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First Steps, Version 3, February 2013 - 1 - Building self-esteem and confidence

A First Steps guide to

Building self-esteemand confidence



First Steps - 2 - Building self-esteem and confidence

“ I’m not good enough”

“ I’m unlovable”

“ I’m always getting things wrong, I must be really stupid”

“ I’m not good enough”

“ I’m so ugly”

…are just a few of the comments from people who are experiencing low self-esteem.

Using self-help tools

The strategies/tools suggested in this booklet are evidence based methods of managingemotions and reducing their negative effects on our everyday life. We are all individuals andrespond to situations in different ways therefore not every tool will work with everyone. Forexample some people find meditation and reading really relaxing, whilst for someone elsethis could be a cause of stress and their preferred relaxation method may be to go to thegym. There are no set rules for managing emotions. A helpful way of thinking about thiscould be to think “is my current method working for me?” If the answer is yes, then great, butif not, these strategies may be an alternative way that is more productive for you.

As with any new skill, self-help can take time and practice. In the same way that reading acookery book will not instantly make you a great cook, simply reading this material will notmake you instantly happy and healthy. But with time, practice and exploration it is possiblefor everybody to experience emotional well-being. Self-help alone may not be adequate foreverybody. If you feel that you need more support, it is important to discuss this with yourGP. In addition there are a number of helpful resources at the back of this booklet or youcould call our phone line/email us for more information/advice.




What is in this booklet?

Page

Introduction 4

Different aspects of low self-esteem 6

How low self-esteem develops 7

How low self-esteem is maintained 10

Cycle of low self-esteem 11

Building self-confidence 12

How can you break the cycle and boost your self-esteem? 13

Changing thinking patterns 14

Keeping a thought record 15

Positive notebook 18

Changing your activity to bui ld your self-esteem and confidence 20

Activi ty diary 20

Goal setting 23

Handling uncomfortable situations 24

Expressing your feelings and learning to say no 26

Taking care of yourself (relaxation, diet and exercise, sleep) 29

Useful contacts 32




Introduction

We all at some point in our lives feel uncertain about ourselves, lack self-confidence, havedoubts about our abilities or think negatively about ourselves. However, if you find that this ishow you are feeling a lot of the time and it is having an effect on your day to day life, thenthis booklet may be helpful to you.

What is self-esteem?

Self-esteem refers to the way we think and feel and value ourselves as a person.

What is self-confidence?

Self-confidence refers to how able we feel to get a task done.

What is low self-esteem?

Most people describe themselves in a negative way at some time in their lives, however if

you think about yourself in this way on a regular basis, then you may have low self-esteem.

The impact of low self-esteem

Low self-esteem can impact on the way that a person feels about them selves and the waythat they function in everyday life.

Personal impacts

The person might:

say a lot of negative things about themselves

criticise themselves, their actions and abilities

put themselves down, doubt themselves, or blame themselves when things go wrong

not recognise their positive qualities

find it hard to accept compliments

focus on what mistakes they have made, or things they didn’t do

expect that things will not turn out well for them

feel depressed, anxious, guilty, ashamed or frustrated

Low self-esteem is having a generally negative overall opin ion of yourself, judgingand evaluating yourself negatively. People who have low self-esteem generally havea rigid, negative belief about themselves. These beliefs are often taken as truths or

facts about themselves, resulting in a negative impact on a person and their life




Impacts on everyday life

Reduced performance at work

Not reaching full potential because of the negative value they place on themselves

Avoiding challenges for a fear of failure

Believing that any achievements were down to luck, rather than a result of their ownabilities or positive qualities

Altered relationships with friends, family or colleagues. For example: becoming overlyupset or distressed by any criticism or disapproval, trying to please others, beingextremely shy or self-conscious or even avoiding social contact

Change in appearance. Some people may lack the motivation for personal care whilstothers may try to hide their perceived inadequacies by paying significant attention tothe way they look, and avoid contact with others unless they look perfect

Altered food and or alcohol intake. Some people may diet whilst others may comforteat or reach for convenience foods. Some people may use alcohol or drugs toincrease their confidence, which in turn has an adverse affect on their self-esteem




Different aspects of low self-esteem

Having negative beliefs and opinions about yourself can affect your thinking patterns andyour behaviour, which can impact the way you feel both emotionally and physically.

Low esteem may affect you as a person in certain different areas. Everybody is different andwill react differently to low self-esteem. Seem people might notice more physical symptoms,

whilst some might notice more changes in their thinking. It is common for people to notice avicious cycle of symptoms (see page 11), but no two people will have the same experience.

Thoughts and beliefs Moods

Thinking you’re not good enough

Thinking other people will see younegatively

Doubt your ability to do things

Blame yourself for things thathappen, even though it might notbe your fault

Be critical of yourself and say thatyou are “too stupid, useless,unattractive, boring, etc”

Focus on criticism and mistakes,ignore success and strengths

Anxiety

Frustration and anger

Sadness

Guilt

Shame

Physical reactions Behaviours

Tension Reduced sex drive

Tiredness

Change in appetite

Sleep problems

Difficulty saying no andcommunicating your needs

Not meeting your own needs andtrying to please others

Holding back from doing things andavoiding challenges

Finding it difficult to make decisions

Putting pressure on yourself to dothings perfectly and working too hard

Shyness and avoiding meeting newpeople

Being oversensitive




How low self-esteem develops

The opinions and beliefs we have about ourselves are influenced and shaped by theexperiences that we have had during our lives. This often (but not always) dates back to ourearly childhood/adolescence, but we continue to be shaped by our day-to-day experiencesthroughout our lives.

Learning about life and ourselves is gained through different ways. We learn by observingwhat other people do or say and the way that we are treated by others, for example theinteraction with our families, the society that we live in, the school we went to and the peersthat we were/are influenced by. Other factors can also influence our self-esteem includingstereotypes and the media.

Meeting high standards or being expected to be perfect. Not meeting someone

else’s expectations or standards. Constantly being criticised can also have a negativeeffect; this could be parents, family, peers or work colleagues who criticise and focuson your weaknesses and mistakes rather than your positive qualities

Being bullied or made fun of . This can result in believing thoughts such as “I’mugly” or “I’m stupid”

Rejection. Feeling rejected by parents, friends, work colleagues etc. can have asignificant impact on the way we feel about ourselves

Difficulties in fitting in or feeling dif ferent to those around you. Feeling asthough you don’t fit in, especially during late childhood and adolescence can influencehow we learn to view ourselves. This is a time when physical appearance may be very

important to a young person. Thoughts such as “I’m unlikeable” or “I’m unattractive”can become real beliefs about ourselves that can become quite rigid as we get older

A lack of positives. This could be growing up or living in an environment with a lackof praise, encouragement, warmth and affection. For example if a child’s basic needssuch as food and clothing were met, but their parents were emotionally distant or notphysically affectionate, these experiences can negatively influence how a personviews themselves

Traumatic life events. Sometimes when families are experiencing stressful ordistressing life events they may become angry, depressed and respond negativelytowards each other. Perhaps a relationship breakup, health problems or bereavement

have affected you. These factors can all affect self-esteem Punishment, neglect, or abuse. How we are treated in life affects the way we see

ourselves. For example, if a child is unfairly punished, neglected or abused they maycome to believe very negative things about themselves. The same may be true for anadult in an abusive relationship

Stress or financial worries. These can also cause low self-esteem, for example byleading to thoughts that you can’t cope or that you are a failure

These factors can lead people to hold certain beliefs about themselves which are calledcorebeliefs.

The fol lowing are some examples of past and present experienceswhich may lead to the development of low self-esteem




Core beliefs

These beliefs are strongly held beliefs about ourselves that influence what we think and howwe feel. They usually influence us subconsciously and we rarely ever challenge if thesebeliefs are true.

Common negative core beliefs are:

I am not worthy

I am unlovable

I am not good enough

I am not important I never get things right

Our core beliefs also relate to how we believe the world ‘should’ be and include our ethicsand values. Examples of these could be:

People should be courteous and polite

I should always get things right

Life should be fair

I must not let people down

We all hold these beliefs and they are central to our being. Quite often just awareness thatthese core beliefs may be shaping your thoughts and feelings can be helpful in challengingyour view of the situation or yourself.

Our thoughts about an event or situation are often closely linked to our core beliefs and willaffect a person’s self-esteem and self-confidence in managing the event or situation.

We continue to experience low self-esteem even though our circumstances have changed from the past because of the

negative core beliefs we hold

I am

not

worthy




Case study

Emma is taking the children to school. She turns the corner and there is a long traffic jam.Emma begins to feel stressed.

Core beliefs“I am not goodenough”“I never get thingsright”“I must not letpeople down”

Importance of situation/eventEmma feels that she must notlet the children down so mustget them to school on time

Negative thoughts“The children will be late, it is allmy fault” (personalising)

“The teachers will realise that Iam a bad mum” (jumping toconclusions)“I should be able to get them toschool on time” (shouldstatements)

How Emma:Feels emotionallyFeels physically

Thinks aboutfuture situationsBehaves

SituationEmma is taking the children to school

Event There is a traffic jam




How low self-esteem is maintained

So far we have looked at how negative beliefs that we hold about ourselves are influencedby our experiences of life and the way that we have interpreted events or behaviours.

Rules and assumptions (the shoulds and musts)What happens in our adult life is that we keep these negative beliefs going. This can be bythe unhelpful rules and assumptions we place on ourselves, for example, rules could be “Ishould always be the best at everything” or “I must never get close to people”, andassumptions could be “people won’t like me if I express my true feelings” or “I must doeverything 100% perfectly otherwise I will fail”. Sometimes the rules that we place onourselves can be unrealistic, extreme and inflexible.

Self-fulfil ling prophecy

We gather information thatconfirms our negative self beliefs

because we pay much moreattention to negative events that

confirm these beliefs

The impact of negative thoughts

The thoughts we have tend to affect the way we behave,and the way we feel physically and emotionally

Unhelpful rules

The rules we place on ourselves actually stop us from testing out whetherour beliefs are true as they restrict our behaviour. For example, a belief that

“I’m unlovable” means that the rule may be “I must never get close topeople”, thus the person never actually gets the opportunity to test out

whether people find them lovable or likeable. This keeps the belief going

Everyday situations

Our responses to certain

day-to-day situations canalso serve to keep our

negative beliefs going, asseen in the cycle of low self-

esteem on the next page




Cycle of low self-esteem

Events from our past may be the starting point for the development of negative self-beliefsand low self-esteem, but certain situations activate these beliefs and trigger a vicious cycle of symptoms, which strengthen our negative self-beliefs.

Our feelings, thoughts, and actions are closely related, and a negative change in one areacan have a negative effect on another.

Cycle of low self-esteem

Thoughts

“I’m a useless and pathetic friend”“I don’t deserve to have friends”

“I shouldn’t let people down”“I’m always being selfish”

“They are better off without a friend like me”

Behaviours

Apologise profusely and putyourself down to friendOvercompensate when tryingto make it up to friend (re-

schedule dinner at a time thatis not convenient for you)Withdrawing and avoiding thefriend for a while

Physical reactions

TenseSweatingHeadacheChange in appetite

Moods

DepressedSadGuilty

Confirms negative belief “I was right – I am worthless”

Difficult situation Cancelled dinner with a friend because of

work commitments

Negative core belief “I am worthless”

Past experiencesParents were overly harsh and critical when I didn’t get exceptionally good school grades




So how does the belief “I am worthless” get confirmed and maintained in the cycle of lowself-esteem?

Firstly, the negative thoughts that you are having about yourself – eg. the negative self-talkare confirming your belief “I’m worthless”.

Secondly, the feeling of depression / low mood can increase negative thinking which mayconfirm your negative belief that you are “worthless”.

Thirdly, all the unhelpful behaviours that are triggered by the negative thoughts mean you areacting in a way that is consistent with the belief that you are “worthless”, e.g. withdrawing,acting in a passive or apologetic way. By acting as though you are “worthless”, you will carryon thinking you are worthless, and maintain feelings of sadness, depression or guilt.

Building self-confidence

Self-confidence comes from our abilities to master skills and achieve goals that matter to us.

It also comes from our sense of self-esteem, that we are able to cope with what is going onin our lives, and that we have a right to be happy. People may lack confidence in some or allaspects of their lives.

How confident you feel about yourself can be seen in many different ways: through yourbehaviour, your body language, and how you speak for example. Below is a table whichcompares common confident behaviours with behaviours that are related with low self-confidence. Do you recognise any of the thoughts or actions in yourself or other peoplearound you?

Self-confident Low self-confidence

Asserting yourself, even if otherscriticise or mock you for it

Changing your behaviour basedon what other people think

Having the confidence to take risksand put in the extra effort to achievegood results

Not venturing out of your comfortzone and avoiding taking risks

Being comfortable when others pay

you compliments and acceptingthem as truths

Dismissing compliments, and not

believing in them

Acknowledging and being proud of your successes and achievements

Waiting for others to praise youon your achievements

Low self-confidence can be destructive and often shows itself as negativity, whereas self-confident people are normally positive, and believe in themselves and their abilities.




How can you break the cycle and boost your self-esteem and self-confidence?

The good news is that whilst we cannot change past experiences, we can start to change thethings we do in the present which are keeping the unhelpful beliefs going. We can start tochallenge the negative views that we have developed about ourselves, and break the cycleof low self-esteem and self-confidence.

The first step to breaking the cycle is to become more aware of the ways that low self-esteem/low self-confidence affects you:

Think about this and make some notes on your self-esteem and self-confidence and:

the way you feel physically

the emotions you experience

the way you think

the things that you do

The second step is to t ry to break the cycle which can be done in a number of ways:

Change negative thinking patterns Challenging unhelpful thoughts and the unhelpful beliefs you hold about yourself

Uncover your strengths and positives

Take action

Ensure you have a balance of activities that need to be done and that you enjoy doing

Set yourself achievable goals

Try to tackle things that you have been avoiding

Take care of yourself

Notes:




Changing thinking patterns

When things happen in the world around us, we usually have a number of thoughts about thesituation and how it relates to us.

We are not usually aware of these thoughts, as they often happen really quickly andunconsciously, and are often coloured by our past experiences. However, if they are quite

negative and critical, it can affect how we feel about ourselves and our ability to deal with thesituation.

If you have negative beliefs about yourself, you can also start to ignore any positiveinformation like strengths, achievements and compliments and may only focus on thingssuch as mistakes, criticism and weaknesses. This acts to strengthen the negative beliefs thatyou may hold about yourself.

Common thinking errors

Jumping to conclusions This is where we make a negative interpretation of an event, even though we do not know allthe facts.

“My manager has asked to see me in her office. I think I am going to be in trouble”.

Catastrophizing An extreme form of jumping to a negative conclusion, where the importance of an event isexaggerated to become a catastrophe.

“I was late for work again today. My boss will be angry and as I am only bank staff,I may be laid off. I won’t be able to pay my bills, so my house may

be repossessed and my children and I will be homeless”.

Al l or nothing Thinking in black and white terms and not allowing for any ‘grey’ areas.

“If I don’t get this right the first time, then there is no point in doing it at all”.

Personalising/labelling Seeing ourselves as the cause of some negative external event or taking the view that weare to blame

“Katy ignored me when I said hello today. Maybe she doesn’tlike me any more as I didn’t make her a coffee”.

Discounting positivesFocusing on negatives and not giving praise for the positive things we do.

“Ok, so I got my report approved today, so what? That’s only what’s expected of me”.

“ Should” statements Trying to motivate yourself with ‘should’, ‘must’ and ‘ought’ statements places unnecessarypressure and expectations on you. These pressures are unhelpful and can lead to feelings of failure.

“I should be able to cope with this; I used to be able to”.




Challenging our thoughts

In order to start changing the way we think about ourselves and improve our self-esteemthere are a couple of strategies that you can use:

Challenging unhelpful thoughts - Identify and question the critical thoughts youhave about yourself

Positive notebook - Helps you to look out for and identify your positive qualities

Both of these strategies aim to increase self-esteem by helping you to recognise and believea more positive view of yourself - replacing the critical overly negative view you mightcurrently hold.

Keeping a thought record

1. Situation: What were you doing? When was it? Where were you? Who were you with?

2. Unhelpful thoughts: What was going through your mind just before you started to feel thisway? What images or memories do you have of the situation? In which unhelpfulthought style did you engage (ie. all or nothing thinking, catastrophizing, etc.)

3. Helpful thoughts: What might be an alternative more helpful thought?

When trying to come up with a helpful thought, here are some tips to help you…

What is the evidence to support the unhelpful thought? What tells you that thisthought is correct?

What is the evidence that does not support the unhelpful thought? This is thehard part because it is often overlooked, but ask yourself these questions: Howwould someone else view the situation? How would I have viewed the situation inthe past? What might I say to a friend who was in a similar situation?

What is the effect of thinking the way I do? Does it help me or make me feelworse?

Now, is there an alternative, more helpful thought that could also be true to thatsituation……



First Steps - 16 -

What was I thinking just beforeI felt li ke this?

Proof that the thought is true Other possib ilities, or What I would say to a friend




Balancing

“ Balancing” is a useful technique to try. When you have a negative, critical thought, balanceit out by making a more positive statement about yourself. For example:

The thought: “I’m unattractive”, could be balanced with: “my husband and children love meand always tell me that I’m beautiful”.

Obviously this is much easier said than done, especially when we are feeling negative, and itcan be difficult at first, but with practice it does get easier.

The double column technique

Another technique that may help is to write down your negative automatic thoughts in onecolumn and, opposite each one write down a more balanced positive thought.

Negative thoughts Balancing thoughts

I’m really not fitting in with others at workbecause I’m unlovable and have nothinginteresting to say

I have two really lovely best friends whoalways ask me to come out with them andphone me up once a week at least so I can’tbe that bad

I have

goodfriends

I’m

unlovable




Positive notebook(based on non-direct quotes in ‘Overcoming Low Self-esteem’ by Melanie Fennell)

Everybody has strengths and weaknesses, but when your self-esteem is low, you can start tofocus on the negatives and discount or ignore some of the positives about yourself.

This keeps the cycle of low self-esteem going, as you pay more attention to the negativeinformation which confirms your negative beliefs about yourself.

A way to start to try and get a more balanced picture of yourself, which will help improve yourself-esteem, is to keep a positive notebook.

Identify and list your posi tive qualities

When you have low self-esteem, it can often be easier to list all of your negative qualities,and difficult to see the strengths you have, but here are some questions you can ask yourself to identify your positive qualities:

Is there anything that you like about yourself?

What are the positive achievements of your life so far, however modest?

What obstacles have you overcome in your life?

What would someone who cares about you say your qualities and strengthsare? Might there be a grain of truth in there?

What strengths and qualities do you appreciate in others? Do you have any of

these yourself?

What negative qualities do you not have?

It is important to list your answers however modest they seem to you. It is easy to dismissthings as insignificant when your self-esteem is low, but they are all important evidence tobuild a picture of all your strengths and positive qualities.

.

Once you have come up with a list of positive qualities, write them in your notebook,leaving room to add new ones in the future.

It may be useful to ask somebody who you trust to help you answer some of these questions




Daily recordings of positive qualities

Once you have created a list of your strengths, spend time every day trying to write downthree positive qualities that you have shown on that day. If three is too difficult, just writingdown one is a good start.

It is important not only to record the positive quality, but also some evidence of the quality.

What did you do that tells you that you have this quality?

This will help you remember your strengths when you look back over your notebook. This isnot about doing things, to make you feel good. It is about reflecting on what you are alreadydoing that proves your qualities. It can be helpful to consider how you felt after each piece of evidence to ensure that you are only using positive examples. E.G Always putting someoneelse’s needs before your own may prove that you are considerate, but could also strengthenyour core beliefs, that other people are more important. .

Here is an example of what a daily record of positive thoughts may look like.

Day Evidence of positive quality Positive quality

Thursday Let another driver into the queue of traffic

Colleagues asked me to join them atlunch

Cooked dinner for partner despitefeeling tired

Considerate

Likeable

Caring

Friday Sorted out problem for colleague atwork

Spoke in meeting even though feltnervous

Sent friend a ‘get well soon’ card

Helpful, skilled

Determined

Thoughtful




Changing your activity to build your self-esteem and confidence

We gain confidence and improve self-esteem by doing things. Achieving small steps can helpto rebuild confidence that you may have lost, and can motivate you to try other things. Also,being active can give you a sense that you are taking control of your life.

Sometimes when we are feeling bad about ourselves we may:

Stop doing things we used to enjoy

Avoid or put off completing tasks

Withdraw from friends and family

Find it difficult to make decisions

Work too hard or try to be perfect

These behaviours all keep the vicious cycle going and strengthen our negative self-beliefs.

A good strategy for identifying how your current activities could be impacting on your self-esteem is by keeping an activity dairy. You can then see what changes you could make toimprove your well-being, make life more satisfying, and take credit for your achievements.

Common backward thinking

• I will do what I enjoy when I feel better’

• ‘I will feel better when I do what I enjoy’

Activ ity diary

Step 1 - What are you currently doing?

The first step is to look at how you currently spend your time and to consider how satisfyingyou find your daily activities and routine. You can use the diary sheet on the next page.

Try to record daily activities, along with ratings of how satisfying you found each activity(sense of pleasure or sense of achievement).

It is important that there is a good balance between duty activities and those activities thatgive you a sense of pleasure and achievement.



First Steps - 21 -

Activi ty diary

Monday Tuesday Wednesday Thursday Friday

Morning

Af ternoon

Evening

What was thebest part of theday?




Step 2 – What would you l ike to change?

Are you gett ing a balance between enjoyable and relaxing activi ties, andactivi ties that need to be done? Can you improve your balance?

Ask yoursel f: if you were helping somebody with their act iv ity diary, whatchanges would you recommend?

What activit ies give you a sense of achievement? When we feel bad aboutourselves it can be difficult to feel that we are actually achieving anything at all,but this strategy can help you to see you might be achieving more than you giveyourself credit for

Did negative thoughts affect your activity? Try to write them down and question them to see if you can come up with a morehelpful view

Are there things that you would like to do or need to do, but feel they areunmanageable?

Try breaking the task down into smaller more manageable steps, and settingyourself goals to achieve them. Each time you achieve a step it will increase yourconfidence, and motivate you to try the next one




Goal setting

Most people find that working towards realistic goals is motivating and satisfying, but it isimportant to start off by setting the right goals. This really will have a positive impact on thesuccess of building confidence and self-esteem.

Remember, change is not always easy, and there may be slips or lapses along the way. This is normal, and so don’t be put off or be hard on yourself if you find that you don’t alwaysstick to the plan!

S Specific By being clear about your target goal you will be able to take pride inachieving it

M Measurable J ust wanting to “build up my social life” is not measurable; taking part in adance class twice a week is.

A Achievable Recognise your limits, if you set goals too high you are more likely to quitand feel that you failed. Challenging yourself is great but don’t expect theimpossible!

R Relevant The goal has to make sense to you and be something you feel isworthwhile and that applies to your views and lifestyle

T Timely Think when the best time is for you to fit in your goals and try not to tackletoo many goals at once

Goal setting is an on-going process

E Evaluate Regularly look again at what has gone well or less well and why thismight be the case

R Redo Set new goals or adapt the ones you have. Give yourself a reward forwhat you achieve, even if you did not complete the goal, but gave it agood shot!




Handling uncomfor table situations

Sometimes when people feel bad about themselves, they might think that things will turn outbadly or might doubt their ability to deal with situations. This might lead to avoiding certainsituations, because they predict that things will not go well.

If you avoid things, it can make you feel better in the short-term as you have not had to

confront your fears or anxieties, but in the long-term it keeps those negative self-beliefsgoing, as you never have the opportunity to find evidence to disprove them.

If you find that you have been avoiding certain activities or situations that you need, or wouldlike, to do, then try the following strategy:

Draw up a list of things that you have been avoiding

Order them with the most manageable task first, working up to the hardestone

Picking the most manageable one, break it down into smaller more specificsteps

You can then start to achieve these smaller steps one by one

Keep practicing each step until you feel comfortable enough to start the nextone

By tackling things step by step, you can start to build confidence in your ownabilities. Don’t forget to take credit for achieving each step, and rewardyourself appropriately

Prediction of what mighthappen?

What actuallyhappened?

What I have concluded

If I speak up in a meetingat work then everyone willstare at me. I’ll getflustered and everyonewill laugh and think I’mstupid

I felt quite uncomfortableand nervous but everyonelistened to what I said andagreed with my point andthe manager thanked mefor raising it

My colleagues don’t thinkI’m stupid and I can makeuseful contributions tomeetings even though Istill feel nervous




Here is an example of somebody who is experiencing low self-esteem, and the different partsof her life it is affecting:

Sarah is 27-years-old. Her low self-esteem issues started when she went tosecondary school, where she found it quite difficult to settle in and make newfriends. She always felt shy and like the “odd one out”. Since then, she hasalways felt that she is somehow not acceptable to other people. Sarah has asmall circle of friends whom she has known since university and has juststarted a relationship with someone whom she has been friends with forsome time.

Recently, Sarah has found that she has been feeling more tense anduncomfortable in social situations, especially where there are a lot of people,or people whom she does not know very well. Her new boyfriend has a lot of friends, and he is often invited to go out with others. He would like Sarah tocome along with him, but she feels very anxious, which also makes her sadand frustrated, as she would really like to meet new people. Sarah thinks that

others will think she is weird and boring.

When she goes out, she often feels very self-conscious and thinks thatnobody wants to speak to her. Sarah is also very quiet and avoids speakingup. Because of the way she feels, Sarah starts to avoid social events. Thismeans that she stops going out as often and does not socialise with otherpeople. As she does not interact with others, she feels rejected, whichconfirms her view that she is unacceptable.

She could tackle this by breaking the task down into more manageable chunks,

starting with the easiest first:

1. Go out with boyfriend to an event where she knows everyone else

2. Go to an event where she only knows her boyfriend and a few other people

3. Go out to an event where the only person she knows is her boyfriend

For each step Sarah should:

Before - predict what she thinks will happen After - reflect on what actually happened

Each step enables Sarah to be in what she determines as an uncomfortable situationand to test if her predictions are true. (see below also)

It is normal to feel anxious in many of these situations and the goal is not necessarily tofeel completely comfortable. However it is enabling her to look at ‘feeling comfortablewith feeling uncomfortable’.

You may find that you are having negative thoughts, which are stopping you fromdoing these steps. You may need to challenge these to help you move forward




Tackling things that you have been avoiding will help to test out your negative view of yourself and gain a more balanced view by building your confidence.

Did you learn anything new about yourself?

Did you cope better than you expected?

Was the outcome better than you expected?

If they didn’t go so well, is there anything you can do differently next time?

Expressing your feelings and learning to say no

Expressing our feelings openly promotes a sense of well-being and freedom from tension. Ithelps us to recover from hurtful experiences, and also helps other people to understand whatis going on inside us. There are times when displays of emotion are not helpful, but hiding orholding back our feelings, can cause tensions that affect our physical and mental health.

Learning to say no in an assertive and tactful way is a difficult, but important, skill to learn.Remind yourself now and then that:

You have the right to say no without feeling guilty

Others have the right to say no to you

Saying yes when you really mean no may reduce your feelings of self-worth

It's better to say no at the time than to let somebody down later

Saying yes to extra work or obligations might cause you stress Taking on too much might lower your standard of work or come at a cost to those

people who are important to you

It might not be such a big deal to the other person to get a no response

Being respected and respecting yourself is more important than being liked




Setting l imits and saying ‘no’

When someone asks for a loan, comes round uninvited, continually expects you towork late, parks in your space…

How comfortable are you with assertively refusing or approaching them about it?

What stops you from saying how you feel?

There are a number of reasons why people have difficulty saying no – they often havethoughts such as:

Saying no is rude, aggressive, unkind, uncaring or selfish

People will be hurt if I say no or it will upset them

If I say no, people won’t like me

Other people are more important

Saying no is petty or small-minded I should be able to do that

The key to refusing requests and saying no is to be able to accept the following beliefs:

Other people have the right to ask and I have the right to decline

When you say no, you are refusing the request, not rejecting the person

When we say yes to one thing, we are actually saying no to something else

When people have difficulty saying no, they usually overestimate the difficulty that theother person will have accepting the refusal. By expressing ourselves openly andhonestly, it liberates the other person to express their feelings too.

How do you feel when someone says ‘no’ to you? Do you find that you always feel as if they are rejecting you or that they must not like or respect you?

Think about what you would say to a friend if they came to you with the same situationthat you are in.




How to say no…

Practicing these techniques may be helpful:

Direct no: Say no without apologising

o “No, thank you”

o This way is quite forceful and can be effective with salespeople or peoplewho are being quite pushy

Reflecting no: Reflecting back the content and feeling of the request, but addingyour assertive refusal at the end

o “I know you were looking forward to a walk this afternoon, but I can’t come”

Reasoned no: Very briefly, give your genuine reason for the refusal

o “I can’t do that for you because I’ve already arranged to do something else”

Rain check no: Say no to the present request, but leave room for negotiation

o “I can’t do that for you now, because I wanted to do something else, but Iwill do it for you next time if you can give me a bit of notice”

Enquiring no: Not a direct no, but a request for more information or an alternative

o “Do you need that to be done for you now or can it be done later?”

Broken record no: Repeat a simple statement of refusal over and over again if therequester is very persistent

o “I’d like to be able to help you out, I just don’t feel I can at the moment”…“As I said, I just don’t feel I can at the moment”… “I appreciate what you’resaying; I just can’t help at the moment”




Taking care of yourself

Learning to relax

How relaxation works

Feeling relaxed and feeling anxious are incompatible. You can't feel them

both at the same time

When you are stressed, the muscles in your body tense up, which causesuncomfortable feelings, such as headache, backache, tight chest, etc.

Relaxing slows down the systems in your body that speed up when you getanxious

If you learn a method of relaxation and use this regularly you will be able tocontrol anxiety more effectively

There are many forms of relaxation including yoga, meditation, imagery, andmany others

Relaxation is a skil l

It may not come naturally and has to be learnt through regular practice

Make time for yourself and develop a routine which you can stick to. Aim toset aside 15 to 20 minutes a day with no interruptions or distractions




Diet and exercise

The food you eat can play an important part in the way you feel, physically and mentally. Toomuch sugar, coffee or salt can cause tension and irritability. Therefore, it can be useful tolook at your eating and activity patterns. A balanced healthy diet can make you feel betterabout yourself as well as being beneficial to your body and immune system. A balanced dietwill also help your body and mind to work more efficiently. For more information, please see

your GP or nutritionist.

Regular exercise is good for us in many ways: it increases our confidence and self-esteem; itstimulates "feel good" chemicals in our bodies; it provides an outlet for tension andfrustration; it relieves anxiety; helps us relax; helps us sleep better and helps to preventphysical illness, such as heart disease and osteoporosis. Choose a sport or exercise youenjoy. Please note that when first undertaking an exercise program you should consult with

your GP.

Sleep

Try and get a good night’s sleep every night. The amount of sleep that you need is differentfor everyone and can range from 5 hours upwards per night. The amount of sleep that weneed often reduces as we age. Research shows that those with a poor sleep pattern aremore at risk of poor mental health and poor sleep can worsen existing mental healthconditions.

How to get a good night ’s sleep

People may worry about not getting enough sleep, but worrying often only makes it worse. Itis easy to overestimate how much sleep you need, or not to realise it is normal to wakebriefly during the night. The occasional bad patch is harmless and usually rights itself. It'sgenerally only of concern if it’s been going on longer than a month.

The average amount of sleep is seven to eight hours a night, but we all need differentamounts, and less as we get older

We pass through cycles of light and deep sleep at night. Around every 90 minutes we

have a period of dream sleep (REM), which is vital for our well-being

Bread, rice, potatoes, pasta and otherstarchy foods

Milk and dairy foods

Foods and drinks high infat and/or sugar

Fruit & vegetables

Meat, fish, eggs, beans and othernon-dairy sources of protein




If we miss out on sleep on a regular basis (not caused by sleep difficulties eg. socialising,children etc) we may incur a ‘sleep debt’, making us tired and irritable, unable toconcentrate or to function properly. It usually stops once the debt is paid off. However

irregular sleep patterns or napping should be avoided if you are having difficulty sleepingat night

Long-term sleep problems may be both the cause or consequence of physical or mentalhealth problems

Things that may disrupt your sleep pattern

Snoring that interferes with breathing

Too much stress

Racing thoughts

Ill-health or physical pain

Emotional difficulties, including anxiety and depression

J et lag or shift work that disrupts our internal body clock

Traumatic events, such as a divorce, redundancy, or bereavement

Different environments e.g. going into hospital, a residential home or a hotel Medicines, such as water pills, steroids, beta-blockers, and some painkillers,

antidepressants, slimming tablets and cold remedies

Withdrawing from certain drugs, such as tranquillisers or antidepressants

Taking street drugs such as ecstasy, cocaine and amphetamines

Overusing alcohol, tobacco and caffeine

Tips to help you sleep

Establish a regular routine. Go to bed only when you're tired and get up at the same timeeach day. Avoid napping during the day

Check your sleeping arrangements. Think about comfort, temperature, light and noiselevels

Learn to de-stress before bed. Dismiss nagging thoughts by writing them down

Have a warm bath, practise a relaxation technique, or listen to a relaxation tape. (Butdon't read or watch television in bed)

Don’t eat late. Avoid rich, spicy or sugar-rich foods, red meat and cheese. Choosingwholemeal, low-fat, magnesium-rich foods (green salads, broccoli, nuts and seeds) mayencourage sleep, as may drinking hot milk and honey.

Get enough exercise. Fit people sleep better

Don't stay in bed. If you can't sleep, get up after 15 minutes and go through yourrelaxation routine again

Keep a sleep diary. This helps you identify potential causes for your sleeplessness

Try some reverse psychology: keep your eyes open and tell yourself to resist sleep

Interrupt unwanted thoughts: repeat a soothing word to yourself. Visualise a scene orlandscape that has pleasant memories for you

Try out complementary remedies. Yoga, meditation, homeopathy or herbal remedies,such as lavender or valerian, may be helpful for some people

Talk to your GP. Sleeping pills can present problems, but a brief course is sometimesappropriate

Night-time relaxation routine

Breathe deeply, counting slowly up to four as you breathe in, hold for another four secondsand then breathe out slowly. Consciously tense and relax your muscles, in turn, starting atyour toes and working up your body.



Useful contacts

First Steps

0808 801 0325 - Monday and Wednesday 10am to 4.30pm and Thursday 11am to 5.30pm.

The helpline will be open on a Tuesday following a Bank Holidaywww.firststeps-surrey.nhs.uk [email protected]

Living Life to the Full

A self-help website offering free modules on confidence building, as well as other topics, thatyou can work through on the internetwww.llttf.com

MINDinfoLINE

0845 766 0163 - Monday to Friday, 9.15am – 5.15pmwww.mind.org.uk [email protected]

Books

The Surrey County Council Library has a very helpful list of self-help books that can beaccessed from the following libraries:

Camberley, Dorking, Epsom, Farnham, Godalming, Guildford, Horley, Oxted, Redhill,Staines, Walton-on-Thames, Woking

You can find the list at www.surreycc.gov.uk if you search “Read Yourself Well”. Many of these libraries also have a self-checkout option, which means you can take out a book

without anyone knowing the book that you choose.

nhs - buidling self-esteem.pdf

Documents