Space From Anxiety - CYP

The Space from Anxiety programme has been designed to relieve the symptoms of anxiety in young people by:

• Focusing on developing more flexible ways of thinking 
• Increasing awareness and understanding of emotions 
• Tackling avoidance and encouraging graded exposure to feared situations

The Space from Anxiety programme has been designed to be used by young people aged 15 and over. It  can  also be  used  with  a  younger  age  group  in  line  with CAMHS protocols and clinical judgment.

After the Welcome and Getting started sections, users have control over what aspects of the program they wish to focus their time on. This can be guided by your support, to ensure they make the most from the program and use the change method tools it contains with a sufficient dose.

Space from Anxiety gives users a better understanding of the connection between their thoughts, feelings and emotions, as well as providing them with the tools that can improve problems in each of these areas. The programme helps them to feel stronger in a safe, confidential environment.

Space from Anxiety consists of 7 modules whose structure and content follow evidence-based principles of traditional, face-to-face, Cognitive Behavioural Therapy (Beck, 2005; Ellis, 1962, 2001;Hyland & Boduszek, 2012) and incorporate values of mindfulness practice (Ma & Teasdale, 2004). The contents of each module are briefly described in the table below.

Understanding Anxiety	This module aims to improve the user’s understanding of anxiety while introducing them to the concept of Cognitive Behavioural Therapy and the CBT cycle.
Noticing Feelings	In this module, users explore the different aspects of emotions and physical reactions, and how they are all connected.
Facing your Fears	Here, users learn about the role of avoidance in maintaining fears and anxiety, recognising safety behaviours, and how to face their fears using graded exposure.
Spotting Thoughts	‘Spotting Thoughts’ focuses on the ‘thoughts’ component of the TFB cycle and introduces the client to negative thinking and its impact on symptoms of anxiety.
Challenging Thoughts	This module focuses on taking action against negative thoughts and thinking traps. The client is introduced to Hot Thoughts and their impact on anxiety. This module helps the user to tackle overly negative thinking patterns using cognitive restructuring techniques.
Managing Worry	This module introduces users to the role of worry in anxiety. They will learn how to cope with and manage their worry more effectively.
Bringing it all Together	In this final module users are given the opportunity to explore how they can bring together all the skills they have learnt throughout the programme, and make a plan for staying well in the future.

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Additional Content

Several “locked” mini modules are also available and allow for further tailoring of the programmes to more fully meet the needs of the user. They can be “unlocked” for the user by the supporter as they see fit across programmes. The mini modules include:

Managing Study and Exam Stress: helps users to establish a study routine and handle stress around exams. 

Getting Active and Eating Well: helps users focus on their overall health by eating well and becoming physically active.

Sleeping Better: helps users to understand sleeping difficulties and develop a healthy sleeping routine.

Friendships & Social Groups: helps users learn how to make and maintain good friendships.

Getting on with your Family: helps users learn how to manage conflict and improve family relationships.

My Self-Esteem and I: helps users to understand the impact of self-esteem on their mood and ways to improve their self-esteem.

Relaxation: helps users to learn techniques and strategies for relaxation.

Core Change Methods

It is important that the user attributes change to the effort that they are making, putting the tools into action in their daily lives. It isn’t the time spent on the programme alone that gets the user well. The core tools need to be utilised regularly and repeated, for them to get the most from them.

Have a look at the CBT Basics module to see how these change methods fit within the overall framework of CBT.

CBT Cycle 

The CBT Cycle is a central tool in the SilverCloud toolbox.  It is based on the core concept of CBT – that when we feel a certain way, there are thoughts, behaviours and physical body reactions associated with that feeling. All of these things can occur seemingly simultaneously, and feel like one big cloud of negativity.

This is where the CBT cycle tool comes in, it helps your users to separate out the different things that are contributing to (or caused by) how they are feeling. This can bring clarity and a sense of control – now they know what is happening, they have the power to change it!

Have a look at the sections below for more information on each component of the CBT Cycle.

Situation/Trigger Event

Triggers for emotions can be internal, like a thought or physical symptom, or an external situation or event. They can also be a once off occurrence or a situation which occurs frequently.

It can be easier for a client, particularly at first, to fill out their CBT cycles when they are experiencing strong emotions, triggered by a particular situation or event. This makes the whole cycle more distinct, and it will be easier for the client to understand the link between the different areas.

Emotions

Naming the emotions elicited by the situation/trigger event is a crucial step in the CBT cycle. Users can rate the intensity of each emotion from one to ten, helping them to recognise that emotions can vary greatly in strength and impact. This in turn will help them to become more aware of subtle changes in their mood.

Physical sensations

There is a complex relationship between the physical body and mood. Sensations in our physical bodies, such as butterflies in our stomach or tired, heavy limbs, can influence the emotions we experience. Equally our emotions can also generate physical outcomes that we feel in our bodies, i.e. muscle tension due to stress or anxiety.

Behaviours

We all engage in hundreds of behaviours each day. Our behaviours include what we do and the actions we take, but also what we do not do or what we avoid. The term 'behaviour' can refer to things that have a beneficial effect on our mood, as well as things that have a negative impact.

Thoughts

Unhelpful or negative thoughts often accompany negative emotions and behaviours. This can be things we think or believe about ourselves, the world, or other people.

The thoughts component of the CBT cycle is key. Once the user has completed a number of CBT cycles, they will begin to see the patterns in their negative thinking. Noticing their thoughts can help them with two things:

• Weakening their belief in these thoughts by labelling them as thinking traps (Spotting Thoughts module)
• Capturing their ‘hot thoughts’ – the ones that have the biggest emotional impact (Challenging Thoughts module)

Cognitive Restructuring with the CBT cycle

When the client gets to the Challenging Thoughts module, new functionality is unlocked in their CBT cycle tool. They can now: identify their hot thought, consider the evidence for and against this thought, and create a more balanced alternative thought.

Coming up with alternative thoughts can take some practice, but it becomes much easier the more the user does it. Remember, as a supporter, your role is to encourage and motivate the user to complete these activities. It is important to remind them to take some time to reflect on the impact of these thoughts on their behaviour and feelings.

Ladder of Fears

This tool encourages users to work towards overcoming a particular fear, using a gradual, step-by-step approach:

1. Identify a target goal that they want to work towards by overcoming their fear.
2. Break the achievement of the goal into smaller steps. The user can add a number of steps to the ladder, each one representing a distinct situation or task, that would help them come closer to their goal.
3. Arrange the steps from ‘most feared’ at the top to ‘least feared’ at the bottom.

You can help the user to work through this tool by encouraging them to set clear but manageable goals for what they want to achieve.

It is important to remember that: 

• If they don’t complete the task it is still a learning opportunity.
• They will be able to go at their own pace and move onto the next step when they feel completely comfortable with their current step.
• It may be necessary to break more difficult steps down into smaller more achievable ones.

A best practice response in relation to this tool is below:

"Well done for working on your ladder of fears again this week. You seem to be much more comfortable going outside than you were when you started this task. Do you think you are ready to move up to the next step on your ladder? It is really important that you are comfortable with this step before moving on to the next one, so only move up if you feel ready."

Worry Tree

The Worry Tree tool helps clients to understand how to deal with their worries, by breaking them down into two categories – practical worries, and hypothetical worries.

Practical worries are usually based on practical problems that require action. We often worry about things that we need to do something about. If the worry is real, the client can use the Problem Solving tool to brainstorm solutions and decide on a course of action.

Hypothetical worries are worries that we can’t do anything about. These worries are around things that could possibly happen, but there is no evidence to say that they definitely will happen. The best way to deal with hypothetical worries is to try and let them go. The Worry Time technique and Staying in the Present audio guides can both help with this.