respiratory conditions

First Steps, Version 1, May 2014

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Emotional health and respiratory conditions

A First Steps guide to


Here at Virgin Care we are keen that this information is shared as widely as possible to help support anyone who might benefit from it. However, can we remind you that it is subject to Copyright

Legislation so please do let us know if you plan to reuse or reproduce any of the content First Steps

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Using self-help tools The strategies/tools suggested in this booklet are evidence based methods of managing emotions and reducing the effects the way that we feel has on our everyday life. We are all individuals and respond to situations in different ways therefore not every tool will work with everyone. For example some people find meditation and reading really relaxing, whilst for someone else this could be a cause of stress and their preferred relaxation method is to go to the gym. There are no set rules for managing emotions. A helpful way of thinking about this could be to think “is my current method working for me?” If the answer is yes, then great, but if 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 a cookery book will not instantly make you a great cook, simply reading this material will not make you instantly happy and healthy. But with time, practice and exploration it is possible for everybody to experience emotional well-being. Self-help alone may not be adequate for everybody. If you feel that you need more support, it is important to discuss this with your GP. In addition there are a number of helpful resources at the back of this booklet or you could call our phone line or email us for more information/advice.

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What is in this booklet?

Page

Introduction 4

Lung conditions and stress 5

What causes stress? 5

The stress jug analogy 6

How does stress affect someone? 7

Strategies for reducing stress 8

Lung conditions and anxiety 10

What causes anxiety? 10

How does anxiety affect someone? 11

Breathing control 11

Lung conditions and depression 12

What is depression? 13

What causes depression? 13

How can depression affect someone? 14

The cycle of low mood 15

Challenging unhelpful thinking 17

Challenging unhelpful behaviours 20

Setting goals 22

Other ways to improve emotional well-being 23

Physical activity and healthy eating 23

Eating a healthy diet 23

Foods to limit in your diet 25

How to get a good nights sleep 27

Social supports 29

Useful contacts 30

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Introduction Living with a lung condition can be difficult and stressful. As well as having difficult physical symptoms that you must learn to cope with such as breathlessness and coughing, you may also experience more tiredness and may find that you are less active than before your diagnosis. Lung conditions can also affect you in ways that you may not have thought about previously. For example, it may affect your ability to get a good night’s sleep, you might find that you are not eating as well as you once used to, and this may lead to feelings of agitation, hopelessness and worry. You might also feel concerned about the future and how your condition will progress. Feeling like this over a long period of time can lead to some people feeling stressed, depressed and/or anxious. The aim of this booklet is to provide you with an introduction of what stress, depression and anxiety are, and how you can use some self-help techniques to manage and improve your emotional health. One in four people in the UK experience a mental health problem at any one time, so remember that you are not alone, and there is a lot of help and support if you require it.

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Lung conditions and stress

Everyone experiences stress at certain times in their lives and few of us manage to keep it under control all the time. It can come from both inside or outside of ourselves.

Inside – These can include feelings and attitudes such as wanting to succeed, to be liked or to make other people happy. These pressures can make you feel worried or angry and sap your energy. Moderate levels of stress can improve our ability to perform our daily tasks but high levels make it difficult to think properly and can makes us feel physically unwell.

Outside – Stressful events can happen at any time. They include moving house, getting married, being made redundant, starting a new job, unexpected health issues, divorce, death of a loved one, difficulties in relationships etc.

What causes stress? Imagine the following two situations.

1. You have some spare time so decide to pop to the shop for some food. When you get into the car, it fails to start

2. You have a meeting with your boss at work this morning. When you get into the car to leave for work, it fails to start

The event is the same for both i.e. the car will not start; however, the way that the person feels about both of them is likely to be quite different due in large part to the beliefs attached to these two different scenarios.

“Stress is a condition or feeling that is experienced when a person perceives that demands exceed the personal and

social resources the individual is able to mobilise.”

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The ‘stress jug’ analogy

As humans, we only have a certain capacity for managing stress. Imagine that all of your stress was in a jug. The fuller your jug is, the greater the symptoms of stress will be. Once the jug is full, your ability to manage any situation that arises is greatly compromised, which is why you may feel less able to cope with matters that would normally have no effect on you. Some of your jug will already be filled with the anxieties of life that we cannot avoid, (i.e. money, illness, family, not having enough time for yourself, etc). Therefore, if you have a large source of stress in one area of your life that is filling your jug, your capacity to manage stress in the other areas will be

compromised. You may feel that you manage your stressful job very well, for example, but feel that you are unable to cope with any stresses at home or vice versa. If you partially empty your jug on a daily basis, you can avoid it ‘over-flowing’ which will help you to reduce your symptoms and to feel more in control. It may be that you are unable to change the main contributor to your stress, but if you can do something about your other sources of stress, you will feel better able to cope. You can empty a little out of your jug on a daily basis by using self-help techniques to: Look at your stressors to see if there is anything you can do to reduce the level of stress

they produce or if you could manage them in a different way

Identify if the stressful situation is really your responsibility. If not, could it be delegated to someone else or could your energy be better used elsewhere?

Have time to relax. This may be by completing a relaxation routine, playing a sport or socialising, etc

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How does stress affect someone? These are the common symptoms of stress. However, it is important to remember that stress affects everyone in different ways, so try to notice what your stressors are so that you can use a technique to reduce the effects.

Cognitive symptoms Emotional symptoms

Memory problems Indecisiveness Inability to concentrate Trouble thinking clearly Poor judgment Seeing only the negative Anxious or racing thoughts Constant worrying Loss of objectivity Fearful anticipation

Moodiness Agitation Restlessness Short temper Irritability or impatience Feeling tense and “on edge” Feeling overwhelmed Sense of loneliness and isolation Depression or general unhappiness Low self esteem

Physical symptoms Behavioural symptoms

Headaches/backaches Muscle tension/stiffness Diarrhoea/constipation Nausea/dizziness Insomnia Chest pain/rapid heartbeat Weight gain/weight loss Skin breakouts (hives, eczema) Loss of sex drive Frequent colds Hot flushes

Eating more or eating less Sleeping too much or too little Isolating yourself from others Procrastination, neglecting responsibilities Using alcohol, cigarettes or drugs to relax Nervous habits (e.g. nail biting, pacing) Teeth grinding or jaw clenching Overdoing activities (e.g. exercising,

shopping) Overreacting to unexpected problems Picking fights with others

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Strategies for reducing stress

Equipping yourself with some useful strategies and tools can be helpful in managing times of stress.

Establish the root of the problem (if possible) and tackle this rather than the consequences. Is your core belief fuelling some of the stress or is there an underlying problem that is triggering events or situations?

Take control

Quite often you cannot control or change an event or situation, but you can always control your actions/reaction to it. Channel your energies into the element of the situation that you can control and do not ruminate on the elements that are beyond your control

Ask for support

This could be from friends or family, a colleague or from an external service (see resources). This could be for a number of reasons including to ask for another person’s perspective/ideas or for help with the tasks that are causing you to feel stressed

Keep your expectations of yourself realistic What would you say to a friend in a similar situation? Quite often our expectations of ourselves are far higher than those we would expect of others. Thinking of advice you may give to a friend if they were in a similar situation can be helpful

Set boundaries

Be realistic about what you can achieve and communicate this with those involved. Unrealistic expectations will reduce what you are able to do and increase your stress. Keep boundaries around leisure and pleasure as these are often the areas we neglect the most

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Communicate effectively Talk to family, friends or colleagues. Sharing your thoughts and fears will increase their awareness and they may have helpful suggestions. It can also reduce the likelihood of situations being misinterpreted and help you with feeling valued and listened to. Learn to be more assertive and how to say ‘no’

Try not to take the situation personally Keeping an objective view can help to resolve the problem and will reduce the emotional impact that it has on you

Reflect on positives, not dwell on negatives We often find ourselves focusing on the things that have not gone so well. This can cause us to hold a more negative view of our situation/ lives. Taking time to reflect on the things that are positive in our lives will help us to maintain a balanced view. Focus on the progress you have made.

Manage your time Use structured prioritisation to make the most of your time. Try scoring activities or writing lists of pros and cons. Make time for breaks and physical activity as these are the things that can reduce stress, but are often not done when you are feeling stressed

Look after yourself (see page 17) Exercise, diet, relaxation, etc. will all affect your ability to manage stress. Make time for family, friends and hobbies

Environment De-clutter your environment by filing, using note books, diaries, etc. This can help you to feel calmer and may save time in the long run. This may be at home or at work

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Lung conditions and anxiety As well as experiencing physical symptoms, some people with lung conditions may experience symptoms of anxiety. Anxiety is a normal healthy reaction experienced by everyone at one time or another. It is our survival mechanism known as the ‘fight or flight’ response. It is simply the body preparing for action either to fight danger or run away from it as fast as possible. Anxiety becomes a difficulty when the response is triggered by events that pose no real threat to us. Our survival mechanism dates back to our cave man days and our bodies still react today in the same way as our ancestors did thousands of years ago. However, our ‘threats’ have changed considerably. Most threats in modern life can not be fought or run away from, so the symptoms are not helpful. In fact they often make us feel worse, especially if we don’t understand them. People often become anxious in difficult situations, like when taking an exam, moving house, having an interview or going to the dentist. These feelings of anxiety usually go away. Sometimes they can even be useful, making us more alert and improving our performance. But if these feelings start to take over and become a big part of our lives, they become a problem. What causes anxiety? Lots of things can ultimately cause anxiety, and it is important to remember that because we are all individuals, everyone will react to different situations in an individual way. For some of us, anxiety may start because of a long and slow build up of stressful events that have happened over a period of time. It can also start when we feel that we no longer have control over our lives, a common reason for people who have a lung condition. This may make someone feel anxious about their health in the future, for example. However, for some of us, there may be no real reason why we have started to feel anxious. It is important to remember that in these cases it could be as a result of the side effects of certain medication, or simply because we have not allowed ourselves enough time to think about the circumstances that caused our anxiety. Having a lung condition can also feel similar to physical symptoms of anxiety, or can make existing anxiety feel even worse. For example, a common symptom of anxiety is experiencing chest tightness, and this will feel worse if you have an existing lung condition. It's not always clear what is causing anxiety. Sometimes, you can just be aware of feeling anxious all the time. When you can't understand why you're anxious, this can create a downward spiral: you can become anxious about feeling anxious. This makes you more anxious, and so on.

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How does anxiety affect someone? As we are all individual, we will all have an individual response towards anxiety. Here is a table of common symptoms someone may have when experiencing anxiety: Thoughts and beliefs Physical reactions Moods Behaviours

Overestimation of danger

Sweaty palms Nervous Avoiding situations where anxiety may occur

Underestimation of ability to cope

Muscle tension Irritable Leaving situations where anxiety begins to occur

Underestimation of help available

Racing heart Anxious Trying to do things ‘perfectly’

Worried and catastrophic thoughts

Pains in chest Panicky Trying to control events to prevent danger

It is important for you to recognise your symptoms and any early warning signs you have when you might be feeling anxious, so that you are able to reduce your symptoms. Panic attacks Some people may experience panic attacks. A panic attack is a sudden overwhelming feeling of anxiety, and you may feel like you cannot breathe, and you may experience chest pains, feel faint, or like you are going to pass out. Some people have said that a panic attack feels like they may be having a heart attack. It is important to remember that if you feel unwell at any stage, to ask for help from anyone who is around you. Try to control your breathing for yourself. A panic attack can last for up to 30 minutes, but it can be reduced if you are able to focus on controlling your breathing. Breathing control An important exercise that you can use to help reduce feelings of anxiety is through proper breathing. It is important to always take the advice of your GP or other health specialist before you decide to take up this activity because of your lung condition. The following breathing exercise has been taken from the British Lung Foundation’s information page on breathing control for those with a lung condition. The exercise below does not apply if you have Chronic Obstructive Pulmonary Disease. If you have this condition and would like more information on conducting breathing exercises, please visit the British Lung Foundation website (www.blf.org.uk) and request their ‘COPD: Living with chronic obstructive pulmonary disease’ leaflet.

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There are five simple steps for controlling your breathing: 1) Breathe out first. At the first signs of panic or the first worrying thought about a physical

symptom, empty your lungs as much as you can. Breathe out so that you feel that there's plenty of room to take a full, deep breath.

2) Breathe through your nose. This automatically slows down your breathing and helps

you to avoid hyperventilating. 3) Breathe deeply into your abdomen. Put one hand on your stomach, the other on your

chest. Breathe so that the hand on your stomach moves, while the one on your chest is nearly still. By directing the breath deep into your abdomen, you stretch your diaphragm and relax tight muscles that make it seem hard to breathe.

4) Count while you breathe. Breathe out first, then breathe in through your nose, counting

"One… two… three". Pause a second, then breathe out through your mouth, counting "One… two… three… four". The counting protects you from rapid, panicky breathing. Make sure you breathe out for one beat longer than you breathe in. This will help you empty your lungs between breaths.

5) Slow your breathing by one beat. Breathe in and count, "One… two…three… four".

Pause, and breathe out, counting, "One… two… three… four… five". As always, you breathe out one beat longer than you breathe in.

If you are able to take a break and control your breathing at the first signs of anxiety, then you can very often prevent yourself from experiencing overwhelming anxiety. It is important to practice breathing exercises at a time when you are not feeling anxious, so that you are practiced in using them if you ever do need to. Lung conditions and depression Statistics indicate that someone is more likely to experience depression if they have a chronic lung condition. Although this may be alarming, it is important to remember that if the signs and symptoms of depression are recognised early, treatment is much more successful. Due to the nature of the condition, lung disease can affect every aspect of your life. Because of this, it is more likely to affect your self confidence and your ability to do things that you were once able to do. Although it is normal to feel sad or upset about having a lung condition, it is important to try and counteract these feelings of sadness so that you do not feel like you are trapped in a constant cycle of negativity. If you find that you are, it can actually hinder your lung condition and your ability to find coping mechanisms, which can potentially lead to you feeling lower.

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What is depression? The terms depression and low mood are often used interchangeably. However, depression is a diagnosable mental illness; whereas low mood describes an emotional state.

Depression is diagnosed by the following:

If you have experienced 1 of the following symptoms, most of the time, for over 2 weeks

Low mood or sadness Loss of interest or pleasure And at least 4 of the following symptoms: Sleep disturbance - either falling asleep or early morning wakening Either a loss or increase in appetite Difficulty concentrating Slowed functioning (either thinking, talking or acting slower than usual) or

agitation Lower sex drive Less energy Loss of self-confidence or self-esteem Thoughts of death or suicide Feelings of guilt

What causes depression? Although depression can be triggered by your lung condition, quite often there is no obvious cause or reason for it. However, if you are depressed, the feelings of sadness that we all can experience from time to time will be more intense and will last for a much longer period. Depression in itself can leave you feeling disconnected from your life. It can also leave you feeling like you have less energy to do things, and can make you feel hopeless about the future. Because of this, you may be less likely to take care of yourself as you would if you felt ok. For example, some people find they may not eat the same types of food, or they may start to eat too much or too little. You also may withdraw from any social activities you take part in, with the thought that you will start to do them once you feel better. Low mood and depression in its mildest form does not stop someone from leading their normal life, but it makes everything seem harder and less worthwhile. If your depression is severe, it can seriously affect your ability to function on a daily basis, and some people feel so bad that they find themselves feeling that life is not worth living. Whilst these thoughts can feel very frightening it is important to remember that they are quite common for someone who feels depressed. If you do feel like this, it is very important that you seek help from your GP or if you feel that you are in imminent danger, the emergency services.

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How does depression affect someone? The way we think

Difficulty in making decisions Difficulties in concentration and

memory Feeling worthless Suicidal thoughts Self doubt

Feeling inadequate Self criticism Negative thoughts Ruminating (keep going over the

same thoughts in your mind) Thoughts of death

The way we feel emotionally

Sad Hopeless Irritated

Angry Numb Guilt

The way we feel physically Weight gain Weight loss Sleep disturbances

including early morning waking, waking during the night and difficulty getting to sleep

Never feeling 100% Aches and pains Decreased or increased appetite Loss of energy/ always feeling tired Restlessness and agitation Tearful

The things that we do

Losing interest and enjoyment in activities you previously enjoyed

Difficulty doing everyday tasks Withdrawal from friends/family or

life in general Drinking/smoking more

Avoiding decisions Poorer performance Letting people walk over you Agitation Frequent crying Irritation/aggression

Everybody is different and will react to depression and low mood in different ways. It is proven that some people, particularly men, will not feel sad or tearful and their main symptom may be physical or feeling angry or frustrated.

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The cycle of low mood We already know that when a person feels low in their mood they are likely to have decreased energy, lack of motivation and decreased interest in previously pleasurable activities. However, imagine a time when you were generally feeling happy and healthy. How would you have felt if you were unable to spend time with friends/family, exercise or spend time doing your hobbies or interests? For most people, being unable to do the things that they enjoy leads them to feeling low and unhappy. Therefore, depression and low mood can become self-fulfilling. We often feel that we will do what we enjoy when we feel better. However the reality is we will not feel better until we do the things that we enjoy.

• “I will do what I enjoy when I feel better” • “I will feel better when I do what I enjoy”

Our thoughts, feelings (physical and emotional) and behaviours also feed in to each other. The following model is a useful way of looking at the different aspects of your low mood.

Life event

Behaviours

Emotional symptoms

Physical

symptoms

Thoughts

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Paul’s example Because of the thoughts that Paul has and the way he is feeling, his physical symptoms worsen and this results in him behaving out of character. Because of the way he has behaved, this is likely to impact his mood even more, and therefore there is a real risk that he might become stuck in a cycle of negativity. However, there are many ways in which he can improve his emotional well-being, through challenging his unhelpful thoughts, finding ways to reduce his physical symptoms, and through monitoring his behaviour.

Event Too breathless to mow the lawn. Reluctant to ask son for help

Behaviours Isolates self and becomes

withdrawn Stops communicating with

family

Emotional symptoms Frustrated Angry Worried

Physical symptoms Faster breathing Tension Lethargy

Thoughts I should be able to do this I don’t want to burden my

family I’m useless

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Challenging unhelpful thinking Events themselves do not cause us to feel upset or depressed. It is our beliefs about these events that determine our emotional reaction. We have a tendency to think “If I think these thoughts, they must be true”. However, when we feel low in mood we are more likely to focus on negative things from the past. We become really good at ignoring any of the positive, and then wonder why we are depressed. Unhelpful thoughts pop into our minds so quickly that it is often difficult to spot them. Think of it this way, we don’t get to choose whether or not a bird lands on our heads. We do get to choose, though, whether or not it makes a nest. This is true of our thoughts as well. Just because we think a thought, does not mean that we have to believe it or continue to think about it! When we experience depression, we tend to think in any or all of the following ways. How many apply to you? All or nothing thinking. Thinking in

absolutes, black and white, or good and bad with no middle ground and a tendency to judge people or events using general labels, eg. “He’s an idiot”, “I’m a failure”

Catastrophizing. Overestimating the chances of disaster, eg. whatever can go wrong will go wrong or a set back being part of a never-ending pattern of defeat

Jumping to conclusions. Making negative interpretations even though there are no definite facts. Also making negative predictions about the future

Negative focus. Ignoring or misinterpreting positive aspects of a situation. Focussing on your own weaknesses and forgetting your strengths

Living by fixed rules. Fixed rules and

unrealistic expectations, regularly using words such as “should”, “ought”, “must” and “can’t”, leading to unnecessary guilt and disappointment. The more rigid these statements are, the more disappointed, angry and depressed you are likely to feel

Personalising. Taking responsibility

and blame for everything that goes wrong

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Challenging our thinking can be a difficult skill to learn, but for most people is an effective way of improving our mood. The following techniques may be helpful. Keeping a thought record Keeping a thought record can be helpful in identifying patterns of negative thoughts. 1. Situation: Who were you with? What were you doing? When was it? Where were you? 2. Unhelpful thoughts: What was going through your mind just before you started to feel this

way? What images or memories do you have of the situation? In which unhelpful thought style did you engage (i.e. 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 this thought is correct? What is the evidence that does not support the unhelpful thought? This is the hard part, because it is often overlooked, but ask yourself these

questions: How would someone else view the situation? How would I have viewed the situation in the 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 feel

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

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Situation: Who / what / where / when?

What was I thinking just before I felt like this?

Proof that the thought is true

Other possibilities or what would I say to a friend?

What is the alternative balanced thought?

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Challenging unhelpful behaviours Another way we can improve our mood is through challenging our negative behaviour patterns. Often these patterns are difficult to identify, so a good way of finding out if you are in a routine that is negatively affecting your mood is through completing an activity diary. Activity diary8 The activity diary is a strategy that is very helpful for people experiencing low mood and low self-esteem. The purpose of the diary is to help you:

identify the activities you are currently doing increase the number of tasks that will increase your mood schedule tasks that may lower your mood in a way that means they have the least

negative effect on you e.g. not doing all the unpleasant tasks in the same day or at the time of day when you are not usually feeling at your best

Sometimes we can neglect ourselves, because we may spend all our time helping others or working hard. Step 1: Keeping an activity diary The first step is to look at how you currently spend your time and to consider how satisfying you 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 find each activity (sense of pleasure or sense of achievement). It is important that there is a good balance between the things that you have to do and the things that you want to do. Step 2: What would you like to change? Once you have kept a diary for a week or so, it is time to reflect on how you spend your time and consider what you would like to change. The following questions may help with this:

What was satisfying and what wasn’t? How can you make your daily activities more satisfying?

Could you reduce the impact of activities that are necessary but are not good for your mood by following these with an activity that does increase your mood?

If you were helping someone you cared about, what changes would you make? Are you striking a balance between enjoyable activities, relaxation, and things for

yourself on one hand, and work, duties, things for other people on the other hand? If not, what could you do to create a better balance?

Did negative thoughts get in the way of you doing this? If they did, write them down and try questioning them. Step 3: Create a new diary for next week that includes what you’ve learned from steps 1 and 2

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Activity diary

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Morning

Afternoon

Evening

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Setting goals Another way to improve our behaviour is through goal setting. Goals give us a sense of purpose and allow us to achieve tasks that may feel overwhelming or unachievable. The key to effective goal setting is to be realistic. It is easy to make the mistake of trying to achieve a goal that is vague and unrealistic. By setting realistic, clearly defined goals, you can measure and take pride in the achievement of those goals. You can see forward progress in what might previously have seemed a long pointless grind. Your self-confidence will increase as you achieve your goals and as you recognize your ability and competence in your achievements. There are five components to consider when setting yourself a goal. These goals are known as SMART goals. These are:

Component Ask yourself …..

S Specific What exactly do I want to achieve?

M Measurable How will I know when I have completed the goal?

A Achievable Is this possible given more current situation/ performance?

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

T Time bound When do I plan to finish the task?

Once you have set your goal, you then need to break the main goal down into achievable ‘steps’ called sub goals. You are far more likely to be successful if you plan a series of small stages which will help you to reach your ultimate goal. By working on and achieving small targets, your confidence will increase far more than if you are trying to achieve goals which are too difficult, and where you run the risk of failing. Once your time frame has expired you should then add a further two components to your goal, making it a SMARTER goal: Component Ask yourself …..

E Evaluate What have I achieved so far? Have I completed my goal?

R Re-do What further stages should I set for myself or is this goal now fully achieved? What is my next goal?

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Other ways to improve your emotional well-being Physical activity and healthy eating Good nutrition is very important for people who have lung disease. Being breathless can make it difficult to eat a balanced diet, but good nutrition can improve the symptoms of the disease. Eating a healthy diet It is important to have a balanced diet to maintain a healthy weight and to give you all the nutrients that your body needs. Healthy eating tips

Base your meals on starchy (carbohydrate) foods for energy eg. wholegrain

bread/cereal/pasta, brown rice, jacket potatoes Eat lots of fruit and vegetables Eat more fish – including one portion of oily fish per week Cut down on saturated fat and sugar – sugary and processed foods can increase

irritability and emotional fragility, plus reducing these foods reduces the risk of high blood cholesterol and cardiovascular disease

Try to eat less salt – 6g max for adults – the effects of excess salt, sugar and caffeine can mimic stress responses

Drink plenty of water or other fluids Cut down on caffeine as it can increase mood swings, symptoms of anxiety and

interfere with sleep – try herbal teas instead Do not use alcohol, drugs or cigarettes to cope Don’t skip breakfast

Fruit and vegetables – try to aim for 5 portions every day

Packed with vitamins, minerals and fibre Low in calories Eat fruit and vegetables of a variety of colours as they have different vitamins

including anti-oxidants (vitamins A, C and E), which help to protect from heart disease Fresh, dried, frozen, canned and 100% juice all count. If a normal weight or underweight then aim for 1/3 of your plate to be fruit and

vegetables. If trying to lose weight increase vegetables to ½ of your plate

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Carbohydrates

Provide energy Low in fat Wholegrain carbohydrates also contain vitamins, minerals and fibre Should be included at every meal Have 1/3 of a plate if you are a healthy weight. Reduce this to ¼ of a plate if you are

trying to lose weight Sources include bread, pasta, rice, potatoes, cereals and oats (try to choose

wholegrain options) Fats

There are two main types of fat: Saturated and Unsaturated Avoid having foods too high in saturated fat (fat that comes from animals) as this can

increase the risk of developing heart disease so try to choose sources of unsaturated fats

All fat is calorific so if you are trying to lose weight then reduce the total amount you have in your diet, from whatever source.

Protein

Main sources are meat and fish Protein is needed to build muscles Other sources apart from meat and fish are cheese, lentils, beans, eggs and nuts If you are trying to lose weight, have about ¼ plate of these foods and cut the visible

fat off meat before cooking Aim for at least two portions of fish a week, including a portion of oily fish (rich in

omega 3 fatty acids – which helps keep the heart healthy)

Oily fish Non-oily fish

Salmon, mackerel, trout, herring, fresh tuna, sardines, pilchards, eel

Cod, haddock, plaice, coley, tinned tuna, halibut, skate, sea bass, hake

Foods rich in unsaturated gats Foods high in saturated fats (try to eat only in small amounts)

Vegetable oils (sunflower, rapeseed, olive oil)

Meat pies, sausages, meat with visible white fat

Oily fish Hard cheese, cream, soured cream and crème fraiche

Avocados Butter and lard

Nuts Pastry

Seeds Cakes and biscuits

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Milk and dairy foods

Important source of calcium, which is needed for strong bones. This is especially important in people who take steroids.

Aim to have 2-3 portions a day Sources include yogurt, milk and cheese If you are trying to lose weight, choose low fat versions (e.g. low fat yogurt, skimmed

milk and cottage cheese) If you are trying to put on weight, choose full fat options Some people who have lung disease find that too much dairy can make their phlegm

thicker, it might be best to get protein and calcium from other sources if this affects you.

Non-dairy sources of calcium are sardines, leafy green vegetables and wholegrain foods

Iron Iron is needed to form the red blood cells that carry oxygen around the body, so it is important to have enough in the diet. Sources include leafy green vegetables such as spinach and broccoli. Foods to limit in your diet Sugar If you are trying to lose weight then reduce your sugar intake. You could use sweeteners instead. Salt Salt can contribute to water retention and increase blood pressure.

Use spices and herbs to improve the flavour of food rather than salt Do not add salt to your food on your plate ¾ of the salt we eat is already in the food we buy (cereals, soups, sauces, bread etc)

so be aware when buying ready meals Avoid highly salted foods and choose low salt options if available Read the food labels and avoid those with more than 300mg in a serving – this may

be described as sodium rather than salt Caffeinated drinks Drinks such as tea, coffee and coke have caffeine in. This can interfere with sleep and cause a person to become dehydrated. Try to avoid caffeine in the run up to bedtime. A good tip is to drink a glass of water for every cup of tea you drink to avoid dehydration.

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Trapped gas/bloatedness Some people can become more breathless if they have ‘trapped wind’ or feel bloated. Certain foods are more likely to cause bloating and you could try avoiding them if it is a problem for you. These include fizzy drinks, beans, peas, cabbage, broccoli, garlic, nuts, apples and melon. Eating when you are unwell Preparation:

- Stock up on food - Freezer/non- perishable items - Ready meals - Delivery companies

It can be difficult to get in all the calories and nutrients that your body needs if you are unwell. Your body demands more energy to fight illness, but people often have no appetite if they are unwell, or find that they are too breathless to eat. This can result in unintentional weight loss, loss of muscle mass and reduced exercise tolerance. Tips to make sure you’re getting enough calories include:

Eat small amounts of food regularly. It might seem easier to face a small meal every few hours than a large meal in one sitting

Eat soft food as chewing can be tiring. Things like soup, mashed potato, rice pudding and custard can give calories, but are not much effort to eat

Keep easy to chew meals in the freezer or have tins of food in store. Then you will have food on hand when you are too unwell to cook

Using sauces on food can make it easier to chew and swallow Make sure you keep your fluid intake up Dietary supplements like Calogen or Fortisip can be prescribed by your doctor if you

are underweight

If you are trying to increase your weight you should fortify your food. Ideas include:

Adding butter to vegetables and mashed potatoes Adding cream to soups, sauces and mashed potatoes Adding mayonnaise to sandwiches or salads Cream cheese in sandwiches is high in calories and protein and doesn’t take much

chewing Add pulses to stews or soups Put grated cheese on top of soups Have full-fat versions of food like yogurts and cheese

If you are underweight and struggle to gain weight speak to your GP who can refer you to a dietician if needed.

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How to get a good night’s sleep People may worry about not getting enough sleep, but worrying only makes it worse. It’s easy to overestimate how much sleep you need, or not to realise that it is normal to wake briefly each night. The occasional bad patch is harmless and usually rights itself. It is only of concern if your sleeping difficulties have been lasting for longer than a month, as long-term sleep problems may cause physical or mental health problems. The average amount of sleep is seven to eight hours a night, but we all need different amounts, and the amount we need decreases as we get older. Things that may disrupt your sleep pattern

Snoring that interferes with breathing Too much stress Ill health or physical pain Emotional difficulties, including anxiety and depression Jet lag or shift work that disrupts our internal body clock Traumatic events, such as a divorce, redundancy, or bereavement 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

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Tips to help you sleep

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

2. Check your sleeping arrangements. Think about comfort, temperature, light and noise levels

3. Learn to de-stress before bed. Dismiss nagging thoughts by writing them down and leaving the list away from your sleeping area

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

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

6. Get enough exercise. Fit people are proven to generally sleep better 7. Don't stay in bed. If you can't sleep, get up after 15 minutes and go through your

relaxation routine again 8. Try out complementary remedies. Yoga, meditation, homeopathy or herbal

remedies, such as lavender or valerian, may help 9. Keep a sleep diary. This helps you identify potential causes for your sleeplessness 10. Try some reverse psychology: keep your eyes open and tell yourself to resist sleep 11. Interrupt unwanted thoughts: repeat a soothing word to yourself. Visualise a scene

or landscape that has pleasant memories for you 12. Talk to your GP. Using sleeping tablets on a long term basis may present problems,

but a brief course is sometimes appropriate especially if nothing else is working for you

Night-time relaxation routine Relaxing before bed is a good way of de-stressing and getting the body and mind ready for sleep. People relax in different ways and it is important to find a method that suits you. These could include:

Breathing exercises

Muscle tension and relaxation exercises

A warm bath

Reading a non stimulating book

Guided/non-guided visualisation exercises For more information on relaxation exercises look at our website www.firststeps-surrey.nhs.uk or call our help line.

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Social supports Social supports (friends, families etc) can be an important way of increasing our mood. When a person feels low in their mood it is not uncommon for them to reduce their contact with their friends/family which can lead to social isolation and the associated negative effects on well-being. Increasing our social support is not simply a case of increasing our contact with more people as not all social contacts are positive. For example, only meeting up with somebody who is very low and has a number of difficulties of their own may have an adverse affect on your mood. It is possible to feel lonely even when surrounded by others. Increasing our positive social contact could be through a number of ways including:

Pushing ourselves to meet up with friends, family or colleagues

Contacting friends via the telephone, internet or email

Doing activities which provide us with the opportunity to meet and choose new friends

Sharing our experiences with the people around us

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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 Holiday [email protected] www.firststeps-surrey.nhs.uk British Lung Foundation 03000 030 555 National self-help organisation for lung conditions www.blf.org.uk Depression Alliance 0845 123 23 20 National self-help organisation for depression and low mood www.depressionalliance.org

Anxiety UK 08444 775 774 National self-help organisation for anxiety www.anxietyuk.org.uk SANELine 0845 767 8000 www.sane.org.uk

MindInfoline 0300 123 3393 www.mind.org.uk NHS Direct 0845 46 47 www.nhsdirect.co.uk Living Life to the Full www.llttf.com Cognitive Behaviour Therapy Self-help Resources www.getselfhelp.co.uk

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Books Surrey County Council Libraries have a very helpful list of self-help books. You can find the list at www.surreycc.gov.uk if you search “Reading Well”. The books are available online and in a selection of their libraries. Or additionally, the books are available to reserve via the Library catalogue. 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.

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