Christmas may only come but once a year, but when it does, it can make managing your mental health trickier than usual. Between the stress of organising, the pressure to be jolly, the squeeze on your finances, and extra social occasions, it’s easy to become overwhelmed. To help you stay well over the festive period, here are 20 top tips for looking after your mental health at Christmas.
 
1. Set boundaries with people – decide who you want to spend time with, and for how long. Tell people what these boundaries are to help manage their expectations
 
2. Give yourself permission to say ‘No’ – if there’s something you don’t want to do, it’s ok to say no. Listen to what you need
 
3. Reframe any decision that starts ‘I should’ – if you’re doing something because you feel you should, ask yourself instead, ‘I need to/I don’t need to’, or ‘I want to/I don’t want to’. Doing this helps you listen to your own needs
 
4. Give yourself permission not to be happy – mental illnesses, such as depression, don’t disappear just because it’s the season to be jolly. It’s ok to feel sad. Give yourself permission to be you
 
5. Take a break from social media – if you notice you’re comparing yourself to others and it’s making your mental health worse, take some time away from social media. This can help turn down the volume on your inner critic
 
6. Organise your time – use a diary or calendar to work out your available time, and say no to anything that feels too much. Remember to schedule in quiet time when you can recover and have space to yourself
 
7. Prioritise your to-do list – make a to-do list, then prioritise things that have to be done and cross out anything that isn’t essential. Tackle one thing at a time and avoid setting unachievable goals
 
8. Set a budget – avoid spending more money than you have by setting a budget for what you can afford, and sticking to it. It’s ok not to buy extravagant gifts
 
9. Keep doing self-care – keep a balance between doing things for others, and doing things for yourself. Think about what you need to do to look after your wellbeing, and prioritise it. Try to keep the routine of your usual self-care activities
 
10. Make time to exercise – physical activity releases endorphins, which make you feel good. Make time to stay active over Christmas to help boost your physical and mental wellbeing
 
11. Get enough sleep – late nights and disruption to sleeping patterns can affect your mood and impact mental health. Try to maintain good sleep hygiene and stick to your usual routine as much as possible
 
12. Balance your diet – balance over-indulgence with plenty of fruit and vegetables to avoid mood and energy dips from eating lots of sugary foods
 
13. Avoid drinking too much alcohol – while alcohol may initially make you feel more relaxed and social, it’s a depressive and can increase feelings of low mood and anxiety. Avoid excessive drinking and stick to recommended guidelines
 
14. Take steps to stay sober - if you have an addiction, Christmas can be a particularly challenging time of year to stay sober. Spend time with people who are supportive of your recovery, and make a plan to leave any social gatherings if you begin to feel uncomfortable. The charity Addaction can provide drug, alcohol and mental health support
 
15. Help out others – helping other people can boost your mood, self-esteem and self-confidence. Volunteering can also connect you with others and build new friendships. Try looking for opportunities to help others in your local community
 
16. Talk to someone – speaking to a friend or family member about how you’re feeling can reduce feelings of isolation and loneliness. Or, if you’d rather talk to someone impartial, you could contact a counsellor
 
17. Create a support network – make a list of all the people, forums, helplines and organisations you can contact any time you need them. Even over Christmas, there’s always support available
 
18. Make a crisis plan – make a plan for what do to if you experience a mental health crisis and have thoughts of suicide. This could include contacting your GP, the local crisis team, NHS 111 (dial 111), Samaritans (dial 116 123), or going to A&E
 
19. Take time to reflect – spend time reflecting on the past year, and what was helpful or unhelpful in managing your mental health. Make a plan for what you’d like to do in the coming year to improve your mental health and wellbeing
 
20. Feel proud – you’ve got through a whole year! Whatever difficulties have come your way this year, you’ve survived them. You’re absolutely awesome!
 
If you want support with managing your mental health, get in touch to make an appointment.

In last month’s article in this Exploring Mental Health series, we looked at anxiety. This month, we’re exploring grief and loss. Grief is a very normal reaction to a loss, and for this reason it isn’t a mental illness. But it is something that affects our mental wellbeing in a wide variety of ways. In this article, we explore how grief can affect you, and how to cope after a loss.
 
Different types of loss
 
Loss is something we all experience at some point during our lives. This can come in many different forms, including:

• Death of a person or pet
• Divorce or relationship break down
• Ill health or injury
• Pregnancy, miscarriage or stillbirth
• Sexual difficulties or changes to your sex life
• Menopause or physical body changes
• Redundancy, unemployment or closure of a business
• Retirement
• Changing job
• Moving house or school
• Finishing school or university
• Bankruptcy or change in financial position
• Repossession of house
• Children leaving home
• Imprisonment

 
How grief can affect you
 
How you experience grief following a loss is something that’s individual to each of us, but the symptoms are far broader than feeling sad and upset. Grief can affect you:

• Emotionally – e.g. numbness, shock, disbelief, fear, panic, hopelessness, worry, sadness, helplessness, loneliness, anger, guilt, yearning, resentment, relief

 

• Behaviourally – e.g. sleeplessness, having dreams/nightmares, loss of appetite, absent mindedness, crying, hyperactivity, avoidance of places or people, increase in or development of addictions, risk taking

 

• Physically – e.g. tightness in chest, breathlessness, pain (this may replicate the place of pain in the person who died), lack of energy, dry mouth, hollowness in stomach, lump in throat, oversensitivity to light, noise or smells

 

• Cognitively – e.g. disbelief, confusion, hallucinations, sensing the deceased’s presence, preoccupation (with tasks, the person who died, the circumstances contributing to the loss etc.), questioning the loss or yourself (including questioning your identity)

 

• Spiritually – e.g. loss/discovery of faith or religion, questioning of previously held beliefs, resumption/renewal of former beliefs

 

• Socially – e.g. loss/gain of friendships or social groups, change in role and identity, loss/gain of social status

 

• Practically – e.g. change in financial position, change in living arrangements, change in work, change in routines

 
You may experience some or most of these symptoms, to varying degrees.

How to cope after a loss
 
There’s no quick way to get through the grief process. It takes time, and it’s not uncommon to still be experiencing symptoms of grief two to three years after a loss. To cope, it can be helpful to:

• Allow yourself to be upset – it’s ok to be sad, for many months and years after a loss. Your emotions may come in waves, so if there are times when you feel less sad than others, that’s ok too – it doesn’t mean you’ve moved on or forgotten

 

• Stop putting pressure on yourself – there’s no right or wrong way to move through the grief process, so try not to judge or criticise yourself. Ignore any expectations that come from others about how you should or shouldn’t be feeling; just do what feels right for you

 

• Take one day at a time – looking ahead and picturing the future can seem impossible, and leave you feeling empty or panicky. Focus on one day at a time, and set yourself small, achievable goals. Put aside any larger, more overwhelming decisions until you’re ready to make them

 

• Talk to others – talking about the loss and how you’re coping can help to reduce isolation and give you support. You might want to talk to friends, family, online forums, support groups or to a therapist

 

• Find outlets for your feelings – this might be through doing something creative, such as music, art or writing; or through doing physical activities

 

• Look after yourself – looking after yourself physically can seem unimportant following a loss, but it’s a vital part of helping you cope. Eating well and getting enough sleep can be challenging, but they can make a big difference to your overall wellbeing

 

• Avoid drugs and alcohol – using these to numb the pain of a loss won’t help in the longer term, and can stop you finding more positive coping methods. If you need help managing your drug or alcohol use, make an appointment to see your GP who will be able to refer you to local support services

 

• Learn your triggers – keep a note of things that negatively affect your mood and how you’re coping. Once you know what these triggers are, you can begin to work out what things help you manage them, e.g. having an activity planned for a particular time of day, or seeing a therapist for a couple of weeks/months at particular times of the year

 

• Make a memory box – this can be filled with things that remind you of the person who died (e.g. photos, letters, books, albums, recipes, clothing, keepsakes, perfume/aftershave etc.), and can be something you get out and look at whenever you want to feel close to them

 

• Create a memorial space – this may be a grave or place where ashes are interred, or it may be a plaque in a special place. Alternatively, you may want to buy a plant or tree for the garden, or have a social space online, such as a Facebook memorial page. Whatever it is, the space can be somewhere you go to think about the person who died, connect with them, and to share memories of them with others

When to get further support
 
Sometimes, the experience of grief can be too difficult to manage on your own, and you may need additional support. This might be due to:

• The nature of the loss (e.g. if it’s an unexpected or violent death)
• Past experiences or traumas that re-emerge following a loss
• Existing physical or mental illnesses
  
• Social isolation or lack of a support network
• Other major life stressors (e.g. financial difficulties or having dependents to care for)
  

If any of these sound familiar, the first step is to speak to your GP. They can give you details of support groups or organisations; refer you to a counsellor; or prescribe medication, where relevant. You could also contact support organisations, such as Cruse Bereavement Care who have a free national helpline as well as local bereavement services throughout England, Wales and Northern Ireland.
 
If you’ve experienced a loss and would like some counselling support, get in touch to make an appointment.

In this month’s instalment of the Exploring Mental Health series, we’re looking at anxiety. Anxiety is something we all experience at some point during our lives, often at times of change or as a result of stressful events. But when does anxiety become a mental health problem, what are the symptoms to look out for, and how can you manage your anxiety?
 
When is anxiety a mental health problem?
 
Feeling anxious is a normal emotion that everyone experiences sometimes. It’s our body’s response to stressful situations or events, and is usually temporary.
 
Anxiety becomes a mental health problem when feelings of anxiety, worry or fear don’t go away, and you experience them all or most of the time, even when there doesn’t seem to be a particular cause.
 
If you can answer yes to any of the following, your anxiety may have become a mental health problem:

• It has become hard to control your worries
• Your feelings of anxiety are strong and it’s difficult to relax
• You’ve felt anxious for a long period of time
• You’re avoiding situations because they make you feel anxious
• You’re not getting pleasure from things you usually enjoy
• Your feelings of anxiety are affecting your daily life
• There doesn’t seem to be a particular cause for your anxiety
• You regularly experience anxiety symptoms

 
If any of these sound familiar, the first step is to visit your GP. They can provide a diagnosis and offer advice on getting support and treatment. There are also some tips on how to manage your anxiety below.
 
What are the symptoms of anxiety?
 
Anxiety can affect our bodies and minds in lots of different ways. Some of the most common symptoms are:
 
Physical symptoms

• Feeling light-headed or dizzy
• Feeling sick
• Needing to use the toilet more/less frequently
• A fast or irregular heartbeat
• Faster, shallower breathing (hyperventilating)
• Tightness in your chest
• Shaking
• Tingling in parts of your body
• Pins and needles
• Headaches or aches in other parts of your body
• Increased sweating or hot flushes
• A dry mouth
• Grinding your teeth
• Feeling restless
• Having panic attacks

 
Cognitive symptoms

• Thinking you might die
• Thinking you have a serious health condition
• Thinking you might lose control
• Thinking others can see your anxiety and are looking at you
• Feeling disconnected from the world around you
• Feeling disconnected from your body or mind
• Feeling a sense of dread and fearing the worst
• Worrying about ‘what ifs’ and things that might happen
• Thinking about a situation over and over again
• Wanting to run away or escape from the situation
• Feeling alert and on edge

 
How to manage your anxiety
 
There are lots of things you can do to control and reduce your anxiety, including:

• Visit your GP – your doctor can give you advice on getting support and treatment

 

• Take medication – in some cases, your GP might prescribe medication to help control your anxiety symptoms

 

• Have counselling – talking to a counsellor can help you identify the causes and triggers for your anxiety, and find ways to reduce and manage it. If you’d like to make an appointment to discuss your anxiety, get in touch.

 

• Talk to someone you trust – this might be a friend, colleague or family member. Opening up about how you’re feeling can create a support network for when you’re finding things tough

 

• Contact support organisations – organisations such as Samaritans and Anxiety UK have helplines you can call when you need support

 

• Join online support groups or forums –these give you the chance to link up with others who understand what you’re experiencing

 

• Keep a journal or diary – this can help you to identify triggers for your anxiety and learn any early warning signs. You can also use it to remind yourself of all the good, positive things in your life, which anxiety can often make you overlook

 

• Plan ‘worry time’ – set aside an amount of time each day to think about what’s worrying you. Between these times, tell yourself to let go of those thoughts until your next worry time. This can feel challenging but also give a greater sense of control over your anxiety

 

• Look after your physical health – a good diet, limiting alcohol and caffeine, getting enough sleep, and exercising regularly can all help to improve your mental wellbeing

 

• Practice mindfulness – relaxation techniques, such as mindfulness, can help to bring you back into the present moment and interrupt anxious thoughts about ‘what ifs’, creating a sense of calm. They can also teach you breathing techniques to help control your anxiety symptoms

 
It’s important to note not all of these tips will feel helpful for everyone. We’re each individual, so it’s about trying different ways to manage your anxiety until you find the ones that work best for you.
 
If you’d like to make an appointment to talk about your anxiety, get in touch.

This year’s Mental Health Awareness Week is focusing on body image. Running from 13th-19th May, the aim is to increase awareness of how we think and feel about our bodies, and how that affects our mental health.
 
What is body image?
 
Body image refers to how we see our bodies, and what we feel about them. This can be our body size or shape, skin colour, appearance, facial features or physical disabilities. It’s also how we believe others see us.
 
What influences body image?
 
Often, we hold an image in our head of what our bodies “should” look like. This image may come from seeing pictures of people on social media, or in films, music videos, on television or in magazines.
 
Our ideal image of ourselves may also be the result of comments from family and friends, or from childhood or adult bullying.
 
Cultural expectations, as well as those related to our age and gender, also play a part in creating our view of what our bodies “should” look like.
 
How does body image affect mental health?
 
When we look at ourselves in the mirror and we don’t see our ideal body, it can create feelings of disappointment, shame and distress.
 
The latest body image report by the Mental Health Foundation has found over a third of all adults have felt anxious or depressed because of concerns about their body image, while one in five have experienced shame.
 
Having a negative body image can result in low self-esteem, anxiety and depression. It can also lead to unhealthy exercise and eating patterns. For some, this can develop into eating disorders such as anorexia and bulimia, or into body dismorphic disorder.
 
How to improve your body image

It’s important to your mental wellbeing to have a positive body image. To help improve how you think and feel about your appearance, try these tips:

• Write down things you like about yourself – these don’t necessarily need to be related to your appearance. Look at the list often to focus on positives, rather than negatives

 

• Don’t dismiss compliments – people give compliments because they notice brilliant things about you. Rather than dismissing them, thank the person, accept the compliment, and write it down to remind yourself of it at difficult times

 

• Stop comparing yourself to others – notice when comparing yourself to others is making you feel worse about your body image. To stop doing this, you may need to…

 

• Change the way you use social media – surrounding yourself with filtered and airbrushed images is unhelpful. Consider unfollowing accounts that show “perfect” bodies, or take a break from using it

 

• Think what you would say to a friend – what would you say to a friend who felt negatively about how they look? Use the same kind, compassionate voice to talk to yourself

 

• Surround yourself with people who make you feel good – if you know people who make you feel worse about your appearance, try to spend less time with them. Focus on relationships that are positive and supportive – people who can be your cheerleaders

 

• Do regular self-care – listen to what your body needs, and look after it. This might be taking a nap, relaxing or having a bath. Doing this shows you love and care for your body

 

• Celebrate your body – think of all the amazing things it’s allowed you to do: your successes, achievements and the things you’ve experienced. Your body is amazing!

 
Seeking help and support
 
If you’re struggling with your body image and it’s affecting your mental health, talk to someone you’re close to, your GP or to a therapist. Talking through your thoughts and feelings can be really helpful, because body image isn’t about how you look, but how you feel about how you look.
 
Visiting your GP is particularly important if you’re concerned you may have an eating disorder or body dismorphic disorder. Your GP will be able to discuss treatment options, which may include medication, therapy or a referral to a specialist service. There may also be local support groups or services your GP can recommend.
 
If you’re experiencing difficulty with your body image and it’s affecting your mental health, get in touch to make an appointment and take a step towards making positive change.

In the previous article of this Exploring Mental Health series, we explored mindfulness – something that would be helpful for managing this month’s topic: panic attacks. Find out what panic attacks are, when they happen and what they feel like. And discover how to manage a panic attack if you experience one.
 
What is a panic attack?

Panic attacks are intense moments of anxiety that can occur suddenly, usually with accompanying physical symptoms.

During a panic attack, your body is in ‘fight or flight’ mode. ‘Fight or flight’ is your body’s automatic response to danger, a response that evolved in humans as a way of protecting us from harm. When we feel under threat, our bodies react by releasing hormones that make us more alert and prepare us to either fight or run. This means we experience physical changes in our body that are designed to increase energy levels and strength so we can survive the threat.

With panic attacks, your body’s ‘fight or flight’ response can be triggered at unpredictable moments, when there is no apparent danger. (Unlike our prehistoric ancestors, our ‘threats’ tend to be stressors such as deadlines and traffic queues, rather than life-threatening situations.) This exaggerated response can be frightening to experience.
 
When do panic attacks happen?
 
Panic attacks can happen without warning. This can be at times when you’re anxious or stressed, or even when you feel relaxed - sometimes even when you’re asleep.
 
Events that trigger feelings of stress or fear may lead to a panic attack, as can experiences such as bereavement, trauma, ill health, redundancy or divorce. Life transitions such as getting married, having a baby or moving house can also be triggers. Panic attacks may also be a side effect of some prescribed medications or drugs, as well as the use of alcohol, nicotine or caffeine.
 
You may experience only a couple of panic attacks in your lifetime, or you may experience them more regularly, Recurrent panic attacks can occur as a result of anxiety or depression, or be triggered by a particular place or situation, particularly if it has triggered a panic attack before. Regular, recurrent panic attacks may be a sign of panic disorder, which you can read more about in ‘When to seek help’ below.
 
What do panic attacks feel like?
 
Panic attacks typically last between 5-30 minutes, with symptoms at their worst within the first 10 minutes. During this time, you may experience any number of the following symptoms, at varying levels of intensity:

• Struggling to breathe or hyperventilation
• Irregular, pounding or racing heartbeat
• Chest pain or discomfort
• Trembling or shaking
• Sweating
• Feeling of choking or suffocation
• Nausea or upset stomach
• Feeling dizzy, light-headed or faint
• Numbness or tingling sensations
• Feeling very hot or very cold
• Feeling disconnected from your mind, body or surroundings
  
  

During a panic attack, you may also fear you’re losing control, going to faint, having a heart attack or dying.

How to manage a panic attack
 
During a panic attack it’s important to remember:

• There’s nothing seriously physically wrong
• You’re not in any danger
• You won’t come to harm
• You’re not going to die
• It will pass

 
Focus on slowing down your breathing, and taking deep, regular breaths. This will slow down your heart rate and begin to reduce the physical symptoms you’re experiencing.
 
Concentrate on counting to five as you breathe in through your nose, and again as you breathe out through your mouth – this will provide you with something to focus on.
 
It can also be helpful to focus your thoughts on a particular image as you do this, such as a flower or a favourite place.
 
Other ways to help manage a panic attack are:

• Splash water on your face (to reduce your heart rate)[i]
• Massage your scalp (to send blood circulation to the brain)
• Shake out your muscles (to help reduce tension and fear)
• Repeat a phrase, such as ‘I’m safe and this will pass’ (to remind yourself you’re in control)

 
As difficult as it might seem, try not to fight the panic feelings as this can leave you overwhelmed, and increase the intensity and length of the panic attack. Accepting what’s happening, and sitting with it until it passes, can help to reduce the scariness of the attack and minimise the length of time it lasts. Repeatedly doing this can also reduce the number of panic attacks you experience.
 
How to reduce the chances of having a panic attack
 
You can help reduce or prevent panic attacks by:

• Learning about panic and anxiety so you understand what’s happening when you experience it

• Avoiding or reducing smoking, alcohol and caffeine

• Exercising regularly to help manage stress and reduce anxiety levels

• Practicing breathing exercises so you can calm yourself more quickly when you experience anxiety and panic

• Practicing relaxation techniques, such as mindfulness, to reduce tension

• Talking to family and friends to increase support and help others understand how you’re feeling

 
When to seek help
 
If you have panic attacks that occur repeatedly, or you’re constantly anxious about having a panic attack, you may have panic disorder. Panic disorder can affect your behaviour, mood and mental wellbeing, but it is treatable. If you’re concerned you may be experiencing it, speak to your GP. They’ll be able to give a diagnosis and suggest treatment options, which may be one or a combination of medication and therapy.
 
If you’re experiencing anxiety and having panic attacks, therapy can help. Take a look at how to get in touch to make an appointment.


[i] Everyday Health, 10 Ways To Stop A Panic Attack, Available: https://www.everydayhealth.com/columns/therese-borchard-sanity-break/ways-stop-panic-attack/