Doctors' Support Network 2016 Dr Alison Holt mental health
By Dr Alison Holt

My name is Alison and I have bipolar disorder. I work as a GP and GP trainer and have a special interest in treating health professionals who become unwell. I have been involved with DSN since 2002 and on the committee from 2004-2015. During that time I variously acted as membership secretary, secretary and treasurer.

What is bibliotherapy?
Bibliotherapy means different things to different people and the use of the word has changed over time. It was a word rarely used in current medical practice until the NICE guidelines for depression in 2004. These suggested that for patients with mild depression, health-care professionals should consider recommending a guided self-help programme based on cognitive behavioural therapy (CBT). 
 Bibliotherapy immediately became a hot topic and certainly in my area this led to a heavy investment by health services in such materials, including a joint venture with the county council to provide a “books on prescription” service via the library service. A distinction is also often made between clinical bibliotherapy (the use of books by trained helping professionals dealing with patients) and developmental bibliotherapy (the use of books to facilitate normal development and self-actualisation in healthy people). As a person with recurrent mental health problems I find it difficult to draw a line between the two – I am learning to steer my path through life and the challenges that poses – the boundaries between “normal development ” and “managing illness” are blurred.  
In this article I would like to go beyond the self help CBT manual. I will explore the various facets of bibliotherapy, including self help, with examples of books that illustrate the theory. 
Forget the heavy medical journals
The earliest references to bibliotherapy in the literature are in the USA in the 1930s. After World War II reading was a key part in distracting and raising morale in injured troops whilst they were recuperating. This is an important facet of bibliotherapy. Immersion in a narrative (written, or in these modern times on television or in film) is a normal, pleasurable activity. When we are unwell we often lose the capacity to enjoy normal things, find life overwhelming and lack concentration. At these times reading the sort of book we would normally enjoy can be impossible. But relaxing and being able to switch off is an important part in recovery. In
Doctors as Patients,
 Joy Pope wrote “Depression often means that the things which you normally turn to for relaxation or pleasure leave you cold, and poor motivation and concentration may make them hard to do……..If you are feeling like this then it is best to keep things simple. Forget the Times Crossword, the hike up the local hills or heavy medical journals. The time for them will return. Try a simple puzzle book or jigsaw, skim through a light magazine or a well-beloved children’s book, potter around a garden centre. Allow yourself to watch ‘trash’ on television, put your usually green fingers to caring for just one planter, or a single winter bulb. Use your creative talents but at a much simpler level than usual.”
Try low-brow books or films
When depressed or anxious it is easy to be dismissive and certain that nothing is going to be enjoyable so why try? But at these times I have enjoyed books aimed at teenagers: the Twilight series and Terry Pratchett’s Wee Free Men books come to mind.  As does a series of books about an American bounty hunter by Janet Evanovitch that I would normally turn my nose up at. If books are not your thing, films for children often have a level of adult humour as well, have very easy to follow storylines and usually a happy ending:  Finding Nemo, The Lion King, Madagascar, Babe...
Reading groups
Reading groups come in a variety of shapes and sizes. Some form among groups of existing friends or acquaintances; others are set up by organisations as a therapeutic intervention; some groups are open (with new members always welcome and the flexibility to come and go ) ; and others are closed ( once formed they are formed with an unchanging membership and an expectation that members will attend regularly ) . What they all have in common is that a book will be read by all members of the group and then the group will meet to discuss what they have read. A reading group can fulfil many needs – it is an opportunity to spend time with other people with an outside focus ( the book ) which may be less anxiety provoking than something unstructured. It provides an opportunity for deep conversation about important topics that are often 'glossed over' in everyday life, based on the experiences of characters in the book. This can help members touch these issues without having to divulge their own experiences or problems. 
How to keep motivation for reading
Immersion in a book can take you to a place where real life and the symptoms no longer seem so important but this can be difficult if concentration or enthusiasm are affected by illness. Knowing you have a deadline to read the book by can be helpful in both getting or keeping you going. Some groups remain superficial – mainly a social occasion, often with food and drink. Others develop a deeper relationship where it becomes safe to externalise feelings brought up by the material read. 
How to find a reading group
To find a reading group near you ask around – friends, colleagues or professionals may know of groups. Your local library may also know of, or run groups. Local mental health charities may also run groups. In my area there are group run by MIND, a local addictions charity and the women’s resource centre. Your local county council website is a good place to start. In my town we also have an annual book club involving the whole town. A “book for Stevenage” is chosen each year with themed events and opportunities for people to get together and discuss what they have read. It has been a great success creating a “buzz” about reading and a sense of community and shared experience. 
Self-help books
One very specific sort of book is the 'self-help book'. The Oxford dictionary defines self-help as the use of one's own efforts and resources to achieve things without relying on others. 

There are many different self-help movements and each has the help that pits own focus, techniques, associated beliefs, proponents and in some cases leaders. DSN is itself a self-help organisation; working on the premise that a peer support network may provide what professionals cannot, including friendship, emotional support, experiential knowledge, identity, meaningful roles, and a sense of belonging. 
Doctors' Support Network 2016 self-help books mental health
Self-help books cover a wide range of subjects but all tend to focus on aspects of the mind or behaviour that believers in self-help feel can be controlled with effort. Self-help books typically advertise themselves as being able to increase self-awareness and performance, including satisfaction with one's life. Self-help books with a focus on mental health are numerous – typing 'self help mental health' into the search bar produces 3,264 hits! Many organisations produce a 'booklist' of suggested self help books although most concede that what is helpful is very subjective and depends on personal circumstances. 

But do self-help books work?
Self-help hit the headlines in 2004 with the publication of the NICE guide-lines for depression. These suggested that patients with mild depression, health-care professionals should consider recommending a guided self-help programme based on cognitive behavioural therapy (CBT). 
The evidence behind this was reviewed in the British Journal of General Practice in 2005 (ref 1) . The research team concluded: “There are a number of self-help books for the treatment of depression readily available. For the majority, there is little direct evidence for their effectiveness. There is weak evidence that suggests that bibliotherapy, based on a cognitive behavioural therapy approach is useful for some people when they are given some additional guidance. More work is required in primary care to investigate the cost-effectiveness of self-help and the most suitable format and presentation of materials.”  
So we have two conflicting sources of evidence – a paucity of well designed randomised controlled trials versus the obvious popularity of this genre. This is where the lived experience of our network comes in. Although what is helpful is subjective, we can share what has worked for us; and that may in turn benefit others. 
CBT self-help books
I hope to provide an overview of some of the books that are out there, starting with those that are based on cognitive behavioural therapy (CBT). CBT is known to be effective in treating a variety of mental health conditions, as Declan has been outlining in his own series. Many people believe that unlike other therapies the 'essence' of CBT can be distilled and delivered by means other than individual therapy with a fully trained psychologist/psychotherapist. Even the most fervent adherents of this position would agree that such 'CBT based interventions' are not as effective as full CBT but they would argue that these more 'diluted' versions may be enough to help those with less severe illnesses start to recover, and equally importantly avoid relapse in the future. 
CBT self-help books
I hope to provide an overview of some of the books that are out there, starting with those that are based on cognitive behavioural therapy (CBT). CBT is known to be effective in treating a variety of mental health conditions, as Declan has been outlining in his own series. Many people believe that unlike other therapies the 'essence' of CBT can be distilled and delivered by means other than individual therapy with a fully trained psychologist/psychotherapist. Even the most fervent adherents of this position would agree that such 'CBT based interventions' are not as effective as full CBT but they would argue that these more 'diluted' versions may be enough to help those with less severe illnesses start to recover, and equally importantly avoid relapse in the future. 
Doctors' Support Network 2016 CBT books mental health
If you are very unwell and thinking of starting a self help book, please remember that this is likely to be a fruitless task. In these circumstances, you may be better served using 'behavioural activation' as discussed in Declan's article: get out and do something! Perhaps try therapy. 
How to choose a CBT book
Choosing a CBT self help book is a bit like choosing a therapist – you need to find one you can work with. Before committing have a look at what is out there, look inside and consider what it is YOU want to get out of this book, from where YOU are at the moment. If the 'tone of voice' is irritating it is not likely that you will engage with the material. 
Give it a go
If your concentration is affected by illness, remember it may be better to buy a book in easier language or less 'intellectual' than you would usually fancy. Smaller books often help with this. If you already understand the theory of CBT but are finding hard to apply it to yourself, go for something with a work-book format where you have to 'do' rather than just read. Remember that CBT is not just about the cognitive learning, but also about the behavioural 'doing'. 
A CBT based self help book will only ever be one part of what goes into recovery from mental illness. But it is a low risk, fairly low cost intervention (particularly with such books often available from libraries) and as such one that I would highly recommend. 
Reading is a healing experience.

1. Anderson L. Lewis G and Araya R et al. Self-help books for depression: how can practitioners and patients make the right choice? Br J Gen Pract. 2005 May;55(514):387-92. 

Clown improvisation : helping you to care without burning out 

Doctors' Support Network 2016 Dr David Wheeler mental health
By Dr David Wheeler

David Wheeler is a General Practitioner from Greenwich. He started clowning in 1993 in his early days as a GP.  David and his colleague Laura Knobloch facilitated a short introduction to clowning for the 2014 DSN conference.
What is the clown? 
Shakespeare in Twelfth Night comments paradoxically “this fellow’s wise enough to play the fool”, which refers to the court jester who can tell the truth about things. This archetypal clown lives in the moment, is emotionally expressive, vulnerable and naïve, an imaginative storyteller, but one who knows what is real and what is fantasy. Our modern clown is also influenced by the philosophy of Carl Rogers: “Being trustworthy does not demand that I be rigidly consistent but that I be dependably real”. You can trust what a clown expresses emotionally; he/she is not trying to hide behind a social mask. The clown also shows awareness of what is going on around, and is sensitive to whoever and whatever else is there. Like the court jester of old, the clown will hold up a mirror to the world and challenge the accepted norm. 
The Risks of Empathy 
In the past, when I have talked about my experience of clowning I have referred to empathic communication … and if you combine this with caring ... you end up with compassion, which has become the buzz word in the NHS! But this combination appears to lead to a double bind.  The very act of involving myself in the patient’s emotional world threatens to overwhelm me, leading to defensive reactions, which block my ability to respond creatively.  The result?
Emotional exhaustion + cynicism + ineffectiveness = burnout. 
Clowning is an antidote to burnout
The clown can express and play with emerging emotions in a way that we suppress in our daily job.  This ability to play in a clown workshop frees us from being drowned by our emotions and can be a powerful antidote to burnout.  The thoughts and emotions don’t stick needlessly. 
What happens in a Clowning Workshop? 
In a clowning workshop, we start with warm-up exercises and progressively move into improvisation on stage with no script or agenda.  By being receptive to what is there we allow stories to emerge. We can relate this to consultations with patients and their frequently bizarre stories.  On stage it is as much about relationships as it is about the story being told. The clowns connect not only with each other but also with the audience (who are other participants). 
In 2012, I organised a one-day clown improvisation workshop for the Greenwich GP Trainers. The trainers highlighted: 
  • the power of simple actions ( less is more )
  •  the value of slowness or stillness to allow one to take in what is happening 
  • the importance of eye-contact, of being responsive 
  • awareness of our physical presence and how it influences others 
  • an alternative way of being with others 
  • sitting with a problem or an emotion without trying to solve it 
  •  letting go and not pre-judging a situation 
  • to connect with one’s own emotions, notice them and be outside of them 
  • reflection in action as well as reflection on action 
  • being authentic and empathic 
All of these benefits were felt to relate to both consultations with a patient and interactions between learners and teachers.
'Our emotions work subversively under the conversation we are having. It is important that we are aware of them; in clowning we show them, whereas in everyday life we usually suppress or try to hide them.' 
​For information and booking on our next one-day introductory workshop go to and for other courses and info :

Cognitive Behavioural Therapy (CBT)

Doctors' Support Network 2016 Dr Declan Fox mental health
By Dr Declan Fox

Dr Declan Fox graduated from Trinity College, Dublin, in 1979 and flirted with General Practice for ten years until he finally did his GP trainee year.  He was a full-time rural GP principal for seven years until two bouts of work-related depression forced retirement on health grounds.  He now pursues sanity, job satisfaction and work/life balance with GP locum work, writing and various mental health activities including flying the flag for CBT in primary care.  He now does most of his GP work in Canada with locums of up to twelve weeks in Prince Edward Island.  He lives in Northern Ireland with his wife, daughter, one dog and two cats.
March 2009
A brief history of CBT : Prof. Beck to the rescue...
CBT, also known as Cognitive Therapy (CT), was developed by an American psychiatrist, Aaron T Beck, back in the 1950s.  At that time he was engaged in psychoanalysis and was frustrated at his results, or the lack of them, with that type of therapy.  Some of us would say that things haven't changed much in psychoanalysis over the years since then.
Anyway, he wondered if there might be a better way of treating mentally ill patients.
In his book, Cognitive Therapy and the Emotional Disorders, he describes the early observations which led to one of the most powerful anti-depressant tools ever discovered.  Briefly, he discovered the phenomenon known as the negative automatic thought but there was a lot more to his early work.
As he continued working on his new therapy, he took on patients others had rejected as hopeless.  Dr Beck, said his colleagues, these people have no motivation.  How can you hope to work with them?
His reply was that it was his job to help those patients find the motivation to become partners in therapy with him.
From those early beginnings, CBT has grown and grown.  Beck's initial approach has been maintained; that of scientific enquiry, of rigorous testing of hypotheses, of detailed clinical research, of constant questioning of theory and method and results, above all a steady focus on the questions every patient wants answered---will this help me get better?
It is now one of the best-researched treatments in the world and that message has finally permeated both those bodies which advise on NHS treatment (particularly NICE) and those holding the purse-strings (particularly the Treasury).
End result? The UK government recently committed over 300 million pounds over three years to fund a massive expansion of CBT training and services.
But was he the first?
Actually, no.  He wasn't the first to write down the vital principles of CBT although he did it in such a way that the whole world was able to learn from his work.  He also worked in a spirit of scientific enquiry which was probably just as valuable as what he published and finally he got us working in a true collaborative partnership with our patients.
I call CBT the codification of common sense.
 I call CBT the instruction manual for living a well-balanced life.  You all know people who cope extremely well with life's disasters and annoyances without being totally bland or blasé about it?  People who are good human beings, who are in tune with their emotions but not overcome by them?
Chances are those people are using CBT tools on themselves without even realising it.
Anyway, the history of CBT probably starts with the Stoic philosophers.  Epictetus is much-quoted.
He said, "Men are not moved by things but the views which they take of them.”
Think about that for a minute.
He was heavily influenced by Socrates, of whom more anon.  In turn Epictetus was a major influence on Marcus Aurelius, another Stoic, whose Meditations are worth a read.
Marcus said, "If thou are pained by any external thing, it is not this thing that disturbs thee, but thine own judgment about it. And it is in thy power to wipe out this judgment now.”
Think about that for a minute.
Think about the last event or exchange which really upset you.
Was it the event?
Or was it the thoughts and emotions you felt in response to that event?
And what was in your mind to make you have those thoughts and emotions?
Think about this scenario
Two different men in their cars.  Going home.  Caught in traffic.
One gets really upset or angry or worried or annoyed.
The other tunes in a radio station with some good music or puts on a CD, sits back and relaxes.
What is the difference?
Which one would you prefer to be?
Given that no amount of rage will clear the traffic jam?
And what would you have to do to react the way you would prefer to react?
Do some thinking on this, please, preferably with pen and paper.
Introducing some important concepts
Collaborative working
We often talk about collaborative working in CBT but what is it? Is it just another buzz phrase or does it mean something?
Actually, it means a lot. It is a key feature of CBT and without it, the therapy simply does not work well.  It is said that in a good therapy session you should see two people working intensely and actively together and that it should be impossible to tell who is who just from looking at the scene.
It's not just a therapist being nice, empathic or understanding; it's not about walking in the patient's shoes and seeing his world from the inside.  Those characteristics are all important but good collaboration is more about two people working on a problem.
The patient brings the raw data; remember the patient is the expert on his problem.
The therapist brings tools, structure, and an effective way of working... which leads nicely on to one of the most important tools in the CBT armoury---Socratic dialogue.
Socratic dialogue
Socrates said he could not make a man do anything, he could only teach a man to think.  He was inspired by his stone mason father and his midwife mother to describe himself as a "midwife of ideas" who helps people bring forth that which is within.
Socratic dialogue is vital for good CBT; it is one of the essential tools for helping patients find their own answers to their own problems.
What is it though?
Well it has four stages;
  • Asking informational questions,
  • Active empathic listening,
  • Summarising a lot,
  • Asking synthesising or analytic questions.
It has to be underpinned with a genuine interest in the person and his situation, a naive curiosity, making as few assumptions as humanly possible, asking questions because you actually want to hear the answer.
The best one-line definition I have ever heard is "the fine art of holding back."  Having done some basic CBT with patients, I can attest to the enormous value of asking questions and holding back from making assumptions or trying to guide the patient towards what I think is the answer.
Behavioural activation
This is of great value for moderate to severe depression in the early stages of treatment.  Simply put, it is about helping patients do something; get out of the house, go for a coffee, meet a friend, whatever. It involves preparation and planning and problem-solving in advance, it involves a review of the activity and learning from that, then planning a bit more activity next time.  If it sounds easy, it's not!  However, It is very effective and some studies show it is the most powerful initial treatment for depression.
Negative automatic thoughts (NATs)
Professor Beck made many observations of these in his psychoanalytical practice.  Basically these are extremely self-critical thoughts the patient has about himself; they are brief and apparently fleeting and very frequent, occurring perhaps hundreds of times a day.
Without going too deeply into what is a moderately advanced CBT technique, we generally find that depressed patients have a lot of very extreme NATs.  They are a function of distorted thinking styles, they are a product of abnormal cognitive development and they are associated with mood dips.  Get enough mood dips and you don't even notice the better bits in between.  It all seems bad.
A key principle in CBT is that these NATs can be spotted with a bit of tuition and practice, and they can then be challenged in a very logical way.  A successful challenge results in mood improvement.
To give an example of how well this technique works, at this stage I spot and challenge my own NATs almost without noticing. I maybe realise afterwards what I just did.
Doctors' Support Network 2016 CBT Five areas approach mental health
The five areas approach is a very good tool to use when beginning to view your life from a cognitive behavioural perspective. It will help you to separate the different components of any mood state.  

Why not start by practicing a few times over the next three months?  

It is preferable to use the tool AS you are experiencing the mood state but in practice, many of us wait until the end of the day!

Holistic support network

Doctors' Support Network 2016 Dr Lynette Bowden mental health
By Dr Lynette Bowden

Dr Deborah Bowden (left) and Dr Lynette Bowden celebrating the launch of the new website.

Fifteen years ago, together with a friend, I started a charity to share some of the things that had helped me in my journey with physical illness and depression.   
Our original project was a residential centre. We were able to show that our holistic model was helpful through Measure Yourself Medical Outcome Profile evaluation. The centre started when NHS funding was easier to come by, and Cornish mental health services funded the stays of people they sent to us.
Sadly, the residential centre was too expensive to run long term and our charity has subsequently been working to find new ways of helping people with difficulties.
DSN members may have previously read articles about the charity in the newsletter. We have had a couple of name changes; last time my piece was about the ‘Transforming Depression’ CDs, and the charity was then called Penwethers Holistic Healing.

New possibilities and ways forward
Our latest venture is a website of practical self help resources including audio and video clips: We were lucky to have a National Lottery grant to help with the website development. One of the key factors about the resources on our new site is their aim to bring people to a place of hope with the idea that there are new possibilities and new ways forward, also to increase strength and resilience in dealing with life’s day-to-day struggles. The resources are presented in a framework of evidence-based help where possible.

The website resources include tracks from the ‘Transforming Depression’ CD. This CD was piloted in three GP practices with the help of a lottery grant and is now used by GPs and NHS resource centres. I recently received a moving email from a recipient who said the CD had helped to save her life. The original CDs are still available for personal or clinical use: we just ask for a donation to cover the cost of postage. All the resources on the site are free to use on the website and the audio tracks can also be downloaded for a small charge.

Would you like to help?
At the moment most of the resources on the new website are my own work, but everyone is encouraged to contribute strategies that have worked for them. We would welcome involvement from anyone who is interested in helping. 

​Please get in touch via the contact page on the website or email me directly:

Experiencing and exploring mindfulness 

Doctors' Support Network 2016 Dr Elwyn Perry mental health
By Dr Elwyn Perry

Elwyn trained as a counsellor and then spent fourteen years working in Accident and Emergency as a doctor before joining The Healthy Company and training in occupational health. She loves her work as there is time to listen to people's concerns and discuss mind body connections with a view to helping people back into the right working environment where they can thrive.  
How I became interested in mindfulness 
I’ve always been interested in the working of the mind, and over the years I have attended many courses to learn techniques to help control the mind, so that it doesn’t control you. Twenty years ago I trained to teach cognitive behavioural therapy (CBT) courses to help others learn about their minds and how to control them. Three years ago, I took a course in mindfulness and began to use it as part of my practice. Recently, I also started to meditate regularly as a way to help regulate my energy levels. I now find myself calmer, more resilient, and more assertive than before – able to handle crises better and recover from distressing events faster. 

Where does mindfulness come from? 
Clinical mindfulness was initially used in the States, developed by Jon Kabat-Zinn as mindfulness-based stress reduction (MBSR). Mindfulness-based cognitive therapy (MBCT) is a form of mindfulness developed by Dr. Mark Williams and John Teesdale. It has proven to be very successful at relapse prevention for people who have suffered at least three episodes of depression. More recently, MBCT has been adapted to treat anxiety and help with eating disorders. 

What is mindfulness? 
Mindfulness is becoming aware of your thoughts, emotions and bodily sensations. I used to think that I was my thoughts and my emotions, and that I couldn’t do anything about them. Now I have learnt that I am bigger than my thoughts and emotions. I can change my behaviour because I don’t have to act out what they were telling me to do. 

How does mindfulness differ from CBT? 
CBT challenges those same thoughts, it helps you to look at them and replace false negative ones with true thoughts, often much more positive, with an accompanying change in emotions and sensations in the body. 

What part does meditation play? 
Simply, meditation is time taken to sit and observe our thoughts – to go within. If you have spiritual beliefs you might also use meditation as a time to connect with energies outside the body and to draw on their positivity and power. 

How does mindfulness work? 
Mindfulness teaches techniques to develop self -awareness by allowing thoughts, emotions and the sensations that they produce to be there; understanding that if you breathe into them, allow them to be there and don’t fight them, they will actually dissipate and pass. The breath is really important- it can be used in so many ways- to reduce adrenaline, to increase awareness of our bodily state, to help ground us when caught up in strong emotions, and to keep us alive! 

Mindfulness is not for everyone 
It is important to remember that it takes time to become proficient in mindfulness techniques and that not everyone will find it useful. Dr. Mark Williams recommends an eight week programme to build up the techniques. 
I am now an associate trainer with an organisation called ‘Mind at Work’ and am planning to run more courses, particularly for the caring professionals, combining CBT and mindfulness techniques to give them tools to be calmer, happier and more in control of their minds. 

Mood mapping

Doctors' Support Network 2016 Melvyn Bragg presenting Dr Liz Miller with MIND award mental health
By Dr Liz Miller

Dr Liz Miller started DSN with GP Dr Soames Michelson in 1996 and was voted MIND Champion of the Year in 2008 by a public poll.  The photo shows Melvyn Bragg presenting Dr Liz Miller with the MIND Champion award.
'You can’t manage what you can't measure' Peter Drucker
Mood mapping helps people measure and manage their moods. Moods usually have an underlying cause, even if we are not always aware of it. Difficult moods may stem from family circumstances, work or other stresses. Mood mapping came out of my own experiences with bipolar disorder. Aged 29 I was diagnosed with bipolar I. Ten disastrous years later, including three sections, and over a year in psychiatric wards, I finally gained sufficient insight to look for ways to improve my mental health. Ten years ago I appeared in Stephen Fry’s documentary 2006 Secret Life of the Manic Depressive and I remain well and free of medication.
The three steps of mood mapping
  • Measure your mood
  • See what’s contributing to your mood
  • And if you need to, see what you can do to improve your mood
1 – Measure your mood
Mood has two parts, energy and being positive or negative, which gives rise to the four basic moods:
  • High Energy, feeling positive – Action
  • High Energy, feeling negative – Stress & Anxiety
  • Low Energy, feeling positive – Calm
  • Low Energy, feeling negative – Exhaustion & Depression
Doctors' Support Network 2016 Dr Liz Miller Figure 1 mood mapping mental health
Figure 1 The Mood Map
​Draw a cross on a piece of paper.
Score your energy, using a scale for example [-5 to + 5], where +5 represents your maximum energy and -5 or 0 represents the least. Mark your score on the vertical axis.
Score your positivity using a similar scale [-5 to +5] on the horizontal axis.
These scores combine to give your mood point. Record your Mood changes over the day, and from day to day.  
Doctors' Support Network 2016 Dr Liz Miller Figure 2 mood mapping mental health
Figure 2 Measuring your mood
2 – Contributions to your mood
Five key areas contribute to mood.
These are:
  • Surroundings and home environment
  • Physical Health, e.g. Diet and Exercise
  • Social networks and Relationships
  • Strategies, Knowledge and Experience e.g. Cognitive Behaviour Therapy, financial expertise, medical knowledge
  • Autonomy - including authenticity, self knowledge and self-expression
Score yourself from 1 – 5 in each area. This may show where your problems lie and which area needs most work.
3 –Improve your mood 
Once you know how you feel, you can work on strategies to improve your mood. From listening to music, going for a walk in the park, or phoning a friend. And for the longer term projects such as a different career and better social networks may help keep you on track.
By building discipline when you are well, it becomes easier to act when you are not so well. It is also true, that when you are not well even the smallest steps are great achievements.
For me, it is important to act before my mood gets out of hand. 'Kill the monster while it's small' tackling a small depression before it becomes paralysis. Once your mood gets stuck in the red zone, it can be difficult to manage it without outside help.
Doctors' Support Network 2016 Dr Liz Miller Figure 3 mood mapping mental health
Figure 3 Moodmap Zones
Contact Liz if you have any further questions about mood mapping:
Mood mapping by Dr Liz Miller (MacMillan 2009) ​

If you wish to purchase Mood mapping using the link on the right then DSN will receive a small commission at no extra cost to you.

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