare hours of the day. Activities may include exercise, social interaction or even routine household chores. If activity seems impossible, try to force yourself to do three things each day, such as getting out of bed, getting changed out of your pyjamas and
brushing your hair. Even the smallest amount of activity is better than no activity at all.

Changes in sleeping patterns

Regular healthy sleeping patterns are extremely important for people recovering from depression. Listed below are a few key points to assist you in establishing healthy sleeping patterns.

· Make sure you get up around the same time every morning regardless of how tired you feel.
· Avoid sleeping during the day or taking naps in the early evening.
· Reduce tea and coffee intake to a maximum of four cups per day and do not have any tea or coffee after 4pm.
· If you wake up during the night, do not lie in bed trying to sleep for more than 30 minutes at a time. Get up, go to another room and engage in a relaxing activity, such as reading, listening to music or a relaxation exercise. When you feel sleepy, return to bed and sleep.

Hopelessness

If you feel that your situation is hopeless and particularly if suicidal thoughts are present, it is essential to seek help and to speak to someone about how you are feeling.
· Speak to someone you trust who you know will listen and try to understand how you are feeling. It is important to be honest with this person about any plans you might have to harm yourself. It is in your best interests to allow them to protect you.
· As much as possible, spend time with others so that you are not alone.
· Call a crisis line or seek help from a mental health professional.
· If urges to act out the suicidal thoughts become overwhelming, a brief stay in an inpatient clinic might be extremely beneficial.
· Remember that these feelings will pass.

Other rescources on depression

To read more about depression, go to the following websites or phone the listed services:

· beyondblue Australia
www.beyondblue.org.au
Phone: 1300 22 4636

· Black Dog Institute
www.blackdoginstitute.org.au
Phone: (02) 9382 4523

What is anxiety?

Anxiety is an uncomfortable feeling of fear or impending disaster and reflects the thoughts and bodily reactions a person has when they are presented with an event or situation that they cannot manage or undertake successfully. When a person is experiencing anxiety their thoughts are actively assessing the situation, sometimes even automatically and outside of conscious attention, and developing predictions of how well they will cope based on past experiences.

Although some anxiety is a normal response to a stressful situation, when the anxiety level is too high a person may not come up with an effective way of managing the stressful or threatening situation. They might “freeze”, avoid the situation, or even fear they may do something that is out of character.

Anxiety generally causes people to experience the following responses:

An intense physical response due to arousal of the nervous system leading to physical symptoms such as a racing heartbeat.
A cognitive response which refers to thoughts about the situation and the person’s ability to cope with it. For someone experiencing high anxiety this often means interpreting situations negatively and having unhelpful thoughts such as “This is really bad” or “I can’t cope with this”.
A behavioural response which may include avoidance or uncharacteristic behaviour including aggression, restlessness or irrational behaviour such as repeated checking.
An emotional response reflecting the high level of distress the person is experiencing.

What causes anxiety?

There is no one cause of high anxiety. Rather, there are a number of factors that may contribute to the development of anxious thoughts and behaviour. Some causes of anxiety are listed below.

Hereditary factors
Research has shown that some people with a family history of anxiety are more likely (though not always) to also experience anxiety.

Biochemical factors
Research suggests that people who experience a high level of anxiety may have an imbalance of chemicals in the brain that regulate feelings and physical reactions. Medication that helps to correct this imbalance can relieve some symptoms of anxiety in some people.

Life experiences
Certain life experiences can make people more susceptible to anxiety. Events such as a family break-up, abuse, ongoing bullying at school, and workplace conflict can be stress factors that challenge a person’s coping resources and leave them vulnerable to experiencing anxiety.

Personality style
Certain personality types are more at risk of high anxiety than others. People who have a tendency to be shy, have low self-esteem, and a poor capacity to cope are more likely to experience high levels of anxiety.

Thinking styles
Certain thinking styles make people more at risk of high anxiety than others. For instance, people who are perfectionistic or expect to be in constant control of their emotions are more at risk of worrying when they feel stress.

Behavioural styles
Certain ways of behaving also place people at risk of maintaining high anxiety. For instance, people who are avoidant are not likely to learn ways of handling stressful situations, fears and high anxiety.

What are the symptoms of anxiety?

Confusion

Trembling

Sweating

Faintness/dizziness

Rapid heartbeat

Difficulty breathing

Upset stomach or nausea

Restlessness

Avoidance behaviour

Irritability

How is anxiety treated?

Psychological treatment, particularly cognitive-behaviour therapy, has been found to be very effective in the treatment of anxiety. Cognitive behaviour therapy is made up of two components. The first component, cognitive therapy, is one of the most common and well supported treatments for anxiety. It is based on the idea that a person’s thoughts in response to an event or situation causes the difficult feelings and behaviours (i.e., it is often not an event that causes distress but a person’s interpretation of that event). The aim of cognitive therapy is to help people to identify unhelpful beliefs and thought patterns, which are often automatic, negative and irrational, and replace them with more positive and helpful ways of thinking. The second component of cognitive-behaviour therapy involves assistance with changing behaviours that are associated with anxiety, such as avoidance or restlessness. These may be dealt with through learning relaxation techniques and through changes in the way that certain situations are handled.

Other treatments used to address anxiety include medication and making lifestyle changes such as increasing exercise, reducing caffeine and other dietary changes.

Your general practitioner or psychologist will be able to provide you with more information on these treatment options.

Tips on how to manage anxiety

Identification of stress and trigger factors
The first step in managing anxiety is to identify the specific situations that are making you stressed or anxious and when you are having trouble coping. One way to do this is to keep a diary of symptoms and what is happening when anxiety occurs. It is also helpful to identify any worrying thoughts as this can lead to finding ways to solve the specific problem that is of concern.

People tend to have a greater ability to manage stressful events than they sometimes realise. Once you have identified a specific situation that is causing the anxiety, problem-solving is a useful technique to help resolve anxiety by addressing the problem. Structured problem solving involves the following steps:

Identify the problem. When you have identified the situations that are contributing to your anxiety, write down the problem and be very specific in your description, including what is happening, where, how, with whom, why, and what you would like to change.

Come up with as many options as possible for solving the problem, and consider the likely chances that these will help you overcome your problem.

Select your preferred option.

Develop a plan for how to try out the option selected and then carry it out.
If this option does not solve the problem remember that there are other options to try.
Go back to the list and select your next preferred option.

Breathing exercises
When people feel anxious they often breathe more rapidly. This rapid breathing can lead to many of the unpleasant feelings such as light-headedness and confusion that may be experienced when anxious. Learning a breathing technique to slow down breathing can often relieve symptoms and help a person to think more clearly. The following simple breathing technique can slow down breathing and reduce symptoms of anxiety. You should begin by timing your breathing and then complete the following steps.

Breathe in through your nose to the count of three (3 seconds) and say to yourself: “IN, TWO, THREE”.

Breathe out through your nose, again counting to three, and say to yourself: “RELAX, TWO, THREE”.

Keep repeating this for two to three minutes, and then time your breathing.

This breathing technique can be used to slow down breathing whenever a person feels anxious and can be done anywhere without anyone else noticing.

Relaxation techniques
People who feel anxious most of the time report that they have trouble relaxing. Knowing how to release muscle tension is an important anxiety treatment. Relaxing can bring about a general feeling of calm, both physically and mentally. Learning a relaxation technique and practising it regularly can help a person to maintain a manageable level of anxiety. A psychologist or other health professional can teach you relaxation techniques or they can be self-taught by using books or CDs that guide you through the steps.

Thought management
Thought management exercises are useful when a person is troubled by ongoing or recurring distressing thoughts. There is a range of thought management techniques. For instance, gentle distraction using pleasant thoughts can help take attention away from unpleasant thoughts. Alternatively, one can learn ‘mindfulness techniques’ to redirect attention from negative thinking. A simple technique is ‘thought replacement’ or using coping statements. Develop a set of statements that will counteract worrying thoughts (e.g., “This is difficult but I have been through it before and have got through it okay”, “Hang in there, this will not last much longer”).

Substitute one of the reassuring or coping statements for the troubling thought. The choice of thought management technique will depend on the type of anxiety problem. A psychologist can help you decide on thought management strategies that are likely to be most helpful.

Lifestyle changes

Plan to take part in a pleasant activity each day. This doesn’t have to be something big or expensive as long as it is enjoyable and provides something to look forward to that will take your mind off your worries.

Increase exercise. Regular exercise will help to reduce anxiety by providing an outlet to let off stress that has been built up in your body.
Reduce caffeine intake.

Caffeine is a stimulant and one of its side-effects is to keep us feeling alert and awake. It also produces the same physiological arousal response that is triggered when we are subjected to stress. Too much coffee will keep us tense, and aroused, leaving us more vulnerable to anxiety.

Reduce alcohol intake. Alcohol is frequently used to help deal with stress, anxiety and depression. However, too much alcohol leaves us more vulnerable to anxiety and depression.

Improve time-management skills. Having a busy lifestyle can add daily pressure to your life and serve to increase stress and anxiety. Much of this stress may be associated with poor time management. Plan and schedule time throughout the day but be prepared to be flexible. Ensure to plan some rest time and some leisure activities and be realistic about time limitations, not scheduling too much into the day.

Anxiety Disorders

For some people the feeling of high anxiety can become severe and interfere with their functioning, making it difficulty for them to cope with normal daily demands. If this high anxiety persists over a long period of time an anxiety disorder may be diagnosed. Almost 30 per cent of the population will experience some form of anxiety disorder at some point in their lives. A range of anxiety disorders can be diagnosed depending on the symptoms experienced. People with an anxiety problem can frequently experience a number of specific anxiety disorders at the same time. If a person is concerned about having an anxiety disorder it is important to seek professional help to determine the best form of treatment to manage the anxiety.

Generalised Anxiety Disorder
This disorder involves persistent and excessive worry, often about daily situations like work, family or health, with associated physical symptoms. This worry can be difficult to control, leading to problems in concentration, restlessness and difficulty sleeping.

Specific phobia
People with a specific phobia experience extreme anxiety and fear if exposed to a particular feared object or situation. Common phobias include fear of flying, spiders and other animals, heights or small spaces.

Panic Disorder
Panic Disorder occurs when a person has sudden surges of overwhelming fear that come without warning. These panic attacks often only last a few minutes, but repeated episodes may continue to occur.

Obsessive Compulsive Disorder (OCD)
In OCD a person has repeated, upsettingthoughts called obsessions (e.g., “there are germs everywhere”). To make these thoughts go away, the person will often perform certain behaviours, called compulsions, over and over again (e.g., repeated hand washing). These compulsions can take over a person’s life and while people with OCD usually know that their obsessions and compulsions are an over-reaction, they can’t stop them.

Social Anxiety Disorder
In Social Anxiety Disorder the person has severe anxiety about being criticised or negatively evaluated by others. This leads to the person avoiding social events and being afraid of doing something that leads to embarrassment or humiliation.

Post-Traumatic Stress Disorder (PTSD)
PTSD can occur after exposure to a frightening and traumatic event. People with PTSD re-experience the traumatic event through memories and/or dreams, they tend to avoid places, people, or other things that remind them of the event, and are extremely sensitive to normal life experiences that are associated with the event.

Anger Management

Anger is a normal human emotion and when it is managed properly it is not a problem. Everyone gets angry, and mild anger can sometimes be useful to express strong feelings and deal with situations.

However, if anger is expressed in harmful ways, or persists over a long period of time, then it can lead to problems in relationships at home and at work and can affect the overall quality of your life. This Tip Sheet can help you understand anger and learn better ways to handle and express it.

Anger may be related to other problems such as an injury to the brain, or drug or alcohol use. It is important to get professional help for these problems.

What is anger?

Anger is an emotion that can range from mild annoyance to intense rage. It is a feeling that is accompanied by biological changes in your body. When you get angry, your heart rate and blood pressure rise and stress hormones are released. This can cause you to shake, become hot and sweaty and feel out of control.

When people have angry feelings, they often behave in angry ways too. Angry behaviours include yelling, throwing things, criticising, ignoring, storming out and sometimes withdrawing and doing nothing.

Anger can often lead to violence if not properly controlled and some people use anger as an excuse for being abusive towards others. Violence and abusive behaviour gives someone power and control over another person usually through creating fear.

Why do we get angry?

Anger is often associated with frustration – things don’t always happen the way we want and people don’t always behave the way we think they should. Anger is usually linked with other negative emotions or is a response to them. You may be feeling hurt, frightened, disappointed, worried, embarrassed or frustrated, but may express these sorts of feelings as anger. Anger can also result from misunderstandings or poor communication between people.

Men and women often, but not always, manage and express anger in different ways. With men, anger may be the primary emotion, as many men believe that anger is a more legitimate emotion to express in a situation. Often men find it harder to express the feelings underneath the anger, like hurt, sadness or grief. For women the reverse may often be true – the anger gets buried under tears.

When is anger a problem?

Anger becomes a problem when it creates trouble for you with other people, your work, your health, day-to-day living or the law. Anger is also a problem when other people around you are frightened, hurt or feel they cannot talk to you or disagree with you in case you become angry.

Some signs that anger is a problem are outlined here.

Anger involves verbal, emotional, physical or psychological abuse.

You feel angry a lot of the time.

People close to you are worried about your anger.

Anger is leading to problems with personal relationships and work.

You think you have to get angry to get what you want.

Anger seems to get bigger than the event that set it off.

Anger lasts for a long time, and well after the triggering event has passed.

Anger affects other situations not related to the original event.

You are becoming anxious or depressed about your anger.

You are using alcohol or other drugs to try to manage your anger.

You are getting angry with the people who are closest to you, or with people who are less powerful than you, rather than dealing with the situation that sparked off your anger in the first place.

Why manage anger?

Anger is not usually a good solution to problems, even if it seems helpful in the short term. Unmanaged anger creates problems – sometimes for you and often for others around you. People with poor anger management are more likely to have problems with personal relationships or work, verbal and physical fights and/or damaged property.

They can also experience anxiety, depression, low self-esteem, psychosomatic illnesses and problems with alcohol or drugs. It is important to manage anger before it leads to other serious problems.

Some people used to believe that venting anger was beneficial. Researchers have now found that ‘letting it rip’ actually escalates anger and aggression and does nothing to resolve the situation.

On the other hand, sitting on your anger and not expressing it may lead to the pressure cooker experience that many people are familiar with.

Expressing some feelings of anger in a controlled way, rather than bottling it up, gives you an opportunity to release some of your underlying feelings, so that you can start to tackle the issues that are making you angry.

What is anger management?

Anger management is about understanding your anger and why it happens. It is about learning and practising better ways of expressing anger, and knowing how to prevent it from occurring in the first place.

Specifically, anger management is about knowing the triggers and early warning signs of anger, and learning techniques to calm down and manage the situation before it gets out of control.

Tips to help manage anger

Identify triggers and warning signs of anger
The first step in being able to manage your anger is to recognise the situations that make you angry and identify your body’s warning signs of anger.

List things that can trigger your anger
Make a list of the things that often set off your anger (for example, running late for an appointment and not being able to find a car park, your teenager leaving dirty dishes in the sink or a co-worker blaming you for something you didn’t do). If you know ahead of time what makes you angry, you may be able to avoid these things or do something different when they happen.

Notice the warning signs of anger in your body
Notice the things that happen to your body that tell you when you are getting angry (for example, heart pounding, face flushed, sweating, jaw tense, tightness in your chest or gritting your teeth). The earlier you can recognise these warning signs of anger, the more successful you will probably be at calming yourself down before your anger gets out of control.

Learn strategies for managing anger
There are a number of different ways of managing anger and some strategies will suit you better than others.

Control your thinking
When you’re angry, your thinking can get exaggerated and irrational. Try replacing these kinds of thoughts with more useful, rational ones and you should find that this has an effect on the way you feel. For example, instead of telling yourself ‘I can’t stand it, it’s awful and everything’s ruined’, tell yourself ‘It’s frustrating, and it’s understandable that I’m upset about it, but it’s not the end of the world and getting angry is not going to fix it’.

Develop a list of things to say to yourself before, during and after situations that may make you angry. It is more helpful if these things focus on how you are managing the situation rather than what other people should be doing. Psychologists call this type of thinking ‘self talk’.

Before:
‘I’ll be able to handle this. It could be rough, but I have a plan.’
‘If I feel myself getting angry, I’ll know what to do.’
During:
‘Stay calm, relax, and breathe easy.’
‘Stay calm, I’m OK, s/he’s not attacking me personally.’
‘I can look and act calm.’
After:
‘I managed that well. I can do this. I’m getting better at this.’
‘I felt angry, but I didn’t lose my cool.’

Take time out
If you feel your anger getting out of control, take time out from a situation or an argument. Try stepping out of the room, or going for a walk. Before you go, remember to make a time to talk about the situation later when everyone involved has calmed down. During a time out, plan how you are going to stay calm when your conversation resumes.

Use distraction
A familiar strategy for managing anger is to distract your mind from the situation that is making you angry. Try counting to ten, playing soothing music, talking to a good friend, or focusing on a simple task like polishing the car or folding laundry.

Use relaxation
Relaxation strategies can reduce the feelings of tension and stress in your body. Practise strategies such as taking long deep breaths and focusing on your breathing, or progressively working around your body and relaxing your muscles as you go.

Learn assertiveness skills
Assertiveness skills can be learnt through self-help books or by attending courses. These skills ensure that anger is channelled and expressed in clear and respectful ways. Being assertive means being clear with others about what your needs and wants are, feeling okay about asking for them, but respecting the other person’s needs and concerns as well and being prepared to negotiate. Avoid using words like ‘never’ or ‘always’ (for example, ‘You’re always late!’), as these statements are usually inaccurate, make you feel as though your anger is justified, and don’t leave much possibility for the problem to be solved.

Try to acknowledge what is making you angry
Acknowledge that a particular issue has made you angry by admitting it to yourself and others. Telling someone that you felt angry when they did or said something is more helpful than just acting out the anger.

Make sure you think about who you express your anger to, and take care that you aren’t just dumping your anger on the people closest to you, or on people who are less powerful than you (for example, don’t yell at your partner, children, dog or cat when you are really angry with your boss).

Sometimes it can help to write things down. What is happening in your life? How do you feel about the things that are happening? Writing about these topics can sometimes help give you some distance and perspective and help you understand your feelings. Work out some options for changing your situation.

Rehearsing anger management skills
Use your imagination to practise your anger management strategies. Imagine yourself in a situation that usually sets off your anger. Imagine how you could behave in that situation without getting angry. Think about a situation where you did get angry. Replay the situation in your mind and imagine resolving the situation without anger.

Try rehearsing some anger management strategies with a friend. Ask them to help you act out a situation where you get angry, so that you can practise other ways to think and behave. Practise saying things in an assertive way.

What are eating disorders?

Eating disorders describe a range of problems associated with eating, food and body image. Unfortunately, in our society it is common for individuals to feel unhappy about their bodies and to be dieting or worrying about food. When these problems are extreme or interfere with an individual’s normal activities and quality of life, these concerns are considered to be psychological disorders.
The most serious eating disorder is anorexia nervosa, which is characterised by dangerously low body weight. Bulimia nervosa is not so frequently life-threatening, but seriously affects the wellbeing of sufferers and can have serious medical complications. This condition is characterised by binge eating and subsequent behaviours that are engaged in to compensate for the binge. Many individuals suffer from other equally unhealthy and disturbing patterns of eating, which are not easily classified. These are known as Eating Disorders Not Otherwise Specified (EDNOS).
Eating disorders mainly affect females but approximately one in ten individuals with an eating disorder is male. It is difficult to accurately estimate the frequency of occurrence of eating disorders due in part to the secretive nature of the disorder. In Australia, anorexia nervosa affects approximately 0.5 per cent of females, bulimia nervosa 2-3 per cent and EDNOS 2-3 per cent.
Individuals with an eating disorder have significant problems with eating habits, weight management practices and attitudes about weight and body shape. These eating-related attitudes and behaviours have numerous negative consequences including:

Low self-esteem, depression, shame and guilt

Obsession and anxiety

Interference with normal daily activities

Alienation from self and often social withdrawal

Physiological consequences, which are potentially life-threatening.

Anorexia nervosa

The key clinical feature of anorexia nervosa is the individual’s deliberate goal to achieve and maintain a low body weight at which the body does not function normally. About half those with anorexia nervosa achieve this weight loss by dieting and avoiding foods. Others may achieve weight loss by a combination of dieting and use of purging behaviours, such as vomiting or use of laxatives. Excessive exercise is increasingly being used to reduce weight.
Another key feature of anorexia nervosa includes an intense and irrational fear of body fat and weight gain. In addition, individuals frequently possess a misperception of their body weight and shape to the extent that they may feel or see themselves as fat, when actually they are emaciated. A further important feature of anorexia nervosa is that sufferers believe their value as a person rests with their thinness – other aspects of personality and relationships are not important in comparison.

These key psychological features contribute to drastic weight loss and a defiant refusal to maintain a healthy weight for height and age. Food, calories, weight and weight management dominate the person’s life. Often the individual becomes obsessed with eating behaviour, which can be reflected in strange eating rituals or the inability to eat in front of others. It is not uncommon for people with anorexia to collect recipes and prepare meals for family and friends but not eat the meals themselves.

There is often conflict with anyone who tries to encourage eating, and withdrawal from social situations, especially when eating may be involved.

There are potentially fatal aspects of anorexia nervosa. In the short-term, starvation may result in physical changes associated with problems such as heart complications or failure. Calcium may be lost from bones, which may result in osteoporosis in the long term.

Bulimia nervosa

The key feature of bulimia nervosa is the re-occurrence of uncontrolled periods of binge-eating, followed by behaviours designed to compensate for the binge. During a binge, the individual may consume large amounts of food in a rapid, automatic and powerless fashion. A sense of loss of control over eating is a key feature.

The binge eating may evoke the sensation of anger and other negative feelings and creates physical discomfort and anxiety about weight gain. Thus, after a binge, the individual uses some form of compensatory behaviour to counteract the effect of the food eaten, such as extreme dieting, fasting or use of excessive exercise. The compensation may also take the form of a purging behaviour such as self-induced vomiting or laxative abuse.

Individuals who binge or purge tend to be highly critical of themselves and have very low self-esteem. They may feel ashamed of their behaviour and withdraw from social gatherings, fearing they will be found out. They may also feel helplessly trapped in this cycle. These feelings are frequently very damaging emotionally and physically, as binge eating and purging behaviours may, like anorexia nervosa, result in metabolic and hormonal changes. Individuals suffering from anorexia and bulimia nervosa share many similar attitudes towards food and weight and shape.

Both groups may have a distorted body image, an intense fear of fat, an excessive preoccupation with food and body weight, and the strong conviction that a slim body shape is absolutely crucial for selfacceptance. Unlike anorexia nervosa, those with bulimia nervosa are, by definition, a normal weight or above. A person who is a very low weight but also binge eats and purges is described as having anorexia nervosa.

Other eating related problems and eating disorders not otherwise specified (EDNOS)

In our society there are many people who experience difficulties with eating behaviours, weight issues and body image problems that can severely affect their lives. These individuals often benefit from psychological help. They may show several features associated with eating disorders but not fulfil the criteria for a complete disorder.

For example, a person may not eat a very large amount of food but still engages in purging behaviours. Alternatively, a person may have experienced drastic weight loss and has a persistent drive for thinness, but does not fulfil all the diagnostic criteria for anorexia. Some research suggests that EDNOS can have the same life-threatening consequences as anorexia and therefore these disorders also require vigorous treatment.

One disorder which comes under the EDNOS category is binge eating disorder (BED). This problem is characterised by recurrent episodes of binge eating but is not followed by unhealthy compensatory behaviours. These binges are accompanied by a sense of loss of control and are associated with low self-esteem and depression and, in some cases, weight gain. As in the case of bulimia, treatments for binge eating disorder are usually very effective.

Unfortunately, the shame which often accompanies bulimia nervosa and binge eating problems often prevents seeking help. However, if an eating related problem is causing distress then it is important to seek professional help.

What causes an eating disorder?

There are many suggested theories of the factors involved in the development of eating disorders, but there is no single consensus on a cause. Most research acknowledges that the development of eating disorders involves a complex set of interactions between cultural, social, family, personality and physical factors (including genetic factors).

Our culture has an unrelenting idealisation of thinness and the ‘perfect’ body is synonymous with beauty and success. Research suggests that this social environment encourages dieting, and dieting predisposes an individual towards eating problems. In the case of bulimia nervosa particularly, the physiological effects of dietary restriction may trigger binge eating.

In addition, feelings of inadequacy, depression, anxiety and loneliness, as well as problematic family and personal relationships, may also contribute to the development of eating disorders. Once the pattern has started, eating disorders may become self-perpetuating. Dieting, bingeing and purging help some people to cope with painful emotions and to gain a degree of control of their lives.

However, at the same time, these behaviours undermine physical health, self-esteem and a sense of competence and control. In anorexia nervosa, starvation frequently contributes to a lack of flexible thinking, which may make change difficult. In almost all cases of eating disorders the individual will possess negative core beliefs about themselves that can trigger and/or maintain the disorder.

Treating an individual with an eating disorder

Many people with eating disorders do not seek treatment for their problems. There are numerous reasons for this. In the case of anorexia nervosa, the individual may not perceive that they have a problem, or may be deeply afraid of the weight gain that will be encouraged or enforced in treatment. In bulimia nervosa, individuals may not seek help as they are ashamed and fear the stigma attached to eating disorders, they may not believe they can be helped, they may not be able to afford treatment, or appropriate treatment may not be readily available. In males, eating disorders may be overlooked because these conditions are more unusual in males.
However, finding appropriate help and treatment for eating disorders is essential – the sooner, the better. The longer abnormal eating behaviours persist, the more difficult it is to overcome the disorder and its effects on the body.

Fortunately, effective treatments for eating disorders are available. Family therapy has been shown to be especially helpful for children and adolescents with anorexia nervosa. When a person is dangerously thin, long-term treatment and/or hospitalisation may be required. As anorexia nervosa is a complex disorder, it is best treated with a team of professionals including psychiatrists, psychologists, general practitioners, dietitians, social workers and nurses. All Australian States have an eating disorder foundation that can provide valuable resources and information about treatments that are available.

Bulimia nervosa and binge eating disorder may be effectively treated. Cognitive behaviour therapy in particular is widely recognised as being effective, usually requiring regular outpatient visits over a number of months. In addition, anti-depressant medication can be very valuable in reducing the urge to binge.

Psychologists are frequently crucial sources of psychological intervention and can play a vital role in helping people with eating disorders to identify and challenge the negative beliefs about themselves that are maintaining the disorder. Psychological therapy often involves education regarding eating disorders and the influence of the social environment. It typically assists individuals to learn about their eating patterns and beliefs, and provides strategies to help change dysfunctional attitudes and behaviours. Another important element of psychological therapy includes changing attitudes towards weight and body image.

Individuals can gain an understanding of factors that put them at risk of eating concerns and learn ways to manage these situations. Building self-esteem and improving self-awareness are usually vital elements of therapy for individuals with an eating disorder. Enhancing social and family functioning can also be an imperative part of recovery. To ensure that improvements are maintained, treatment also focuses on relapse prevention, providing individuals with the skills necessary to manage possible setbacks in the future.

Seeking professional assistance

An essential thing to remember is that people can and do recover from eating disorders. Finding the right professional help can be of great benefit in this process.

In collaboration with a psychologist, the help of a dietitian and a GP or psychiatrist is recommended. A dietitian is helpful to advise on diet and eating regimens, and a GP or psychiatrist may treat medical complications and monitor medication – especially anti-depressant medications if they have been prescribed.

Family and friends offering support and encouragement can play an important role in the success of the treatment program.

Post Traumatic Stress

Potentially traumatic events are powerful and upsetting incidents that intrude into daily life. They are usually defined as experiences which are life threatening, or where there is a significant threat to one’s physical or psychological wellbeing.

The same event may have little impact on one person but cause severe distress in another individual. The impact that an event has may be related to the person’s mental and physical health, level of available support at the time of the event, and past experience and coping skills.

Situations and events that can lead a person to experience psychological trauma include:

> Acts of violence such as an armed robbery, war or terrorism
> Natural disasters such as bushfire, earthquake or floods
> Interpersonal violence such as rape, child abuse, or suicide of a family member or friend
> Involvement in a serious motor vehicle or workplace accident.

Other less severe but still stressful situations can also trigger traumatic reactions in some people.

What are the symptoms of psychological trauma?

Many people have strong emotional or physical reactions following experience of a traumatic event. For most, these reactions subside over a few days or weeks. For some, the symptoms may last longer and be more severe. This may be due to several factors such as the nature of the traumatic event, the level of available support, previous and current life stress, personality, and coping resources.

Symptoms of trauma can be described as physical, cognitive (thinking), behavioural (things we do) and emotional.
Physical
Excessive alertness, on the look-out for signs of danger
Easily startled
Fatigue/exhaustion
Disturbed sleep
General aches and pains
Cognitive (thinking)
Intrusive thoughts and memories of the event
Visual images of the event
Nightmares
Poor concentration and memory
Disorientation
Confusion
Behavioural
Avoidance of places or activities that are reminders of the event
Social withdrawal and isolation
Loss of interest in normal activities
Emotional
Fear
Numbness and detachment
Depression
Guilt
Anger and irritability
Anxiety and panic

As long as they are not too severe or last for too long, the symptoms described above are normal reactions to trauma. Although these symptoms can be distressing, they will settle quickly in most people. They are part of the natural healing process of adjusting to a very powerful event, making some sense out of what happened, and putting it into perspective. With understanding and support from family, friends and colleagues the stress symptoms usually resolve more rapidly. A minority of people will develop more serious conditions such as depression, posttraumatic stress disorder, anxiety disorders, or alcohol and drug problems.

Tips on managing psychological trauma

There are several things you can do to look after yourself and promote recovery from a traumatic event or situation. The following points provide some general advice.

>Recognise that you have been through a distressing experience and give yourself permission to experience some reaction to it. Don’t be angry with yourself for being upset.
>Remind yourself that you are not abnormal and that you can and are coping.
>Avoid overuse of alcohol or other drugs to cope.
>Avoid making any major decisions or big life changes.
>Do not try to block out thoughts of what has happened. Gradually confronting what has happened will assist in coming to terms with the traumatic experience.
>Don’t ‘bottle up’ your feelings – share your experiences with others when opportunities arise. This may feel uncomfortable at times, but talking to understanding people that you trust is helpful in dealing with trauma.
>Try to maintain a normal routine. Keep busy and structure your day.
>Make sure you do not unnecessarily avoid certain activities or places.
>Allow yourself time to rest if you are feeling tired, and remember that regular exercise is important.
>Let your friends and family know of your needs. Help them to help you by letting them know when you are tired, need time out, or need a chance to talk or just be with someone.
>Make time to practise relaxation. You can use a formal technique such as progressive muscle relaxation, or just make time to absorb yourself in a relaxing activity such as gardening or listening to music. This will help your body and nervous system to settle and readjust.
I>f the trauma that you experience stirs up other memories or feelings from a past unrelated stressful occurrence, or even childhood experiences, try not to let the memories all blur together. Keep the memories separate and deal with them separately.
>Express your feelings as they arise. Whether you discuss them with someone else or write them down in a diary, expressing feelings in some way often helps the healing process.

When to seek professional assistance

You should seek professional assistance if the symptoms resulting from the trauma are too distressing or last for more than a couple of weeks. Warning signs may include:

>Being unable to handle the intense feelings or physical sensations
>Feeling numb and empty
>Continuing to experience strong distressing emotions
>Continuing to have physical symptoms of being tense, agitated, and on edge
>Continuing to have disturbed sleep and/ or nightmares
>Having no-one to support you and with whom you can share your feelings and emotions
>Having relationship problems with friends, family and colleagues
>Increasing your use of alcohol or drugs.

How is psychological trauma treated?

Most people who experience a traumatic event will not require treatment. Most will work through their anxiety with support from close friends and family. However, for some people the response to the trauma can be debilitating and treatment from a trained mental health professional will be needed to help the person to recover.

Treatments for a severe trauma response include trauma-focused psychological interventions. These focus on providing education, stress management techniques, and helping the person to confront feared situations and distressing memories. Medication, particularly some of the new antidepressant drugs, can often be useful alongside trauma-focused psychological approaches.

Posttraumatic Stress Disorder (PTSD)

PTSD is a clinical condition that may develop in some people following exposure to a traumatic event. PTSD involves three main groups of symptoms:

Re-experiencing the trauma in the form of intrusive memories, nightmares or flashbacks
Avoidance of reminders and numbing of emotional responsiveness
Hyperarousal – feeling jumpy and on edge.

PTSD is very distressing and can lead to serious ongoing problems with social relationships and the ability to work or carry out normal daily activities. PTSD usually requires professional assistance as these problems tend not to resolve by themselves with the passage of time.

Depression, anxiety disorders (such as panic, phobias, and general anxiety) and alcohol or drug disorders may also develop following trauma in some people. These conditions may occur with, or in the absence of, PTSD.

Other resources on psychological trauma and PTSD

The Australian Centre for Posttraumatic Mental Health (www.acpmh.unimelb.edu.au) website contains useful information for trauma survivors, their families, and health practitioners. Free copies of consumer and practitioner versions of the Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder can be downloaded. (These guidelines are also available from www.nhmrc.gov.au/publications/synopses/mh13syn.htm).

The US National Center for PTSD (www.ncptsd.va.gov) website also contains a range of useful resources for consumers and practitioners, as well as links to several other useful sites.

What is positive ageing?

Positive ageing is a term used to describe the process of maintaining a positive attitude, feeling good about yourself, keeping fit and healthy, and engaging fully in life as you age.

Ageing is often associated with many rewarding experiences. It is however also a time when significant changes might occur. For example, some people experience changes in physical functioning, social networks, employment, and bereavement can become more common. Keeping a positive attitude toward ageing is particularly important as it allows you to continue to feel good and have a sense of control as you face another part of the life cycle. As people age it is natural for them to move in and out of periods of positive ageing. Those who age positively live longer and healthier lives, and enjoy a good quality of life.

A survey conducted by the Australian Psychological Society (APS) found there are many common challenges experienced by older people. The most common difficulties were around:

>Maintaining health and fitness
>Maintaining social networks and activities
>Feelings of sadness and loss
>Ensuring financial security
>Decreases in mobility, and
>An increased reliance on others

How you manage, think about and cope with these sorts of challenges can affect how well you cope with getting older.

Strategies to achieve positive ageing

There are a number of ways to prevent, delay or manage some of the physical, psychological, social and personal challenges people face as they age – some of these are described below.
Maintaining a positive attitude
The way you feel about yourself and the ageing process can affect how you view life and the extent to which you are involved in activities and the opportunities life offers. If you can make choices and have control over important aspects of your life, and take part in and enjoy activities, you are more likely to feel good about yourself and get more out of life.

Staying connected
Social interaction and relationships with others are associated with positive ageing and feeling optimistic about life. Maintaining social networks through membership of clubs, engaging in voluntary work and keeping in touch with family encourages interaction with others, prevents isolation and promotes good mental health and physical activity.

Keeping the brain active
Keeping the brain active, alert and flexible can promote good mental health and positive ageing throughout the lifespan. Having an active mind can be as simple as reading a book, learning a new hobby or problem solving (e.g. doing crosswords). Learning new skills is exercise for the brain and makes it work a little harder.

Managing stress
Stress is a natural part of life that can be challenging to manage. Stress can result from positive experiences (e.g. having grandchildren) or negative ones (e.g. bereavement), and affects people in different ways. High levels of stress can affect physical and mental health (e.g. heart disease, depression), the quality of relationships and financial security. The way you respond to stress and daily hassles is often a good predictor of whether you will age positively, and how much you will enjoy life.

One major stressor that a lot of older people face is having to become a carer. Caring for a spouse or a family member can be very demanding. If you become a carer you need to ensure that you are looking after yourself to avoid burnout, isolation, illness and mental health problems. Keeping as free from stress as possible, and learning how to effectively cope with unavoidable stress, can promote positive ageing in all areas of your life.

Some good ways to manage stress and cope with daily hassles include:
Thinking things through before getting upset (e.g. calling a friend for advice, writing things down)
Relaxing when feeling tense (e.g. exercise, deep breathing) Using stress management skills, such as problem solving or goal setting

Volunteering or seeking part-time employment
Many older people find part-time employment or voluntary work rewarding and a chance to give something back to the community. Any type of work can help to keep your mind sharp and can provide a social network outside of the home and family.

Engaging in physical activity
Exercise is a great way to minimise the risk of a chronic condition such as heart disease or diabetes occurring or becoming worse. Taking part in leisure activities that you find interesting and suitable for your level of physical functioning is an effective way of becoming more active. Physical activity can also provide social interaction through being outdoors, engaging with others, or by becoming a member of an activity program or club.

It is important to remember that as you age, your physical capabilities are likely to change. Seeking guidance from a health professional before engaging in strenuous activity can reduce any risks involved.

Having regular medical checkups
Older people who have fewer medical conditions have a better quality of life, better mental health and are less restricted in their daily activities. By having regular medical check-ups, engaging in illness prevention (e.g. not smoking, drinking alcohol in moderation) and having regular tests or check-ups (e.g. blood pressure, dental) you can help to reduce the possible onset of chronic conditions.

Resources to assist positive ageing

There are many resources and organisations that can help support people to achieve positive ageing.
The Australian Government provides a phone and internet service which is a single point of access to government and non-government resources for Australians over 50 years of age. This service provides information on a range of topics including health, finances, work, volunteering,lifestyle, events and discussion forums.

Website: www.seniors.gov.au
Phone: 1800 500 853 (Aged and Community Care Infoline)

Seeking psychological help

If you find it difficult to change your diet, cut down alcohol consumption, stop smoking or motivate yourself to exercise more and get out for social activities, a psychologist can help. Psychologists are trained to help people manage emotional stress and adjust to difficult life circumstances, as well as treat psychological disorders such as depression and anxiety. Psychologists can also support a person to maintain healthy behaviours, such as exercise, and change risky behaviours, such as smoking.

Psychologists also work with individuals and their families affected by dementia by providing strategies to manage memory difficulties, initial support at the time of diagnosis and continued support as the condition progresses.

Why do people use alcohol and other drugs?

People tend to choose the substances that help them in some way, such as increasing pleasure, or decreasing emotional or physical pain. As alcohol and other drugs act directly on the central nervous system, they can seem to be predictable and effective ways to change how a person feels – at least in the short-term.

Substance use is often associated with important social rituals such as celebration, socialising, relaxation, healing, spirituality and commiseration. In some groups, clubs or communities, alcohol or other drug use can be seen as part of belonging to the group.

The choice of substance is influenced by the particular needs the person is trying to meet. Because different people may experience the same drug in different ways, it is hard to know why an individual has their particular pattern of substance use without getting to know more about what it means for them. The availability and cultural norms associated with different substances can also influence individual preferences.

When might alcohol or other drug use become a problem?

With time, some people can find their alcohol or other drug use becomes problematic, because the harm or risk of harm associated with the substance use outweighs the benefits. Substance use may be a problem when you:

>Have difficulty meeting responsibilities at home, work or school
>Use more than you intended despite wanting to cut down or quit
>Have recurring problems with health, safety, relationships, finances or the law through the substance use
>Need the substance to cope with everyday life or particular experiences
>Organise other events or needs around your substance use
>Need increasing amounts of the substance to have the same effect
>Feel sick or moody without the substance, but feel normal upon resuming use
>Have tried unsuccessfully to reduce or cease use.
>Find yourself using as a way to maintain your friendships.

What kinds of problems can alcohol or other drug use cause?

We often tend to think of the immediate harm associated with what drug is being used, how much and how often. But substance-related risks or harm can occur at any stage of drug use, including:

>How you get hold of the substance (e.g. raising the money or risks in buying the substance)
>How you put the substance into your body (e.g. drink, eat, inhale, smoke, snort, or inject)
>The effect of the drug on your body (e.g. increased heart rate, unconsciousness or long-term liver damage)
>What you do while under the influence of the drug (e.g. increased risk taking or neglect of other responsibilities)
>What happens when you cease to use (e.g. depression when “coming down” or withdrawal symptoms).

What can you do if you think you have a problem?

It can sometimes be hard to admit that your alcohol or other drug use has become a problem, especially if you still enjoy aspects of the drug use. Think about whether you would like to change your use in some way, such as:

>What you use
>How much you use
>When or how often you use
>Method of use
>Where you use
>Who you use with
>What you do to get hold of or afford the drug
>What you do while under the influence of the drug.

It can be useful to ask yourself what are the helpful and not so helpful consequences of using the substance, and what are the advantages and disadvantages of cutting down or quitting. These questions are particularly useful in identifying what goals you would like to set for yourself in changing your substance use, and the challenges that you might experience in working toward achieving those goals.

Replacing the substance use

It helps to identify what needs the substance use is meeting, and find alternative ways of meeting those needs.

>Experience pleasure or relaxation
>Feel more confident or assertive
>Socialise or feel a sense of belonging
>Have a break from problems
>Cope with painful feelings or memories
>Pass the time
>Complete other goals or tasks
>Delay or avoid doing unpleasant tasks
>Prevent the onset of withdrawal symptoms
>Do what you would ‘normally do’ – it’s a habit.

While substance use may help to meet these needs in the short term, prolonged use of substances over time may be less effective in meeting these needs, as well as creating additional problems such as those noted previously. Just as it takes time to develop substance use habits, it sometimes takes a while before the alternative solutions feel natural and effective. Finding other ways to meet your needs can involve trial and error. Instead of looking for one solution that will replace the substance, it usually helps to replace the use with a variety of alternatives.

Dealing with cravings

People often experience strong urges to use the substance when they first try to cut down or stop their use. The following suggestions have been found to be useful by some people to cope with cravings:

>Work out when you are most likely to experience cravings and plan how you intend to cope with them before they happen
>Identify when the craving starts – it is easier to deal with cravings before they become more powerful
>Remind yourself that cravings are a normal part of cutting down and that they will pass with time – the less you give into cravings the weaker they become
>Try to find something to distract yourself with – even if you only delay using the substance
>Talk to someone supportive
>Try to work out when you are more likely to crave the substance – e.g. in certain situations, with particular people, or when you feel a certain way – and plan ahead how you will deal with each situation when it comes up.
>It is a good idea to plan alternative activities for the times you would normally use alcohol or other drugs, but you may also need to look at broader changes to your lifestyle or coping strategies.

Strategies to cut down

Some people choose to cut down their use rather than stop immediately, either to regain control over their use or as a step toward stopping completely. It is advisable to seek medical advice prior to cutting down or ceasing use, as some people experience severe withdrawal symptoms. Seek medical assistance if you become unwell during a reduction in substance use.

The following strategies have been found to be useful in cutting down:

>Plan your use – set limits on the day, time and amount being used
>Try to have at least two substance free-days a week
>Fit your substance use around other priorities
>Plan ahead how you will deal with times you might find difficult – you may need to avoid some situations at first
>Delay the first use and each use after that
>Don’t try to keep up with others – go at your own pace
>Ask a friend to support you
>Find something else to do to take your mind off wanting to use for example it can help to take up a new hobby
>Identify friends who support your efforts to change and who you feel comfortable with – you may initially decide to spend less time with friends who use the substance you are trying to reduce
>Decide how you intend to respond to friends who might offer you the substance before you see them – such as “Not tonight”, “No, but you go ahead”, “No, doctor’s orders” or simply “No, thanks”
>Remind yourself of the good things about cutting down
>Seek some counselling
>Talk to a GP about pharmacological treatments
>Join a support group
>Identify other things you have in common with friends apart from substance use.

Rewarding Effort

Reward your efforts to change, even if you don’t always meet your goals. Changing habits can be difficult, and being hard on yourself just tends to make it worse. Try not to rely on will-power alone – it’s a hard way for anyone to change their habits.

Try a range of strategies to cut down or quit. Each time you try to make changes, ask yourself what you could do differently next time and what you would still do the same. You may choose to get some help along the way. But the most important thing is to keep trying. It’s worth it.

Where to get help

If you have tried making some of the changes suggested in this brochure and found it difficult, it could be time to speak with a psychologist who specialises in alcohol and other drug use issues. They can help you to work out where you are getting stuck in making changes and help you to develop strategies that are relevant to you.

If you are using substances to cope with other difficulties, psychologists can also help you to find other ways to deal with these problems. These problems might include grief and loss, abuse, trauma, relationship break ups, low self-esteem, or overwhelming emotions such as anger, anxiety or depression.

It can also be valuable to seek help when someone you care about has a problem with alcohol or other drug use, as it can be an emotionally difficult and draining experience. Psychologists can assist you to find ways to deal with challenging situations and look after yourself.