Understanding Self-Help within the Stepped Care Model
The NHS in the UK promotes a ‘stepped care’ model for mental health treatment, where each step corresponds to a level of support, starting with self-help as the foundation. Think of it as climbing a staircase, beginning with the most accessible and manageable steps. Self-help is about taking those initial steps towards feeling better, and from my experience working both in the NHS and in private practice, these early interventions can often have a significant impact. However, if self-help isn’t enough, the next steps might include group therapy or working directly with a therapist.
For anyone looking to explore self-help, organisations like Mental Health Ireland, the HSE, or Mind UK provide excellent resources to get started.
What is Self-Help?
Self-help is about equipping yourself with tools and techniques to manage your mental health at your own pace. In my clinical work, I often describe self-help as learning to be your own therapist. Here are some practical forms of self-help I’ve found effective for my clients.
Reading
Books can be powerful tools for understanding and managing mental health. For example, a client once shared how Mind Over Mood by Greenberger and Padesky helped her apply CBT techniques to reframe unhelpful thoughts. If you’re struggling with low mood or anxiety, this book provides step-by-step guidance to challenge negative thought patterns.
Tip: Look for books recommended by trusted professionals or endorsed by reputable organisations like the RoyalCollege of Psychiatrists.
Joining Support Groups
Connecting with others who share similar challenges can provide a sense of belonging. I’ve seen clients flourish after joining local support groups for social anxiety. One client, for instance, began by attending an online forum through Anxiety UK and later transitioned to in-person meetings, where she built confidence in sharing her experiences.
Using Online Programmes and Apps
Structured online programmes, particularly those based on CBT, can be incredibly effective. For instance, SilverCloudoffers evidence-based programmes often recommended by the NHS. I’ve seen clients with mild anxiety benefit from the structured approach these programmes provide.
Lifestyle Changes
From my experience, lifestyle adjustments can make a profound difference. One client struggling with insomnia and anxiety found that a combination of regular morning walks and reducing caffeine intake dramatically improved his mood and energy levels. Research backs this up—physical activity and healthy eating are consistently linked to better mental health outcomes
Self-Help for Specific Challenges
Panic Attacks
Panic attacks are sudden episodes of intense fear and physical symptoms, such as a racing heart or difficulty breathing. Self-help strategies include:
- Grounding Techniques: A client once described feeling overwhelmed in crowded places. We practised a grounding exercise where she focused on her senses—naming five things she could see, four she could touch, three she could hear, two she could smell, and one she could taste. This simple exercise helped her regain control during a panic attack.
- Breathing Exercises: Diaphragmatic breathing (or “belly breathing”) can calm the body’s fight-or-flight response. I often recommend the 4-7-8 method: inhale for four counts, hold for seven, exhale for eight.
- Lifestyle Adjustments: Clients who experience frequent panic attacks have found reducing caffeine and alcohol consumption beneficial. Maintaining a consistent sleep routine also helps regulate the body’s stress response.
Obsessive-Compulsive Disorder (OCD)
OCD involves persistent, intrusive thoughts (obsessions) and repetitive behaviours (compulsions). Effective self-help strategies include:
- Exposure and Response Prevention (ERP): In both my NHS and private practice work, I’ve guided clients through ERP exercises, such as touching a “contaminated” object without washing their hands immediately afterwards. This gradual exposure reduced their anxiety over time.
- Thought Challenging: A client with intrusive thoughts of harm learned to question the validity of her thoughts, recognising them as just thoughts rather than facts. For example, she reminded herself, “I’ve never acted on these thoughts before, and they don’t align with my values.”
- Mindfulness: Mindfulness helps clients observe their obsessions without judgement. Apps like Headspace or the book The Happiness Trap by Russ Harris are great tools to get started.
Health Anxiety
Health anxiety involves excessive worry about having or developing a serious illness. Self-help strategies include:
- Limiting Reassurance-Seeking: I once worked with a client who compulsively googled symptoms. We created a rule to delay any online health searches by 24 hours, which reduced her anxiety significantly.
- Cognitive Reframing: When faced with thoughts like “This headache must be a brain tumour,” replace them with more balanced perspectives, such as “Headaches are common and usually harmless.”
- Focus on the Present: Mindfulness and relaxation techniques, such as progressive muscle relaxation, can help shift focus away from health-related worries.
Emotional Regulation
Learning to identify and manage your emotions is a foundational skill for maintaining good mental health. Emotional regulation isn’t about suppressing emotions but understanding and responding to them in a healthy way.
Identify Your Emotions
I often encourage clients to notice how emotions manifest in their body and behaviour. For example, a client described feeling a tight chest and clenched fists whenever she was angry, which helped her recognise and address her anger before it escalated.
Develop Coping Strategies
Managing intense emotions requires trying different strategies to find what works for you. For example, a client overwhelmed by anxiety found deep breathing and progressive muscle relaxation helped calm her physical symptoms, while listening to music or stepping outside for a walk gave her the emotional distance needed to process her feelings.
Seek Support
Sharing your struggles with a trusted friend, family member, or therapist can provide perspective and emotional relief. One client found that calling a close friend during moments of sadness helped her feel heard and validated.
Cognitive Restructuring
Cognitive restructuring is a transformative technique that helps identify and challenge negative thought patterns.
Identify Negative Thoughts
Start by paying attention to your internal dialogue. A client struggling with self-doubt frequently caught herself thinking, “I’ll never be good enough.” Together, we worked on recognising these unhelpful patterns as they arose.
Challenge Your Thoughts
Ask yourself:
- Is this thought based on facts or assumptions?
- What evidence supports or contradicts it?
Replace Negative Thoughts
For instance, a client who often thought, “I’m terrible at everything,” replaced it with, “I’ve faced challenges before and succeeded. I can try my best again.”
When to Seek Professional Help
While self-help can be incredibly effective, there are times when professional support is essential. If your symptoms are severe, worsening, or impacting your daily life, seek help from a licensed therapist or your GP.
Resources like Psychology Today or the BACP can help you find a professional near you.