Low mood - what is it and what helps

- Hello and welcome everybody to this webinar, hosted by the National Wellbeing Hub in Scotland. I'm very pleased to be here to present along with Alastair Dobbin,

what it is and what helps. So we hope you find this afternoon helpful. And we provide a resource on the National Wellbeing Hub of a Feeling Good App. We are both the founders, and we're very pleased that you're able to access this help free of charge on the app, on the website, and you will find free access codes. And also on this website there's lots of other information which is really helpful for you. So next slide please Alastair.- [Alastair] Oh sorry, yeah.- (laughs) Wake up, yeah.- [Alastair] All right, yes.- So as I said, I'm Sheila Ross, I'm a psychologist and a psychotherapist, and I'm here with Alastair Dobbin, who was a GP in Edinburgh for over 30 years, and works at Edinburgh University, he's an honorary fellow at the university, and involved in Medical Student Education. Okay, so next slide Alastair. So quickly before we get into the body and the meat of understanding low mood and what it is and what we can do to help, just to signpost you to the National Wellbeing Hub. As you go onto the home page it says free apps, next page please. And when you click on that, you can see Feeling Good, that's one of the apps, so click on that. And it takes you through to a page which as you... It's a video you can watch, a couple of questionnaires, just about where you work and what sort of work you do. And once you fill in those, they're anonymous, in the next page you got a couple of codes. These are codes, wellgood is the username and positive is the password. And these you put in the app once you download it, and there's links to download it there, next page. And this is what it looks like on the app store, free to download. Next page. And this is where you're taking throughout the terms and conditions to put in the username and password, wellgood and positive. And that will unlock the whole app for you free of charge. Next page please. Okay, so let's think about, how do you know you have low mood? What is low mood all about? So I'd like just to get you thinking around this topic for the next sort of 45 minutes. So I'd like you to just think about this and put your answers into the Q&A box. Now the Q&A box is up in my Teams and I think they're all the same, there's too little speech bubbles overlapping that have got a question mark in it. When you click on that, you will see the chat box and you're able to put in the comments. So just think how do you know you have low mood? What is your experience of low mood? How does it feel like? What do you notice in other people?- [Alastair] Who have it?- Yeah, that makes you think. Okay, someone's just asked me to confirm the username again, user name is wellgood and the password is positive.- [Alastair] We'll flag it up at the end of the presentation (indistinct).- Yeah, well flag it up at the end-- [Alastair] time to... There'll be a slide of all the resources at the end and we'll let you take a picture or visual or whatever.- Yeah, and you can always find the information through the Wellbeing Hub website. Okay, so how do you know if you've got low mood? Somebody's saying, irritable, yeah. Teary, yeah Not having motivation to do things. Oh, totally I know. Feeling tired and heavy. Lack of interest and focus, lack of patience. Numb, when I'm in a low mood I don't want to talk to anyone, I just want to lie in the dark room and sometimes have a little cry. Yeah, so that's withdrawing socially, not wanting you to talk, feeling sad. Feeling teary someone has already said yeah, absolutely. Lots of really personal into descriptions of what is like, lack of motivation and others can be very irritable and short is one way that we can recognise other people. No motivation. Avoid social situations, eat lots of junk food. Yeah, that sort of... It's trying to self-sooth, isn't it? I'm feeling down, disinterested, irritable, no energy, unmotivated. These are great, everybody's sort of... And we all recognise struggling to get up for work in the morning, that's right. So sometimes we don't sleep well. And so even though as we can be tired and quite often we don't sleep well I think if we're done. No motivation, low energy, eating too much, tears, fatigue, no appetite. Lots of great things. Everything's such an effort, yeah. Want to sleep, cry. I said withdrawal and these are all super. Yes, so withdrawing, numb, loss of generosity. That's an interesting one, that's right. I guess we get a sense of caring less about others I think, isn't it? In that sense. Feeling flat, uninterested. Feeling no control, yeah that's expecting the worst to happen, absolutely. So when I get a little mood I stop doing things I know can help, listen to music, pull back from friends. Now that's interesting. And we will definitely be coming up at the end. We're gonna be talking about what we do to help. So hold onto that and we'll tell you about how you can make that switch so that you can get into that and helping yourself again. And over-preparing, overthinking. These are all really insightful, really super common. So thank you. I'll just pass over to Alastair now. Hello, Alastair. I can't hear you. You're on... I don't know, I still can't hear you. Are you muted? Definitely, can't hear you. Jenna, I don't know if you can check his... Do anything.- [Jenna] I'll try. It's on.- [Sheila] Oh, that's you muted. I can see that, try click that unmute. Oh, no. Maybe try speaking now. Okay, can you just put it back onto presentation for just on the presentation for a moment, Jenna? Everyone give me five minutes. I'm gonna see if I can help out, okay. Jenna, can you just...- [Jenna] Yeah.- [Alastair] Can you hear me? (indistinct)- [Jenna] I can here you now Alastair,(indistinct) It's very faint. I can...- Okay, so I'll just carry on. And thanks for your forbearance and what I'm gonna do. Hang on. Okay. So we were talking about, I think you covered most of these things. Poor sleep, particularly at waking up through the night. That's the problem with low mood. You wake up in the middle of the night, can't get back to sleep. Poor focus and concentration, tired all the time, withdrawn, avoid socialisation, get all of these things have been covered, and possibly not lack of positive feelings, that's almost more of a technical term, but that's certainly true. You cannot... It's very hard to experience positive emotions. If something happens that might normally make you feel happy, you can't feel happy inside. And we'll be coming back to that because that's an important point and there are ways to increase your positive feelings. Okay, so we gonna have a quick go at looking at some very interesting research. What does research tell us about low mood and depression? So we're gonna look at a study that was done in America by the National Institutes of Mental Health, one of the largest studies of depression ever undertaken, and what happened was... Don't worry if you don't understand all the sermons. I'm sure probably most of you do. They took a whole bunch of people, about 250 people and they divided them random into four groups and they had 16 weeks of treatment. So the four groups were one group got cognitive behavioural therapy, CBT, which is a way of looking at your thinking errors. And they had support of a psychologist. Another looked at interpersonal therapy and a psychologist slightly different for CBT in that you try and approach it through what's happening with your relationships. The third group got an antidepressant and saw a psychiatrist. All these people were seen once a week by either the psychologist or the psychiatrist, and the last group got a placebo, they got dummy tablet and they saw a psychiatrist. So the psychiatrist didn't know who was on the dummy tablet and who was on the antidepressant. So they were treating them as if they all had the antidepressant. So 16 weeks, that's actually a lot of treatment. Every week they would see the psychologist or the psychiatrist. And so what was the outcome? Okay, we're actually gonna ask you this question, which it doesn't matter what you say, we're not gonna judge you on it. So which group you think did best out of these four groups? Was it a cognitive behavioural therapy, or the interpersonal therapy, or the people get any antidepressant, or people getting the placebo? Okay, so these are the four groups. So if you'd like to tell Sheila, which of these groups you think might have done the best.- [Sheila] Yes. And put in the chat box.- Yeah, we'll just spend a little time seeing what the general outcome is. Very interesting, a massive study. It was enormous study. They filmed all the consultations and they examined all the-- [Sheila] We have a few answers in.- Okay.- [Sheila] Some people were saying one, two, one. Someone said all the same. And a one placebo group. Someone saying two, option four, CBT. George is saying CBT. One or two are saying number five.- Okay.- [Sheila] Only one person so far has said psychiatrist.(laughs)- Oh, really.(both laughing) Okay, once I got this I can either have the psychiatrist.- [Sheila] Well-- That's pretty interesting.- [Sheila] Only one said number three. (laughs)- Okay, all right.- [Sheila] Yeah.- Very interesting.- [Sheila] Well, yeah, okay.- Or maybe we just move on? Thanks very much for all your replies. The answer is it there was no difference between the groups and this was 16 weeks of therapy and nobody did better than anybody else. And it was a very intensive course, actually a treatment. They called it a short course, in 1985, in fact, that's a massive amount of therapy. They checked again, at 18 months to see if any group had done better. Again, no difference. So what does it tell us? This is very interesting, what does tell you? That all these groups who were getting recognised therapy delivered by experts in their field and they didn't do any better than getting a dummy tablet down the antidepressant. No group did better. CBT very intensive form of therapy, nobody did better than the placebo group, okay. So they went back and they looked at all the things that they had recorded in all these groups'cause they asked them lots of questions to start with. They had to fill out questionnaires. And again, as I say, they were filled every interview with a psychologist or the psychiatrist was recorded and then a specialist will go over it to see whether they had a good relationship. And the best predictor of recovery was... Well, there's two actually. One was the patient therapist relationship. That seemed to be very important. And they measured that at the start of the second session. But the most important thing was the patient's expectation. Did the patient think that they were going to get better? So this was able given a scale, how much do you think you're going to recover? So from one thinking not at all, to five which is, yeah I'm really sure I'm going to get better. So this was a sliding scale. And they found that the people who expected to recover actually did better than anybody else, because there was as I say, no difference between the actual therapies. And so what it came down to is if you thought you were going to get better at the beginning, this is actually before you actually saw a therapist, then you would get better. And it's still important to have the relationship with the therapist that was important, but if you didn't have the expectation of recovery, then you aren't gonna get anywhere. And a number of studies have backed this up. A lot of expectancy has been examined in all sorts of other cases. And these are various papers that you can get hold oFf. And they said, "Well, yes." Other people have said,"Yeah, well, expectancy causes the majority of change in treatments, not just for depression, but other psychiatric disorders too." So that's very interesting. And at the end and the thing is, so the outcome really says,"Patients who expect treatment to be effective, engage more constructively in sessions with the therapist, which brings about reduced reduction in symptoms." So we're gonna just go out on this for a bit longer. So there was such the expectation if you could see yourself recovering, if you could feel that you're going to recover and see yourself recovering, that's what drove recovery. I'm not saying that the other things don't have any impact, we'll go into that later. So positive expectation it's like optimism. It's sort of hope. It's the ability to picture yourself actually feeling better how you would act and how you would be if you actually saw yourself recovering. So you're able to have this called a visualisation. And it gives you a feeling of hope. And of course, that is very important. So really, we got lots of different therapies here and they all have that various skills that they can help to a certain extent. One of the major skills and probably the most important skill is that they increase positive expectation partly because you're seeing a specialist. So of course you think, "Oh yeah, well, this is good. I'm going to get better." But you've got to have that feeling at the beginning before you start. But once you're there you think,"Oh, this person's really gonna help me." So just seeing a therapist would tend to trigger a belief that you're going to get better. Just here now we're gonna go basically, we're gonna look at what is the main cause of people getting low mood, depression, distress, anxiety? The most significant cause of all these things is what has happened to you in the past? It's maybe something from your childhood. Maybe it's something from when you were adolescent, maybe as an adult, you had PTSD from something, or you just had a bad experience. So this is what actually makes the difference. It's not genetic, just because you had a relative who was depressed or had low mood, or it doesn't mean that you're going to get it. Genetics really has no impact on whether or not you get distressed. And personality type again, are you an extrovert and introvert? Used to be thought that, that would make a difference, but again, that has been disproved. Genetics disprove personality type disprove. So that only really leaves what's happened to you. So and this is getting more clearer and clearer. We haven't got everything about genetics sorted out yet, but there is no clear genetic cause of depression or anxiety or whatever. There may be a genetic cause of some things like schizophrenia or bipolar disorder, but all the other things, no genetic evidence, no evidence of genetics makes a difference. Personality type. People used to think that, and you still get quizzes in magazines and stuff, but the guy who invented the personality type, I think has been largely discredited. He was making up the results of his research. So we have a new mantra really for mental health for distress, okay."Don't ask what's wrong with me instead ask what's happened to me?" Okay, so we're gonna talk about things that do happen to people. In 1994, this big study came out of ACEs, Adverse Childhood Experiences. Looking at the impact of certain things that happened when you were a child. And what they found out, they had a huge... There's a huge study by an American health insurance. So this was people who actually didn't have any particular problems. And they just asked all these people,"What happened to you when you were a child? Were you physically abused, sexually abused, emotionally abused? People ignoring you, not looking after your emotional needs." So the figures were absolutely staggering. 63% of people have had at least one adverse event as a child. And 30% of men physically abused, 27% women. And again, sexual abuse, very, very common. And 10% of all people had been emotionally abused. So this doesn't necessarily mean when you talk about abuse or adverse events, we're not talking about something that you might call the police about. Although you might I suppose if it was obvious sexual abuse, but what we're talking about is like, I'm a very anxious person. A lot of doctors are, it's something that you're picked to be anxious so that you look after your patients more carefully and phone them up if you're worried about them. So and what am I anxious? I don't know, sometimes it keeps me awake, sometimes... I'm sure there is something from my childhood. My mother was very anxious and I probably just picked that up by being with her, okay. So and 38% people have two or more categories, 12.5% had four or more. So obviously this thing it's what's happened to you really. And it's not that you know what's happened to you. We will go into that shortly because we've been working with a group in Canada who's been looking very closely at all of this. People in low mood or stressed people, why can't they just cheer up for him to say,"Look you have a new grandchild, you should feel happy about that." The problem is paradoxically, if you're in low mood, thinking of something positive memory it me makes you feel worse. The reason is this something we called a counterfactual effect? When you're thinking if you think of a positive memory from the past, you compare it to how you're feeling now. And it makes you feel worse because you think,"Oh yeah. Look, I was a happy person then. And now look at me, I just move about and can't sleep and so on." The counterfactual effect can be reduced generally by what we call de-centering, which is like relaxation exercises focusing on the body, mindful relaxation. And we're going to that later on. Sheila is gonna take us through some great stuff. So unhelpful thinking patterns. So if we look at just briefly gonna go into that. So here we are. So what some thoughts on these cows doing here? The reason I put the cows in is because something called rumination, okay. You know that cows you may know have six stomachs and they eat the grass and they have one stomach and that's beginning to digest it and then take it back in their mouth, they chew it a bit more swallow again. So the key swallowing the same grass for until is reasonably digested. So rumination though when we're talking about feeling low, feeling bad about yourself. And so rumination is repeated negative feeling. So you might be feeling okay for a bit and then suddenly you feel,"Oh no, it's not worth it. I'm too tired, I can't be bothered." These are the sort things that have been examined in bits of research. These are the things that if you are ruminating, this is the kind of thing that comes up for you."Why do I have problems other people don't have? what have I done to deserve this? Why can't I handle things better? Look and what have I done to deserve this?" And these are three very common ideas that people with low mood have. And also another important point is you can't suppress these bad feelings. It's like suppression is not a strategy. So if you been thinking,"Oh, I feel really bad." Oh, you think of something from the past and it makes you feel bad. She thinks, "Oh, put that up online." But the thing about the pink elephant, if someone says to you, "Don't think of a pink elephant, it just keeps coming into your mind. You can't stop visualising it." Suppression is not actually a good strategy for trying to help you feel better. In fact, if you suppress a memory, you tend to get worse when something triggers that memory. So why is all this happening? Well, it looks like what's happening is you've got an unconscious link to things that happened in your past. Somethings that happened in your past, something that has given you a bad feeling. Now, these things are... We've been working with a Canadian research group and they've been looking at various things about recall about negative events. About things that have happened to you in the past. So people couldn't remember the things that have happened, but they cannot recall the emotions that surrounded that particular event. That they might know, "Oh yes. I remember I had a car crash and it was pretty bad. And I can remember when it was and so on." What they've blocked out, the really nasty bits of that event. Like someone was screaming or the family thought they were gonna die. These things are blocked out by the brain. You know it happened, but you've lost sight of the impact that it has on you. People don't know the impact that these events have had on them. We call this the firewood effect here. And we'll give you a link to something about our research later. But the thing about firewall memories like suppressing. Firewall memories anything that is related to that particular memory maybe somebody's accident or expression on their face or something that's happening to you currently in your life. These things will make you... It will get you to recall what happened before, but you weren't recognised that that's what's causing your problem. It's all happening outside your aware brain. So you just feel low and paradoxically, that makes you feel worse. The fact that you can't remember it because your unconscious remembers it, but not your conscious mind. So here we have what we call... It's a kind of a continuum of all bad feelings of emotional distress running from depression, anxiety at the bottom through low mood to peak performance, because we're on this continuum. All of us are somewhere on this continuum. And what takes you down is the negative triggers that pulls you down to depression and anxiety. What takes you the other way is priming. And we will go into that. And that's being fed information that you're okay, that you're all right. And accessing positive emotions from memories, which help you out.'Cause memories can help you out to deal with this. And we'll go into this in a minute. So next question is, what do you do to feel better? Or you will have time for questions, obviously. It's about 20 minutes. So sheila.- Yes, and again in the Q&A box. What do you do to feel better? Somebody mentioned that at the beginning that there was some things that I know saying that they know the person better. And I know sometimes there's a bit of problems accessing those, but I'll pick up on that just often you won't this. So I think. What are your favourite strategies? Going for a walk. Yeah, that's a really great one and I think we've all become much more aware of the benefit of walking outside or the pandemic and the influence and beneficial effect of nature, which is really... Well, it's great for us and it's also great for nature. If we can help protect it more, listen to music, walk the dog. Yeah, pets have got a very special place. I think they're very nonjudgmental perhaps.(both laughing) And the kinds of factual fact that Alastair was talking about was all about self judgement . We judge ourselves. So we can learn a couple of things from animals. Exercise, yeah. I think that's a great one. Yoga, totally follows a breathing in, And we're gonna talk about breathing in a minute, when you're shopping. We gonna have to sit for a sec. So as long as it's not moderate drinking sensible within the guidelines and baths, yeah. That's exercise, walking dogs, sex, go for a walk. Eat, yeah again, it's on healthy eating, exercise, listen to music, talk, yeah. Lots of colorings. Yeah, that's nice. Yeah, it's a good one. Keep the routine. Ah, that's a good one. I said it's about that sense of control, isn't it? You've got a control of your environment because I think often as someone said I think in one of the comments,"How'd you feel when you're depressed is lack of control." So I think and also it's the familiarity as well. So there's that sense of safety with routine, and automaticity across, but not have to think about things too much. Try to exercise even if you don't feel like it. Get out sized schedule relaxation. Eat chocolate, and chocolate is really good for you. Eat the dark chocolate is quite... Walking, meditation, breathing exercises, think positive thoughts. Yeah, these are all really great. And find out what your triggers are. That's a really good one and time with pets. Mindfulness, and someone's gonna sing in their bath. Yeah, that's like an internal mantra when I feel panicked and low workout and it helps me. Yeah, as well, if you need mantras or sayings that we can say to ourselves. And I think about those internal sayings. I guess their affirmations is they have... If you phrase them all positively, is it rather than anything like, "I don't want to." You say, "I want to." So it's a positive thing Then they're extremely successful. And the idea of just having them and they're about yourself, what you want to achieve, what you want to connecting to. Then they are very, very successful strategy. Taking a cold shower, this is my mood. Has it been like all the cold water swimming is I think that has been shown to help them low mood. Pampering and looking after yourself, give yourself time. Of course, there's lots and lots and lots. So it's really great. So one is good to recognise that you do have coping strategies, and lots of things that work and you know what? So what's the next slide Alastair?- Okay, yes. Another way of making yourself feel better, which a lot of these things that you've mentioned actually do tap into is the link between the body and the mind. Buddhist recognise this. What happens in your mind is almost entirely done through your body. The body is where you feel your emotions. So what happens is here we have, we're gonna talk about applied relaxation because this is a particular type of relaxation that is very effective. Our own app uses a lot of applied relaxation. This is one of the things that you learned through the app. So applied relaxation well, I'll briefly run through it. And what you do in applied relaxation is you do something called Jacobsen relaxation, which involves squeezing your hand and then relaxing. Squeeze your hand, notice the tension, relax and you notice the difference and you work through the muscles in your body. Another thing is as you squeeze the hand, you take a deep breath in and you hold your breath. And then when you relax, you breathe out. So you get a big rush of positive emotions. It slows your pulse down. Your body tells you that you're stressed because your pulse speeds up. And if you're fit, this is where being fit helps. If you're fit then your pulse rate is slower anyway. So your body is not telling your brain,"Hang on, you're a bit stressed out." So, and the other thing is breathing. You breathe in and out, deep breaths in and out, slow deep breathing (inhales deeply) in and then (exhales deeply) out. So these three things are called applied relaxation. It's been shown, it's credited and recognised as being a very, very powerful way. And we've found this ourselves of making yourself feel better because once you have got the positive emotions in your body, these good feelings in your body, they feed straight into your emotional brain and they make you feel good about yourself. Also, what applied relaxation does is it switches on something called the parasympathetic nervous system, so your pulse becomes a regular in a kind of up and down pattern. And it affects every part of your body. You're more likely to smile and interact well with other people. You're more likely to think positively. And the person that existed also switches off the sympathetic system, which is your fight or flight system. So all of this stuff in applied relaxation will make you experience positive emotions. And once you've got those then this has all sorts of beneficial effects on your mind. And it's a combination as I say, a Valsalva manoeuvre holding your breath, Jacobsen relaxation and slow breathing into your stomach. I think Sheila's gonna take us through this shortly. And it increases the blood circulation to the brain and the body, feeds into the emotional brain. And it changes the brain rhythm because you slow your breathing down. So your breathing rhythm slowed down, which switches you into a zone called the default mode, which is where you have access to all the whole lot of past events. And you can pick out things that might allow you to find more helpful memories to guide new solutions. And this is something again, we've done research on, but we won't go into that now. So over to you Sheila.- Thanks, Alastair. So yeah, that's the theory of it. So let's just experience this for ourselves. And so just make yourself comfortable for a moment. And as most people are sitting in a chair, and just take a moment. We'll start off with squeeze your left hand, right? Squeeze it really tight. Hold that just do what's comfortable. If you got arthritis or anything, just be careful, but squeeze your left hand, hold it for a moment and notice the tension that's developing in your fingers and your forearm. Be aware of that. Notice it. And then release that and let that hand relax. I do the same with the other. Squeeze your hand, hold it. So you can... And I get, notice that tension. The thing is the hand, the forearm, and release it and let your hands rest gently on your lap. Now shrug your shoulders up to is hold them there for a moment. Notice that I release them down. Shoulders are really common place we carry attentions. Just do that again. Shrug up to your ears, hold it, and then release, and let that feeling of more comfort in your shoulders. Go down on your arms, your hands, heavy on your lap. And now I can just squeeze and stretch out your legs and flex your feet up to the ceiling, your toes to the ceiling, tensing all your legs, noticing it, and relax your feet down. Do that one more time. Stretch your legs, flex your feet, and relaxing down on to the floor. Now, we look at the face and just lift your eyebrows up to the ceiling. Notice your body wrinkling, and then relax your eyebrows, and your forehead. Screw your eyes up and really aware of the difference. Make a funny face with your mouth, your jaw, maybe a grimace or push your lips forward. Holding it. What's important is to hold that for a moment, because as you release, you notice a difference. I noticed particularly that your tongue is on the floor of your mouth, so that your jaws relax,'cause the jaw is another place it's very common to carry tension. And as you do that and just allow all the muscles in your face to feel more relaxed. You can allow your eyes to close, and begin to draw your attention inside your body, and to notice your breathing. And taking a deep breath all the way down to your belly. Pushing it out as you breathe in. And then breathe out, pulling your stomach and letting it fall down. And then breathing in then count four in your mind. This a hold as after you breathe in and then breathe out two, three, four and hold. Now, breathing in two, three, four hold your breath. And breathe out two, three, four. Just allow your mind to scan your body, releasing any tensions you notice, giving yourself permission to let go of tensions, to use only the muscles you need, to follow your breath and just notice your feelings and your awareness of your thoughts and your mind, and how perhaps they feel a bit more distant, more able to observe them rather than being in them. In a sense of being an observer within yourself, that brings a sense of calm and balance, and neutrality in your mind and body. Just hold that for a moment absorbing it in you, hold that sense of being in that internal awareness state of mind, body, balance. And as you allow yourself to open your eyes come back to this presentation bringing that with you forward so that you able to get a clearer, more refreshed sense. And I hope that you notice that sense of separation from your thoughts, not in them, but observing them. That's a sort of mindfulness type state, but it also very... It's the state that you get into when you're walking, when you're cuddling your pets, when you're reading or you're colouring, there's lots of other ways of getting into it. But most of them focus around the breathing, the body aspect because as Alastair was saying,"The mind and body they're integral. They're not separate." I'm breathing is the quickest and most effective way into calming your mind is with the body. And then when you do that, all those ruminations, all the suppression thoughts they're further away. And that gives that mental space that you can actually take a moment to connect with all of your coping mechanisms. All the things that helps get better.- [Alastair] (coughs) Yeah.- So some things a bit of a struggle, I can't do it. Don't beat yourself up, give yourself the opportunity to breathe, and just begin to gently do a small bit of it, and it can make all the difference. So next slide please, Alastair.- [Alastair] Other ways.- Yeah. So just as I was saying, these are all about exercise is so great'cause we talk about being in the zone, is that automatic function that you're not thinking because really what you wanna do when you've got low mood is you wanna switch off your thinking brain because you're overthinking, and it's usually full of negative stuff. So focusing on the body as you switch that off, and then you're able to connect with more positive things. And next slide please, Alastair.- [Alastair] Yeah.- And that helps you find the solutions-- [Alastair] That's right, yeah.- Yeah. That you need. So next slide. So just to quickly at the end, because it's about quarter to and I want to give you time to ask questions is to just to say a little bit about the app, which is one of the resources is that this is how it looks. And it has a lot of guided visualisations. Has a lot of... Remember I talked about affirmations about mantras, a lot of positive affirmations, and the feeling good for life try this. The green one there, that is a core track that we've done a lot of research on over what? 15 years in the NHS. And so we know it was very helpful when you listen. And one of the first things it does is it helps you relax. Going through this testing releasing, and that helps you sleep better and we sleep better. We usually feel an awful lot better as well. And then there's actually a sleeping better track and there's some other tracks too. Next slide please, Alastair. And this Feeling Good for Life is the main track. And it's got all these different components. So it helps key you into your positive memories or your positive experiences, taking good things from the past to the present. And the reason that this works is because the relaxation is first. So you remember Alastair saying,"Why can't the depressed people just cheer up?" It's because they're so full of all the... There's all that self-evaluation. The likes first get into that neutral zone, you stop judging yourself. Somebody said things that help is acceptance. I think that's right. Acceptance is a really big core of accepting ourselves as we are. And none of us are perfect. What a boring world it would be if everybody was perfect. And accepting ourselves and stopping that judgement , which is what is so toxic about social media. And then we're able to actually build up our self-esteem and our confidence. Next slide. There's a neat thing in the app that you can choose the audio settings like male or female voice, mirror Alastair and background music too. We do talk quite slowly, which can seem a bit weird at first, but so is to encourage the slow breathing. That's why we talk slowly. Next slide.- [Alastair] (indistinct) yeah.- Yeah. Click through this. This is on our foundation, our chart, your website, but lots of evidence on helping low mood, depression, anxiety, burnout, and well-being and rehabilitation.- [Alastair] Yeah.- And the final one before I look at the questions is do you want to talk about this? It's not just chat.- Yeah, very briefly. These are all things that we've done studies on the first lot depression and low mood and very good results for that. It's such a simple act to use. All you need to do is listen, and it will take you through all the exercises. You don't need to go away and do a lot of homework. If you listen engrain these helpful therapeutic methods and ideas in your mind, anxiety, burnout. Burnout is one of the reasons we're here today talking to you because we had a study, which showed that NHS started very well recovering from burnout, listening to the app. Each track is about 20 minutes long, wellbeing, quality of life, very good stroke, rehabilitation of carers and the charges. Multiple sclerosis, it's very good for rehabilitation. It helps you to see your recovery. And it does the same for depression. One at the bottom, these are all the other things that it does. It increase concentration, coat focus. It's based on Olympic sport. So it's not surprising that it makes you perform better at work. It engages you with the work you do. All of your working for health or social care, and this means that potentially you have a good sense of purpose and meaning in your job, which a lot of people don't have, so you're lucky in that way. And I think the app will help you to reengage with that. Chronic pain, headaches, irritable bowel, all these things are stress related. So it's very good for all these things. And this is what happens. We'll give you a link shortly to this animation. I recommend you watch this. This is about our research, what our experimental research show that what it does it changes memories of past events that have made you feel bad. Not consciously, it's all done in the unconscious mind. It takes you through the breathing. So it's well worth watching this. What positive mental training does is it changes the way you feel about past events so that you're no longer having this constant retraumatization. Okay, so we're gonna ask any questions that you... Sheila, you put them in the chat box. In the meantime, I'm gonna show this slide so you could take a photo of it or something. It's got a lot of resources for the app. It's got the research video channel, it's got the username and password there. So you might like to take a picture of this and perhaps Sheila you could moderate the questions.- [Sheila] Yeah. I'm just gonna try and pick up. Oh, I'm gonna maybe put in the announcement one. This go to the... Sorry, I can't type and talk at the same time, but they could to the evaluation,'cause it'd be really super caring.- That's top. Impressive, isn't that (indistinct).- [Sheila] I think it's maybe easier to pick up from the chat box.- Oh, yeah.- [Sheila] And someone was just saying,"How do you change the voice on the app?" You do that as when you go to a particular track to play track, it has a button audio settings there.- Audio settings there.- [Sheila] And that's it.- And if you click on that, it offers you the option of Sheila, and you can have piano, guitar, and there's all sorts of different types of music.- [Sheila] And at the moment people are asking that you can share the codes with your colleagues. Please share the codes with all your colleagues. These codes are not for your patients, unfortunately, and if you're in Luthien we've got patient codes and we're hoping that we can get patient codes, but for wellgood and user positive are for colleagues just not (indistinct).- Yes.- [Sheila] You can share this as widely as possible. So that's fine.- I think if it's in your family, it's reasonable to use as well.- [Sheila] Yeah.- Important to point out that we've never had a bad side effect from people using the app.- [Sheila] Absolutely. That you're right Alastair. And I knew, please ask any questions or comments. At the beginning you're talking about expectation. I just wanted to... I didn't I was seeing a physiotherapist recently. I've got some rotator cuff problem. And I was telling him about expectation and he said,"Yeah, there was a very big study in back pain." And she said that expectation of recovery-- Absolutely.- [Sheila] Is the most important factor. And I think what we doing and what the app taps into is visualisation. Is that sense we can shift our expectation. If we feel more positive, we are more able to accept and expect good things to happen in the future.- [Alastair] Yeah.- And we can that the continuum of mood we're able to move away from some of the things that hold us back, our negative experiences, beyond the expectations.- Yes, and our research... One of the main things is just confidence that it gives you confidence. Basically there's one track, it's a short track called Confidence. And if you listen to that, it's 10 minutes and our research with this group in Canada showed that it completely changed the way people felt. They had good burst of positive emotions, and they had all sorts of benefits from just 10 minutes of listening. And all of that is in our research. It's fascinating stuff. And the animation is also, if you watch this three and a half minutes, watch it when we finished and it explains exactly how it all works. It's very useful.- [Sheila] Somebody is saying,"How do you help a person that has low moods who doesn't think that they need help?" Yeah, how are we gonna say Alastair?- All right, well, it's obviously we had a guy who went to the Royal Edinburgh Hospital because he was feeling really bad. And the psychiatric nurse there said,"Well, why don't you use this? Because I used it and it comes from Olympic sport." And this guy thought, "Well, I play golf. So maybe that'll help my golf." And so he listened to it and he had a huge improvement. And in fact he won the golf championship after that. It sort of completely removed his... What do you call it?- [Sheila] Yeah. And I think-- But, yeah. It's difficult. Some people you can't make people listen to this obviously.- I think if there was something like this person wasn't sleeping well. That's a good way of saying,"Well, look, this app can help you sleep even better."- [Alastair] Absolutely. Yes.- Or there's another route. So it's not like you're working particularly on the mood. You're focusing on something else that they want to see.- Right too, chronic pain. This has been shown to work very well for chronic pain. Chronic pain is essentially an emotion, and this will reduce pain. So if somebody as Sheila says, maybe they got poor sleep, or maybe they've got a lot of pain. I use this almost all the time for sleep. Sorry, go ahead.- [Sheila] No, I just wanna a few questions. So it'd be nice to get to them. Sorry to cut you off.- Go ahead, carry on.- "How do I best manage my anxiety and stay mentally positive while helping my son?" Well, I think the thing to do is breathing. Breathing is the best thing for anxiety. You'll know that when you're anxious, you're breathing more rapidly. And when people actually say,"You often hold your breath without even realising." And so it's just being more picky, drink that to get to be really body aware. And then you are becoming a role model for your son, and you can maybe do things together like walking or running or jogging, or anything that encourages the sort of physical aspects. You can also talk about it. And diarrhoea, journaling is a great way to become more aware of emotions and the triggers. And you can talk about perhaps other routes, what does the anxiety affect? And then talk about the thing that's affecting so that you're focusing more on a positive outcome.- [Alastair] Yes, of course.- Rather than a specific deficit.- [Alastair] Well hyperventilation is something you could see people gasping and breathing really fast. A lot of us actually breathe faster than we need to and not at the time. And that makes you feel anxious because you're not kicking in with this parasympathetic nervous system. All you need to do is slow it down. And the app teaches you how to do that without even thinking about it. It automatizes it, it makes it an automatic thing. And what you do you just squeeze the offer well. When you've been practising you just squeeze your wrist. Take a deep breathe in (inhales deeply) and it's gone because you've already, almost immediately in that state because you've practised getting into it. Switch off your fight or flight, amazing.- And someone says,"Is being positive to do with personality?" That's really interesting, isn't it? And I think you can pick it up by the (indistinct).- Well, personality, is it your personality? No, I would say it's more these things triggers from the past and they just keep coming back and keep annoying you. Personality types, as I said, the evidence is not good. The research that we did, and you can read about this in the research papers. Research we did with the Canadian university is that they... Wait a minute, sorry. (laughs) What were we talking about? Sorry.- [Sheila] Personality. Yeah, you think that the research (indistinct).- Personality, yeah. They indoctrined what was the most important thing? Was it in terms of feeling bad? Was it your personality type or was it what had happened to you? Very interesting. And the conclusion was well what's happened to you trumps everything else. Your personality is probably the personality type you're is probably because of what's happened to you.- And just to say that the recent remember my dad was an identical twin and he was in the Second World War, and my dad was depressed most of his life, and particularly from about 40 on. He struggled with depression. I think he stopped working actually, because he was so depressed. So I grew up with a depressed father, but his identical twin was a medic and didn't go to war and never had depression. So they were brought up the same. They went to the same school, I think maybe sometimes there's a real vulnerability. They were both very sort of soft and sort of caring people, but they hadn't seen each other for years, but then when they met up, they were dressed identically. Honestly, it was amazing. I couldn't tell the difference from their backs. Same sports jacket, same hat, same glasses frames. It was so funny.- [Alastair] Couldn't tell them apart.- So that's a real sort of a demo of one that with twin studies, they can look at these things.- [Alastair] Yeah.- So what else. Somebody said it is quite a tricky one. I'm afraid we're not gonna have enough time to answer it properly. So how do you approach someone with low mood who's using negative coping strategies for example, alcohol and convinced them to try more equitable, positive coping methods?- [Alastair] Yeah.- I think you have to begin to understand yes, you say it's a negative coping strategy. So they're trying to help themselves feel better. And that it takes quite a bit of understanding and insight and opportunity. So that would very much depend on the individual. And maybe that this is somewhere where somebody needs to speak to somebody just to help guide them through if they can, or you have to give them a bit of time on that.- Yeah, it's tricky. I think probably what's happening is they're using the alcohol to sort of self-medicate to calm themselves down. But that's the kind of vicious cycle. Maybe if you say, "Well." If you use it and you say,"Well, look, I find this very useful. It helps me to calm down." Or you say that I was listening to this doctor who was talking about it and he uses it all the time and he's okay. Because of using the app, it's so easy to use, honestly. I don't know. I'm sorry, you're having that problem. I feel for you. I was brought up again with an alcoholic in my family. So I'm well aware of the problems that this entails. He did get over it though. And I think if you listen to the app, you might be in a better place to deal with this kind of anxiety too.- [Sheila] Yes, that's right. It's always easier to deal with people that we feel more positive of ourselves.- Yeah.- [Sheila] And that's infectious, positive can we help them?- Yeah, it's because if you can say to him,"Well, I can see how you might improve. I'm sure you've got the resources inside you." This is what the mental training does. It helps you find the resources, it finds more positive memories for you all done unconsciously and puts them into your kind of processing modes. And then you don't feel your negative triggers anymore. It has removed your negative triggers. Watch the videos, the animation is very good.- So this last comment someone says,"Will the app increase energy?" Yes, definitely. And it is associated with positive feelings.- [Alastair] Yeah.- Increases vitality. So I'm sorry, that's (indistinct).- [Alastair] It feels like a psychiatrist did it.- (laughs) Thanks Alastair. That's one of part three. So thank you for your time. And I hope that you have enjoyed it. And recording of this I believe will go on the Hub. So you bet to pick up all the references there. So thank you Alastair too for your input. And-- [Alastair] Thank you very much.- Have a good rest of the day. Thanks a lot.- [Alastair] Yeah.- Bye.- [Alastair] Bye.