• Panic is the word used to describe high levels of anxiety. When people experience panic, many uncomfortable physical symptoms occur in their body. These can include: a rapid heart rate, sweating, a tight and painful chest, breathlessness and dizziness. As these physical feelings of panic are so intense, they can be very frightening. Because of their severity, people often worry that they are having a heart attack, going mad, or are about to faint.
• As soon as people begin having thoughts like these, they become even more anxious and their physical symptoms of panic get worse. As they get worse, people become even more convinced that they are having a heart attack, going mad etc. Before long, a vicious cycle develops which continues in this way until someone experiences a full blown panic attack. A panic attack is basically when these symptoms reach their peak.

Panic Attack Symptoms:

• • Increased heart rate
  • Sweating
  • Trembling / shaking
  • Feelings of breathlessness, shortness of breath
  • Feelings of choking
  • Heart palpitations
  • Chest pain
  • Feeling dizzy, lightheaded
  • Muscles tense up (feel tight)
  • Chills / hot flashes
  • Numbness or tingling sensations
• If you or another person is experiencing a panic attack some things that can help include;
  • put ice in the hand because holding something cold is distracting
  • do the 5,4,3,2,1 method;
    • Say 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste.

We all feel angry at times – it’s part of being human. Anger is a normal, healthy emotion, which we might experience if we feel:

• • let down in some way
  • denied of something that we feel entitled to
  • attacked
  • deceived
  • frustrated
  • invalidated or unfairly treated
  • sadness (foundation, expressed with anger)

Anger isn’t necessarily a ‘bad’ emotion; in fact it can sometimes be useful. For example, feeling angry about something can:

• • help us identify problems or things that are hurting us
  • motivate us to create change, achieve our goals and move on
  • help us stay safe and defend ourselves in dangerous situations by giving us a burst of energy as part of our fight or flight system (internal alarm system) – This reaction quickly and helpfully prepares the body for action. It prepares us to either protect against or escape danger.
  • Anger only becomes a problem when it gets out of control and harms you or people around you. Unhelpful ways you may have learned to express anger include:

• • • Outward aggression and violence – such as shouting, swearing, slamming doors, hitting or throwing things and being physically violent or verbally abusive and threatening towards others.
    • Inward aggression – such as telling yourself that you hate yourself, denying yourself your basic needs (like food, or things that might make you happy), cutting yourself off from the world and self-harming.
    • Non-violent or passive aggression – such as ignoring people or refusing to speak to them, refusing to do tasks, or deliberately doing things poorly, late or at the last possible minute, and being sarcastic or sulky while not saying anything explicitly aggressive or angry.

Anger is your external way to express something that is going on for  you internally (a reflection of how you feel on the inside).

Tips for Dealing with Anger: 

• • Box breathing (Count to 4 while breathing in, hold it for 4 seconds, count to 4 while releasing and then wait 4 seconds before you start again -4x4x4x4
  • Take space from the situation and walk away
  • Bite into a lemon
  • Ask yourself what’s making you so angry.
  • Denial
  • Shock
  • Isolation
  • inclusion / social support -– welcoming others –helping them to make others feel that they belong at all levels (family, community, organization, nation)
  • understanding/empathy
  • believe that what others think and feel matters; given them the chance to explain their perspectives, express their point of view, actively listen in order to understand them
  • Accountability; take responsibility for your actions; if you have violated the dignity of another, apologize, make a commitment to change hurtful behaviors.

Depression / Depressive Symptoms

• Depression is a low mood that lasts for a long time, and affects your everyday life.
• Depression can be due to a variety of things and or a chemical imbalance
• In its mildest form, depression can mean just being in low spirits. It doesn’t stop you leading your normal life but makes everything harder to do and seem less worthwhile. At its most severe, depression can be life-threatening because it can make you feel suicidal.
  • “It feels like I’m stuck under a huge grey-black cloud. It’s dark and lonely, suffocating me all the time.”
• People who are low or depressed normally have a critical way of thinking about: Themselves:
  • I’m boring
  • I’m ugly
  • I’m a failure
  • No-one likes me
  • Everyone is better than me
  • Things will never get better
  • What’s the point?

• People’s behavior patterns also typically change if they low or depressed. For example, they tend to spend a lot of their time indoors (often in bed) and don’t socialize or do as much as they used to.
• Clinical symptoms
  • Suicidal ideations / suicidality
  • Interest deficit (anhedonia)
  • Guilt (worthlessness, hopelessness, regret, energy deficit)
  • Appetite significantly decreased or increased
  • Psychomotor agitation
  • Sleep disturbances (significant increase or decrease)

Tips for managing depression;

• • Try to understand what is causing the depression?
  • Exercise
  • Eat healthy
  • Sleep
  • Identify what makes you happy and do those things more

More Tips on coping with depression:

• • Aim for eight hours of sleep. Depression typically involves sleep problems; whether you are sleeping too little or too much, your mood suffers.
  • Eat a healthy, depression fighting diet. What you eat has a direct impact on the way you feel. Consider the following tips for having a healthy depression fighting diet;
    • Reduce intake of caffeine, trans fats and foods with high levels of chemical preservatives or hormones because they will adversely affect your brain and mood.
    • Minimize sugar and refined carbs such as sugary snacks, baked goods, pasta, French fries and other comfort foods.
    • Don’t skip meals. Try to eat something at least every 3-4 hours because going too long between meals can make you feel irritable and tired.
    • Boost your B vitamins. Deficiencies in B vitamins can trigger depression. To get more, take a B-complex vitamin supplement or eat more citrus fruit, leafy greens, beans, chicken and eggs.
  • Converting Negative thoughts into positive thoughts. See the chart below:

Depressive Pessimistic Thoughts	Positive Alternative Goal
“I am lost.”	“Find a bearing.”
“No one appreciates me.”	“Find exceptions to this statement.”
“I will never get over feeling depressed.”	“Question hopelessness-thinking assumptions.”
“I can’t stand how I feel.”	“Learn to tolerate when I don’t like.”
“I am useless.”	“Question uselessness assumption.”

In the left column write your negative thoughts then in the right column, convert your negative thoughts into positive statements of what you can do to change. After seeing goals, make sure to have specific plans for reaching them. The fact is that goals without plans are often fated to fail (Gollwitzer, 1999).

Implement the plan. When you are done, evaluate and revise your plan.

• • Cognitive change: People sometimes develop a justification for delaying a task and hope for a better tomorrow. It is also called a false hope because you put things off until later.

Justifying thoughts	Flip Technique
Don’t think about going to the gym. Wait. You will feel rested and ready. Perhaps you will go in a day or so. Besides, exercise as a remedy for depression wont work if you are depressed.	Use the flip technique by putting one foot in front of the other and heading to the gym.
Activity remedies for depression, like house cleaning, are a pain and waste of time. You have better things to do, like watching your favorite soap opera.	Start cleaning the house while listening to the soap opera. Here you are doing two things at once; one activity that is passive, the other that is active.

• • A lack of scheduled activities and inconsistent routines can increase feelings of helplessness and a loss of control over the direction of your life. Adding a plan to your day can help you regain that sense of control and decrease the feeling that you’re just a passive participant in life. (Specify an activity for each hour after you wake up until you go to bed; plan for your day the night before; think about your activities and see what you actually did; think about how you felt about what you did; and note the situations and thoughts which may have negatively affected your mood.
  • Reach out to your social support network. Call a friend or family member to get together for tea or meet up somewhere outside.
  • Do some volunteering activities
  • Smile at people even the strangers.
  • Set small goals. Depression can make the simplest task seem daunting, so breaking things down into small makes the task seem more doable. For example, instead of getting stuck thinking “how am I going to get to work everyday this week”, think about getting to work today, then break it down even further; like getting out of bed, having a shower, getting dressed and so on. Each time you complete a step, give yourself credit. Getting out of bed when fighting depression is an accomplishment.
  • Find ways that make you laugh. Humor gives you a break from all the negative thoughts depression brings. Possible ways of laughing varies; it involves talking to a friend, watching a funny show, following a humorous account on social media, reading jokes or any other way, it can all help.

• Traumatic stress is a type of anxiety disorder which you may develop after being involved in, or witnessing, life threatening traumatic events like an attack, a fire, a natural disaster, a car accident, etc.
• It is perfectly normal to have a psychological reaction to traumas that can last for a few days or a few weeks. We may;
  • feel numb
  • have trouble sleeping
  • shock and disbelief
  • anger, helplessness or fear
  • flashbacks (re-picturing and or experiencing the events)

• Experiencing these things after a traumatic event may be called an ‘acute stress reaction’.
• You might re-experience the incident through intrusive flashbacks or nightmares. Following such an experience, it is also common to avoid things that remind you of the incident.
• Some people find it most helpful to try and forget about the trauma and just get on with life, while other people find it helpful to talk about their feelings to someone.

The intensity of symptoms will likely pass within a month or so. Everything always changes. My feelings are waves that come and go.
Talk about the experience in a safe environment, or write about it. If you continuously avoid examining your reactions and not expressing your distress or concerns will likely increase or prolong negative reactions. 

Tips for managing Traumatic stress:

• • If the traumatic situation is ongoing, get some help to make yourself safe. You may need some help in finding a safe place to stay.
  • Reach out to others for support. You don’t have to face it alone. Talk to someone you can connect with for an uninterrupted period of time, someone who listens to you without judging, criticizing or continually getting distracted. That person could be a friend, your significant other, your family, or a professional therapist.
  • Know that how you are feeling is very normal for someone who has experience a traumatic event
  • Accept that it might take some time to adjust. Be kind to yourself.
  • Some who experience traumatic stress might develop a sense of helplessness. One way of coping with sense of helplessness is through helping others. Volunteer your time, give blood, reach out to a friend in need, and donate to a charity. Taking positive actions directly change the sense of helplessness.
  • Engage in some physical exercises and focus on your body and how it feels as you move. Some rhythmic exercises that engage both arms or legs, such as running, walking, dancing or swimming are the best exercises that you can focus on your breathing, or the feeling of wind on your skin.
  • Spend time in nature. Anyone with traumatic stress can benefit from the relaxation, seclusion and peace that come with being out in the nature.
  • Carry an object that reminds of the present. It will be helpful if you touch or see something during a flashback. This might be something precious such as a keyring, photo of a loved one or a piece of jewelry in your bag or pocket.
  • Keep a diary of what triggers you to have flashbacks. Keeping a diary of triggers helps you to notice the signs that bring the memories of the trauma; thus, you can avoid them.
  • There is a connection between your actions and how you feel. Believe in your own capacity to influence the course of your life.
  • Be engaged and present in your life, and this helps you to be active, instead of passive, during challenging times.

Self-harm is when you hurt yourself as a way of dealing with very difficult feelings, painful memories or overwhelming situations and experiences. Some people have described self-harm as a way to:

• • express something that is hard to put into words
  • turn invisible thoughts or feelings into something visible
  • change emotional pain into physical pain
    • distraction from emotional pain
  • reduce overwhelming emotional feelings or thoughts
  • have a sense of being in control
  • escape traumatic memories
  • have something in life that they can rely on
  • punish yourself for your feelings and experiences
  • stop feeling numb, disconnected or dissociated (see dissociative disorders)
  • create a reason to physically care for themselves

Ways of self-harming can include:

• • cutting yourself
  • poisoning yourself
  • picking or scratching at your skin
  • burning your skin
  • hitting yourself or walls
  • pulling your hair

Tips for dealing with Self-harm:

• • Understand why they self harm: they don’t know how to deal with the flooding of emotions, they self harm because that distracts them from what they were thinking about. And the brain releases endorphins when it gets pain and that “high” becomes addictive.
  • Take a rubber band and flick it on your wrist (if you’re cutting on the wrist)
  • If you know someone who is self harming, remove sharp objects, acknowledge that you know what is going on, acknowledge that they’re in pain and need help, give them a chance to talk about what is going on for them

Sleep Disturbances – Insomnia

There’s a close relationship between sleep and mental health. Living with mental health challenges can affect how well you sleep, and poor sleep can have a negative impact on your mental health.

• Sleep problems can be broadly categorized into three types:
  • Problems getting to sleep – lying awake and not being able to fall asleep.
  • Problems staying asleep, for example waking up early in the morning.
  • Poor quality sleep – not feeling refreshed by the sleep you do get.
• You may find a sleep problem can lead you to:
  • have negative thoughts, feel depressed or anxious – if you have little sleep you may feel less able to rationalize worries or irrational thoughts
  • feel lonely or isolated – if you feel tired you may not want to be sociable or see friends

Tips for dealing with Sleep Disturbances

• • If you can’t sleep, get out of bed
  • Don’t use electronics before sleeping
  • Have a routine around sleep
  • Don’t do anything in bed other than sleep
  • Read before you sleep

• Being under pressure is a normal part of life. It can help you take action, feel more energized and get results. But if you often become overwhelmed by stress, these feelings could start to be a problem for you.
• You might find that your first clues about being stressed are physical signs, such as tiredness, headaches or an upset stomach.
• There could be many reasons for this, as when we feel stressed we often find it hard to sleep or eat well, and poor diet and lack of sleep can both affect our physical health. This in turn can make us feel more stressed emotionally.
• Stress is a commonly experienced problem. You are likely to know others who have been in a similar situation. There is no need to feel embarrassed or concerned about stress. Often it can help to tell others about how you feel stressed. They may be able to offer helpful advice and support. Stress is not harmful in itself. You are not weak because you struggle with it. Stress over a long period of time can, however, make us more vulnerable to health problems.

Tips for coping with stress:

• Shift the focus of your mind from negative thoughts to positive thoughts. This helps you take control over your perspective. If you turn your focus towards all that is positive about you and your life, you will start to feel better about yourself and your environment.
• Accept that there are events that you cannot control
• Stopping and taking a few deep breaths can take the pressure off you right away, just follow the following steps;
  1. Sit in a comfortable position with you hands on your lap and your feet on the floor. Or you can lie down.
  2. Close your eyes.
  3. Imagine yourself in a relaxing place. It can be on the beach, in a beautiful field of grass, or anywhere that give you a peaceful feeling.
  4. Slowly take deep breaths in and out.
  5. Do this for 5 to 10 minutes at a time.
• Slow down. Modern life is so busy and sometimes we just need to slow down and chill out. For example: set your watch 5 to 10 minutes ahead. That way you will get places little early and avoid the stress of being late. Or when you have an exam coming soon, try to prepare for it from a week ago just to avoid the stress of the night of the exam.
• Set a time aside for things you enjoy. Try to do something every day that makes you feel good, and it will help relieve your stress. It does not have to be hours – even 15 to 20 minutes will do. These hobbies could be reading, knitting, doing puzzle or anything else.
• Talk about your problems and thigs are bothering you, can help lower your stress. You can talk to your family, friends, a religious leader, your doctor or your therapist. You can also talk to yourself. It is called self-talk and we all do that. But keep in mind that for self-talk to help reduce stress, you need to make sure it is positive and not negative. For example, do not tell yourself “I can’t do this”. Tell yourself instead “I can do this”.

• Suicide is the act of intentionally taking your own life. Suicide is best understood not so much as a movement toward death as it is a movement away from something and that something is always the same: intolerable emotion, unendurable pain or unacceptable anguish. Reduce the level of suffering and the individual will choose to live.
• Suicidal feelings can range from being preoccupied by abstract thoughts about ending your life, or feeling that people would be better off without you, to thinking about methods of suicide, or making clear plans to take your own life.
• If you are feeling suicidal, you might be scared or confused by these feelings.
• But you are not alone. Many people think about suicide at some point in their lifetime.

How you might think or feel	What you may experience
-            hopeless, like there is no point in living -            tearful and overwhelmed by negative thoughts -            unbearable pain that you can’t imagine ending -            useless, unwanted or unneeded by others -            desperate, as if you have no other choice -            like everyone would be better off without you -            cut off from your body or physically numb	-            poor sleep with early waking -            change in appetite, weight gain or loss -            no desire to take care of yourself, for example neglecting your physical appearance -            wanting to avoid others -            self-loathing and low self-esteem -            urges to self-harm

• Suicidal feelings can be overwhelming. How long these feelings last differs for everyone.
• It is common to feel as if you’ll never be happy or hopeful again.
• But with support from family and friends, doctors, and mental health professionals, and self-help, the majority of people who have felt suicidal go on to live fulfilling lives.
• The earlier you let someone know how you’re feeling, the quicker you’ll be able to get support to overcome these feelings.

Tips for coping/ overcoming Suicidal thoughts:

• • Remove anything you could use to harm yourself or ask someone else to remove these for you. If you are in an unsafe location, move quickly
  • Tell someone how you are feeling. Telling someone else how you are feeing can help you to feel less alone and more in control.
  • If you are thinking of harming yourself, find self-harming coping techniques that work for you such as; holding an ice cube in your hand until it melts and focus on how cold it feels, tearing something up into hundreds of pieces.
  • Focus on your senses. Taking time to think about what you can smell, taste, touch, hear and see can help to ground your thoughts.
  • Avoid taking drugs as it can make you feel worse. If you can; get a glass of water, eat something if you are hungry, sit somewhere comfortable, and write down how you are feeling.
  • Get outside. If you are feeling numb, feeling the rain, sun or wind against your skin can help you to feel more connected to your body.
  • Make a deal with yourself that you won’t act today.
  • Find your reasons to live. Like;
    • Write down what you are looking forward to, whether it is eating your favorite meal, seeing a loved one or catching up on the next episode of a TV show.
    • Make plans to do something you enjoy tomorrow or in the near future. Plans don’t have to be big or expensive
  • Repeating to yourself that you can get past these feelings can help you regain hope and focus on getting through it. Remember that the thought about killing yourself are just thoughts and you do not have to act on them.
  • Spend time with people who you like and trust.
  • Learn from others – reading about other people who have managed difficult times can be inspirational.
  • Call a helpline