A First Steps guide to

Emotional health and

respiratory
conditions

First Steps, Version 1, May 2014

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Emotional health and respiratory conditions

Using self-help tools

The strategies/tools suggested in this booklet are evidence based methods of managing
emotions and reducing the effects the way that we feel has on our everyday life. We are all
individuals and respond to situations in different ways therefore not every tool will work with
everyone. For example some people find meditation and reading really relaxing, whilst for
someone else this could be a cause of stress and their preferred relaxation method is to go
to the gym. There are no set rules for managing emotions. A helpful way of thinking about
this could be to think is my current method working for me? If the answer is yes, then great,
but if not, these strategies may be an alternative way that is more productive for you.
As with any new skill, self-help can take time and practice. In the same way that reading a
cookery book will not instantly make you a great cook, simply reading this material will not
make you instantly happy and healthy. But with time, practice and exploration it is possible
for everybody to experience emotional well-being. Self-help alone may not be adequate for
everybody. If you feel that you need more support, it is important to discuss this with your
GP. In addition there are a number of helpful resources at the back of this booklet or you
could call our phone line or email us for more information/advice.

Here at Virgin Care we are keen that this information is shared as widely as possible to help support
anyone who might benefit from it. However, can we remind you that it is subject to Copyright
Legislation so please do let us know if you plan to reuse or reproduce any of the content
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Emotional health and respiratory conditions

What is in this booklet?

Page
Introduction

Lung conditions and stress

What causes stress?

The stress jug analogy

How does stress affect someone?

Strategies for reducing stress

Lung conditions and anxiety

10

What causes anxiety?

10

How does anxiety affect someone?

11

Breathing control

11

Lung conditions and depression

12

What is depression?

13

What causes depression?

13

How can depression affect someone?

14

The cycle of low mood

15

Challenging unhelpful thinking

17

Challenging unhelpful behaviours

20

Setting goals

22

Other ways to improve emotional well-being

23

Physical activity and healthy eating

23

Eating a healthy diet

23

Foods to limit in your diet

25

How to get a good nights sleep

27

Social supports

29

Useful contacts

30

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Emotional health and respiratory conditions

Introduction
Living with a lung condition can be difficult and stressful. As well as having difficult physical
symptoms that you must learn to cope with such as breathlessness and coughing, you may
also experience more tiredness and may find that you are less active than before your
diagnosis.
Lung conditions can also affect you in ways that you may not have thought about previously.
For example, it may affect your ability to get a good nights sleep, you might find that you are
not eating as well as you once used to, and this may lead to feelings of agitation,
hopelessness and worry. You might also feel concerned about the future and how your
condition will progress.
Feeling like this over a long period of time can lead to some people feeling stressed,
depressed and/or anxious. The aim of this booklet is to provide you with an introduction of
what stress, depression and anxiety are, and how you can use some self-help techniques to
manage and improve your emotional health. One in four people in the UK experience a
mental health problem at any one time, so remember that you are not alone, and there is a
lot of help and support if you require it.

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Emotional health and respiratory conditions

Lung conditions and stress

Stress is a condition or feeling that is experienced when a

person perceives that demands exceed the personal and
social resources the individual is able to mobilise.

Everyone experiences stress at certain times in their lives and few of us manage to keep it
under control all the time. It can come from both inside or outside of ourselves.

Inside These can include feelings and attitudes such as wanting to succeed, to be
liked or to make other people happy. These pressures can make you feel worried or
angry and sap your energy. Moderate levels of stress can improve our ability to
perform our daily tasks but high levels make it difficult to think properly and can makes
us feel physically unwell.

Outside Stressful events can happen at any time. They include moving house,
getting married, being made redundant, starting a new job, unexpected health issues,
divorce, death of a loved one, difficulties in relationships etc.

What causes stress?

Imagine the following two situations.
1. You have some spare time so decide to pop to the shop
for some food. When you get into the car, it fails to start
2. You have a meeting with your boss at work this morning.
When you get into the car to leave for work, it fails to start
The event is the same for both i.e. the car will not start; however, the way that the person
feels about both of them is likely to be quite different due in large part to the beliefs attached
to these two different scenarios.

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Emotional health and respiratory conditions

The stress jug analogy

As humans, we only have a certain capacity for managing
stress. Imagine that all of your stress was in a jug. The fuller
your jug is, the greater the symptoms of stress will be. Once
the jug is full, your ability to manage any situation that arises is
greatly compromised, which is why you may feel less able to
cope with matters that would normally have no effect on you.
Some of your jug will already be filled with the anxieties of life
that we cannot avoid, (i.e. money, illness, family, not having
enough time for yourself, etc). Therefore, if you have a large
source of stress in one area of your life that is filling your jug,
your capacity to manage stress in the other areas will be
compromised. You may feel that you manage your stressful job very well, for example, but
feel that you are unable to cope with any stresses at home or vice versa.
If you partially empty your jug on a daily basis, you can avoid it over-flowing which will help
you to reduce your symptoms and to feel more in control. It may be that you are unable to
change the main contributor to your stress, but if you can do something about your other
sources of stress, you will feel better able to cope.

You can empty a little out of your jug on a daily basis by using self-help techniques to:

Look at your stressors to see if there is anything you can do to reduce the level of stress
they produce or if you could manage them in a different way

Identify if the stressful situation is really your responsibility. If not, could it be delegated
to someone else or could your energy be better used elsewhere?

Have time to relax. This may be by completing a relaxation routine, playing a sport or
socialising, etc

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Emotional health and respiratory conditions

How does stress affect someone?

These are the common symptoms of stress. However, it is important to remember that stress
affects everyone in different ways, so try to notice what your stressors are so that you can
use a technique to reduce the effects.

Cognitive symptoms

Memory problems
Indecisiveness
Inability to concentrate
Trouble thinking clearly
Poor judgment
Seeing only the negative
Anxious or racing thoughts
Constant worrying
Loss of objectivity
Fearful anticipation

Physical symptoms

Headaches/backaches
Muscle tension/stiffness
Diarrhoea/constipation
Nausea/dizziness
Insomnia
Chest pain/rapid heartbeat
Weight gain/weight loss
Skin breakouts (hives, eczema)
Loss of sex drive
Frequent colds
Hot flushes

First Steps

Emotional symptoms

Moodiness
Agitation
Restlessness
Short temper
Irritability or impatience
Feeling tense and on edge
Feeling overwhelmed
Sense of loneliness and isolation
Depression or general unhappiness
Low self esteem

Behavioural symptoms
Eating more or eating less
Sleeping too much or too little
Isolating yourself from others
Procrastination, neglecting responsibilities
Using alcohol, cigarettes or drugs to relax
Nervous habits (e.g. nail biting, pacing)
Teeth grinding or jaw clenching
Overdoing activities (e.g. exercising,
shopping)
Overreacting to unexpected problems
Picking fights with others

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Emotional health and respiratory conditions

Strategies for reducing stress

Equipping yourself with some useful strategies and tools can be
helpful in managing times of stress.

Establish the root of the problem (if possible) and tackle

this rather than the consequences. Is your core belief
fuelling some of the stress or is there an underlying problem that is triggering events
or situations?

Take control
Quite often you cannot control or change an event or situation, but you can always
control your actions/reaction to it. Channel your energies into the element of the
situation that you can control and do not ruminate on the elements that are beyond
your control

Ask for support

This could be from friends or family, a colleague or from an
external service (see resources). This could be for a number
of reasons including to ask for another persons
perspective/ideas or for help with the tasks that are causing
you to feel stressed

Keep your expectations of yourself realistic

What would you say to a friend in a similar situation? Quite often our expectations of
ourselves are far higher than those we would expect of others. Thinking of advice you
may give to a friend if they were in a similar situation can be helpful

Set boundaries
Be realistic about what you can achieve and communicate
this with those involved. Unrealistic expectations will reduce
what you are able to do and increase your stress. Keep
boundaries around leisure and pleasure as these are often
the areas we neglect the most

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Emotional health and respiratory conditions

Communicate effectively
Talk to family, friends or colleagues. Sharing your thoughts
and fears will increase their awareness and they may have
helpful suggestions. It can also reduce the likelihood of
situations being misinterpreted and help you with feeling
valued and listened to. Learn to be more assertive and
how to say no

Try not to take the situation personally

Keeping an objective view can help to resolve the problem and will reduce the
emotional impact that it has on you

Reflect on positives, not dwell on negatives

We often find ourselves focusing on the things that have not gone so well. This can
cause us to hold a more negative view of our situation/ lives. Taking time to reflect on
the things that are positive in our lives will help us to maintain a balanced view. Focus
on the progress you have made.

Manage your time

Use structured prioritisation to make the most of your time.
Try scoring activities or writing lists of pros and cons. Make
time for breaks and physical activity as these are the things
that can reduce stress, but are often not done when you are
feeling stressed

Look after yourself (see page 17)

Exercise, diet, relaxation, etc. will all affect your ability to manage stress. Make time
for family, friends and hobbies

Environment
De-clutter your environment by filing, using note books, diaries,
etc. This can help you to feel calmer and may save time in the
long run. This may be at home or at work

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Emotional health and respiratory conditions

Lung conditions and anxiety

As well as experiencing physical symptoms, some people with lung conditions may
experience symptoms of anxiety. Anxiety is a normal healthy reaction experienced by
everyone at one time or another. It is our survival mechanism known as the fight or flight
response. It is simply the body preparing for action either to fight danger or run away from it
as fast as possible. Anxiety becomes a difficulty when the response is triggered by events
that pose no real threat to us. Our survival mechanism dates back to our cave man days and
our bodies still react today in the same way as our ancestors did thousands of years ago.
However, our threats have changed considerably. Most threats in modern life can not be
fought or run away from, so the symptoms are not helpful. In fact they often make us feel
worse, especially if we dont understand them.
People often become anxious in difficult situations, like when taking an exam, moving house,
having an interview or going to the dentist. These feelings of anxiety usually go away.
Sometimes they can even be useful, making us more alert and improving our performance.
But if these feelings start to take over and become a big part of our lives, they become a
problem.

What causes anxiety?

Lots of things can ultimately cause anxiety, and it is important to remember that because we
are all individuals, everyone will react to different situations in an individual way. For some of
us, anxiety may start because of a long and slow build up of stressful events that have
happened over a period of time. It can also start when we feel that we no longer have control
over our lives, a common reason for people who have a lung condition. This may make
someone feel anxious about their health in the future, for example.
However, for some of us, there may be no real reason why we have started to feel anxious. It
is important to remember that in these cases it could be as a result of the side effects of
certain medication, or simply because we have not allowed ourselves enough time to think
about the circumstances that caused our anxiety. Having a lung condition can also feel
similar to physical symptoms of anxiety, or can make existing anxiety feel even worse. For
example, a common symptom of anxiety is experiencing chest tightness, and this will feel
worse if you have an existing lung condition.
It's not always clear what is causing anxiety. Sometimes, you can just be aware of feeling
anxious all the time. When you can't understand why you're anxious, this can create a
downward spiral: you can become anxious about feeling anxious. This makes you more
anxious, and so on.

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Emotional health and respiratory conditions

How does anxiety affect someone?

As we are all individual, we will all have an individual response towards anxiety. Here is a
table of common symptoms someone may have when experiencing anxiety:
Thoughts and beliefs

Physical reactions

Moods

Behaviours

Overestimation of
danger

Sweaty palms

Nervous

Avoiding situations where

anxiety may occur

Underestimation of
ability to cope

Muscle tension

Irritable

Leaving situations where

anxiety begins to occur

Underestimation of help Racing heart

available

Anxious

Trying to do things
perfectly

Worried and
catastrophic thoughts

Panicky

Trying to control events to

prevent danger

Pains in chest

It is important for you to recognise your symptoms and any early warning signs you have
when you might be feeling anxious, so that you are able to reduce your symptoms.
Panic attacks
Some people may experience panic attacks. A panic attack is a sudden overwhelming
feeling of anxiety, and you may feel like you cannot breathe, and you may experience chest
pains, feel faint, or like you are going to pass out. Some people have said that a panic attack
feels like they may be having a heart attack. It is important to remember that if you feel
unwell at any stage, to ask for help from anyone who is around you. Try to control your
breathing for yourself. A panic attack can last for up to 30 minutes, but it can be reduced if
you are able to focus on controlling your breathing.

Breathing control
An important exercise that you can use to help reduce feelings of anxiety is through proper
breathing. It is important to always take the advice of your GP or other health specialist
before you decide to take up this activity because of your lung condition.
The following breathing exercise has been taken from the British Lung Foundations
information page on breathing control for those with a lung condition. The exercise below
does not apply if you have Chronic Obstructive Pulmonary Disease. If you have this
condition and would like more information on conducting breathing exercises, please visit the
British Lung Foundation website (www.blf.org.uk) and request their COPD: Living with
chronic obstructive pulmonary disease leaflet.

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Emotional health and respiratory conditions

There are five simple steps for controlling your breathing:

1) Breathe out first. At the first signs of panic or the first worrying thought about a physical
symptom, empty your lungs as much as you can. Breathe out so that you feel that there's
plenty of room to take a full, deep breath.
2) Breathe through your nose. This automatically slows down your breathing and helps
you to avoid hyperventilating.
3) Breathe deeply into your abdomen. Put one hand on your stomach, the other on your
chest. Breathe so that the hand on your stomach moves, while the one on your chest is
nearly still. By directing the breath deep into your abdomen, you stretch your diaphragm
and relax tight muscles that make it seem hard to breathe.
4) Count while you breathe. Breathe out first, then breathe in through your nose, counting
"One two three". Pause a second, then breathe out through your mouth, counting
"One two three four". The counting protects you from rapid, panicky breathing.
Make sure you breathe out for one beat longer than you breathe in. This will help you
empty your lungs between breaths.
5) Slow your breathing by one beat. Breathe in and count, "One twothree four".
Pause, and breathe out, counting, "One two three four five". As always, you
breathe out one beat longer than you breathe in.
If you are able to take a break and control your breathing at the first signs of anxiety, then
you can very often prevent yourself from experiencing overwhelming anxiety. It is important
to practice breathing exercises at a time when you are not feeling anxious, so that you are
practiced in using them if you ever do need to.

Lung conditions and depression

Statistics indicate that someone is more likely to experience depression if they have a
chronic lung condition. Although this may be alarming, it is important to remember that if the
signs and symptoms of depression are recognised early, treatment is much more successful.
Due to the nature of the condition, lung disease can affect every aspect of your life. Because
of this, it is more likely to affect your self confidence and your ability to do things that you
were once able to do. Although it is normal to feel sad or upset about having a lung
condition, it is important to try and counteract these feelings of sadness so that you do not
feel like you are trapped in a constant cycle of negativity. If you find that you are, it can
actually hinder your lung condition and your ability to find coping mechanisms, which can
potentially lead to you feeling lower.

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Emotional health and respiratory conditions

What is depression?
The terms depression and low mood are often used interchangeably. However, depression
is a diagnosable mental illness; whereas low mood describes an emotional state.
Depression is diagnosed by the following:
If you have experienced 1 of the following symptoms,
most of the time, for over 2 weeks
Low mood or sadness

Loss of interest or pleasure

And at least 4 of the following symptoms:

Sleep disturbance - either falling asleep or early morning wakening

Either a loss or increase in appetite
Difficulty concentrating
Slowed functioning (either thinking, talking or acting slower than usual) or
agitation
Lower sex drive
Less energy
Loss of self-confidence or self-esteem
Thoughts of death or suicide
Feelings of guilt

What causes depression?

Although depression can be triggered by your lung condition, quite often there is no obvious
cause or reason for it. However, if you are depressed, the feelings of sadness that we all can
experience from time to time will be more intense and will last for a much longer period.
Depression in itself can leave you feeling disconnected from your life. It can also leave you
feeling like you have less energy to do things, and can make you feel hopeless about the
future. Because of this, you may be less likely to take care of yourself as you would if you felt
ok. For example, some people find they may not eat the same types of food, or they may
start to eat too much or too little. You also may withdraw from any social activities you take
part in, with the thought that you will start to do them once you feel better.
Low mood and depression in its mildest form does not stop someone from leading their
normal life, but it makes everything seem harder and less worthwhile. If your depression is
severe, it can seriously affect your ability to function on a daily basis, and some people feel
so bad that they find themselves feeling that life is not worth living. Whilst these thoughts can
feel very frightening it is important to remember that they are quite common for someone
who feels depressed. If you do feel like this, it is very important that you seek help from your
GP or if you feel that you are in imminent danger, the emergency services.

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Emotional health and respiratory conditions

How does depression affect someone?

The way we think
Difficulty in making decisions
Difficulties in concentration and
memory
Feeling worthless
Suicidal thoughts
Self doubt

Feeling inadequate
Self criticism
Negative thoughts
Ruminating (keep going over the
same thoughts in your mind)
Thoughts of death

Angry
Numb
Guilt

Never feeling 100%

Aches and pains
Decreased or increased appetite
Loss of energy/ always feeling tired
Restlessness and agitation
Tearful

Avoiding decisions
Poorer performance
Letting people walk over you
Agitation
Frequent crying
Irritation/aggression

The way we feel emotionally

Sad
Hopeless
Irritated

The way we feel physically

Weight gain
Weight loss
Sleep disturbances
including early
morning waking,
waking during the night and
difficulty getting to sleep

The things that we do

Losing interest and enjoyment in
activities you previously enjoyed
Difficulty doing everyday tasks
Withdrawal from friends/family or
life in general
Drinking/smoking more

Everybody is different and will react to depression and low mood in different ways.
It is proven that some people, particularly men, will not feel sad or tearful and their
main symptom may be physical or feeling angry or frustrated.

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Emotional health and respiratory conditions

The cycle of low mood

We already know that when a person feels low in their mood they are likely to have
decreased energy, lack of motivation and decreased interest in previously pleasurable
activities. However, imagine a time when you were generally feeling happy and healthy. How
would you have felt if you were unable to spend time with friends/family, exercise or spend
time doing your hobbies or interests? For most people, being unable to do the things that
they enjoy leads them to feeling low and unhappy. Therefore, depression and low mood can
become self-fulfilling. We often feel that we will do what we enjoy when we feel better.
However the reality is we will not feel better until we do the things that we enjoy.

I will do what I enjoy when I feel better

I will feel better when I do what I enjoy

Our thoughts, feelings (physical and emotional) and behaviours also feed in to each other.
The following model is a useful way of looking at the different aspects of your low mood.

Life event

Thoughts

Emotional
symptoms

Physical
symptoms

Behaviours

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Emotional health and respiratory conditions

Pauls example

Event
Too breathless to mow the lawn. Reluctant to
ask son for help

Thoughts

I should be able to do this

I dont want to burden my
family
Im useless

Emotional symptoms

Physical symptoms

Frustrated
Angry
Worried

Faster breathing
Tension
Lethargy

Behaviours

Isolates self and becomes

withdrawn
Stops communicating with
family

Because of the thoughts that Paul has and the way he is feeling, his physical symptoms
worsen and this results in him behaving out of character. Because of the way he has
behaved, this is likely to impact his mood even more, and therefore there is a real risk that he
might become stuck in a cycle of negativity. However, there are many ways in which he can
improve his emotional well-being, through challenging his unhelpful thoughts, finding ways to
reduce his physical symptoms, and through monitoring his behaviour.

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Emotional health and respiratory conditions

Challenging unhelpful thinking

Events themselves do not cause us to feel upset or depressed. It is our beliefs about these
events that determine our emotional reaction. We have a tendency to think If I think these
thoughts, they must be true.
However, when we feel low in mood we are more likely to focus on negative things from the
past. We become really good at ignoring any of the positive, and then wonder why we are
depressed.
Unhelpful thoughts pop into our minds so quickly that it is often difficult to spot them. Think of
it this way, we dont get to choose whether or not a bird lands on our heads. We do get to
choose, though, whether or not it makes a nest.
This is true of our thoughts as well. Just because we think a thought, does not mean that we
have to believe it or continue to think about it!
When we experience depression, we tend to think in any or all of the following ways. How
many apply to you?

All or nothing thinking. Thinking in

absolutes, black and white, or good
and bad with no middle ground and a
tendency to judge people or events
using general labels, eg. Hes an idiot,
Im a failure

Negative focus. Ignoring or

misinterpreting positive aspects of a
situation. Focussing on your own
weaknesses and forgetting your
strengths
Living by fixed rules. Fixed rules and
unrealistic expectations, regularly using
words such as should, ought, must
and cant, leading to unnecessary guilt
and disappointment. The more rigid
these statements are, the more
disappointed, angry and depressed you
are likely to feel

Catastrophizing. Overestimating the

chances of disaster, eg. whatever can
go wrong will go wrong or a set back
being part of a never-ending pattern of
defeat
Jumping to conclusions. Making
negative interpretations even though
there are no definite facts. Also making
negative predictions about the future

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Personalising. Taking responsibility

and blame for everything that goes
wrong

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Emotional health and respiratory conditions

Challenging our thinking can be a difficult skill to learn, but for most people is an effective
way of improving our mood. The following techniques may be helpful.

Keeping a thought record

Keeping a thought record can be helpful in identifying patterns of negative thoughts.
1. Situation: Who were you with? What were you doing? When was it? Where were you?
2. Unhelpful thoughts: What was going through your mind just before you started to feel this
way? What images or memories do you have of the situation? In which unhelpful
thought style did you engage (i.e. all or nothing thinking, catastrophizing, etc)
3. Helpful thoughts: What might be an alternative more helpful thought?
When trying to come up with a helpful thought, here are some tips to help you

What is the evidence to support the unhelpful thought?

What tells you that this thought is correct?

What is the evidence that does not support the unhelpful thought?
This is the hard part, because it is often overlooked, but ask yourself these
questions: How would someone else view the situation? How would I have viewed
the situation in the past? What might I say to a friend who was in a similar situation?

What is the effect of thinking the way I do? Does it help me or make me feel
worse?

Now, is there an alternative, more helpful thought that could also be true to that
situation

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Emotional health and respiratory conditions

Situation:
Who / what / where /
when?

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What was I thinking just

before I felt like this?

Proof that the thought is

true

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Other possibilities or
what would I say to a
friend?

What is the alternative

balanced thought?

Emotional health and respiratory conditions

Challenging unhelpful behaviours

Another way we can improve our mood is through challenging our negative behaviour
patterns. Often these patterns are difficult to identify, so a good way of finding out if you are
in a routine that is negatively affecting your mood is through completing an activity diary.
Activity diary8
The activity diary is a strategy that is very helpful for people experiencing low mood and low
self-esteem. The purpose of the diary is to help you:
identify the activities you are currently doing
increase the number of tasks that will increase your mood
schedule tasks that may lower your mood in a way that means they have the least
negative effect on you e.g. not doing all the unpleasant tasks in the same day or at the
time of day when you are not usually feeling at your best
Sometimes we can neglect ourselves, because we may spend all our time helping others or
working hard.
Step 1: Keeping an activity diary
The first step is to look at how you currently spend your time and to consider how satisfying
you find your daily activities and routine. You can use the diary sheet on the next page.
Try to record daily activities along with ratings of how satisfying you find each activity (sense
of pleasure or sense of achievement).
It is important that there is a good balance between the things that you have to do and the
things that you want to do.

Step 2: What would you like to change?

Once you have kept a diary for a week or so, it is time to reflect on how you spend your time
and consider what you would like to change. The following questions may help with this:

What was satisfying and what wasnt? How can you make your daily activities more
satisfying?
Could you reduce the impact of activities that are necessary but are not good for your
mood by following these with an activity that does increase your mood?
If you were helping someone you cared about, what changes would you make?
Are you striking a balance between enjoyable activities, relaxation, and things for
yourself on one hand, and work, duties, things for other people on the other hand? If
not, what could you do to create a better balance?

Did negative thoughts get in the way of you doing this? If they did, write them down and try
questioning them.

Step 3: Create a new diary for next week that includes what youve learned from steps
1 and 2

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Emotional health and respiratory conditions

Activity diary
Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Morning

Afternoon

Evening

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Emotional health and respiratory conditions

Setting goals
Another way to improve our behaviour is through goal setting. Goals give us a sense of
purpose and allow us to achieve tasks that may feel overwhelming or unachievable. The key
to effective goal setting is to be realistic. It is easy to make the mistake of trying to achieve a
goal that is vague and unrealistic. By setting realistic, clearly defined goals, you can measure
and take pride in the achievement of those goals. You can see forward progress in what
might previously have seemed a long pointless grind. Your self-confidence will increase as
you achieve your goals and as you recognize your ability and competence in your
achievements.
There are five components to consider when setting yourself a goal. These goals are known
as SMART goals. These are:
Component

Ask yourself ..

Specific

What exactly do I want to achieve?

Measurable

How will I know when I have completed the goal?

Achievable

Is this possible given more current situation/ performance?

Relevant

The goal has to make sense to you and be something you

feel is worthwhile and that applies to your views and lifestyle

Time bound

When do I plan to finish the task?

Once you have set your goal, you then need to break the main goal down into achievable
steps called sub goals. You are far more likely to be successful if you plan a series of small
stages which will help you to reach your ultimate goal. By working on and achieving small
targets, your confidence will increase far more than if you are trying to achieve goals which
are too difficult, and where you run the risk of failing.
Once your time frame has expired you should then add a further two components to your
goal, making it a SMARTER goal:
Component

Ask yourself ..

Evaluate

What have I achieved so far? Have I completed my goal?

Re-do

What further stages should I set for myself or is this goal now
fully achieved? What is my next goal?

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Emotional health and respiratory conditions

Other ways to improve your emotional well-being

Physical activity and healthy eating
Good nutrition is very important for people who
have lung disease. Being breathless can make it
difficult to eat a balanced diet, but good nutrition
can improve the symptoms of the disease.

Eating a healthy diet

It is important to have a balanced diet to maintain a healthy weight and to give you all the
nutrients that your body needs.
Healthy eating tips
Base your meals on starchy (carbohydrate) foods for energy eg. wholegrain
bread/cereal/pasta, brown rice, jacket potatoes
Eat lots of fruit and vegetables
Eat more fish including one portion of oily fish per week
Cut down on saturated fat and sugar sugary and processed foods can increase
irritability and emotional fragility, plus reducing these foods reduces the risk of high
blood cholesterol and cardiovascular disease
Try to eat less salt 6g max for adults the effects of excess salt, sugar and
caffeine can mimic stress responses
Drink plenty of water or other fluids
Cut down on caffeine as it can increase mood swings, symptoms of anxiety and
interfere with sleep try herbal teas instead
Do not use alcohol, drugs or cigarettes to cope
Dont skip breakfast

Fruit and vegetables try to aim for 5 portions every day

Packed with vitamins, minerals and fibre

Low in calories
Eat fruit and vegetables of a variety of colours as they have different vitamins
including anti-oxidants (vitamins A, C and E), which help to protect from heart disease
Fresh, dried, frozen, canned and 100% juice all count.
If a normal weight or underweight then aim for 1/3 of your plate to be fruit and
vegetables.
If trying to lose weight increase vegetables to of your plate

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Carbohydrates

Provide energy
Low in fat
Wholegrain carbohydrates also contain vitamins, minerals and fibre
Should be included at every meal
Have 1/3 of a plate if you are a healthy weight. Reduce this to of a plate if you are
trying to lose weight
Sources include bread, pasta, rice, potatoes, cereals and oats (try to choose
wholegrain options)

Fats

There are two main types of fat: Saturated and Unsaturated

Avoid having foods too high in saturated fat (fat that comes from animals) as this can
increase the risk of developing heart disease so try to choose sources of unsaturated
fats
All fat is calorific so if you are trying to lose weight then reduce the total amount you
have in your diet, from whatever source.

Foods rich in unsaturated gats

Foods high in saturated fats

(try to eat only in small amounts)

Vegetable oils (sunflower, rapeseed,

olive oil)

Meat pies, sausages, meat with visible

white fat

Oily fish

Hard cheese, cream, soured cream

and crme fraiche

Avocados

Butter and lard

Nuts

Pastry

Seeds

Cakes and biscuits

Protein

Main sources are meat and fish

Protein is needed to build muscles
Other sources apart from meat and fish are cheese, lentils, beans, eggs and nuts
If you are trying to lose weight, have about plate of these foods and cut the visible
fat off meat before cooking
Aim for at least two portions of fish a week, including a portion of oily fish (rich in
omega 3 fatty acids which helps keep the heart healthy)
Oily fish

Non-oily fish

Salmon, mackerel, trout, herring, fresh

tuna, sardines, pilchards, eel

Cod, haddock, plaice, coley, tinned

tuna, halibut, skate, sea bass, hake

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Emotional health and respiratory conditions

Milk and dairy foods

Important source of calcium, which is needed for strong bones. This is especially
important in people who take steroids.
Aim to have 2-3 portions a day
Sources include yogurt, milk and cheese
If you are trying to lose weight, choose low fat versions (e.g. low fat yogurt, skimmed
milk and cottage cheese)
If you are trying to put on weight, choose full fat options
Some people who have lung disease find that too much dairy can make their phlegm
thicker, it might be best to get protein and calcium from other sources if this affects
you.
Non-dairy sources of calcium are sardines, leafy green vegetables and wholegrain
foods

Iron
Iron is needed to form the red blood cells that carry oxygen around the body, so it is
important to have enough in the diet. Sources include leafy green vegetables such as
spinach and broccoli.

Foods to limit in your diet

Sugar
If you are trying to lose weight then reduce your sugar intake. You could use sweeteners
instead.

Salt
Salt can contribute to water retention and increase blood pressure.

Use spices and herbs to improve the flavour of food rather than salt
Do not add salt to your food on your plate
of the salt we eat is already in the food we buy (cereals, soups, sauces, bread etc)
so be aware when buying ready meals
Avoid highly salted foods and choose low salt options if available
Read the food labels and avoid those with more than 300mg in a serving this may
be described as sodium rather than salt

Caffeinated drinks
Drinks such as tea, coffee and coke have caffeine in. This can interfere with sleep and
cause a person to become dehydrated. Try to avoid caffeine in the run up to bedtime. A
good tip is to drink a glass of water for every cup of tea you drink to avoid dehydration.

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Trapped gas/bloatedness
Some people can become more breathless if they have trapped wind or feel bloated.
Certain foods are more likely to cause bloating and you could try avoiding them if it is a
problem for you. These include fizzy drinks, beans, peas, cabbage, broccoli, garlic, nuts,
apples and melon.

Eating when you are unwell

Preparation:
-

Stock up on food
Freezer/non- perishable items
Ready meals
Delivery companies

It can be difficult to get in all the calories and nutrients that your body needs if you are unwell.
Your body demands more energy to fight illness, but people often have no appetite if they
are unwell, or find that they are too breathless to eat. This can result in unintentional weight
loss, loss of muscle mass and reduced exercise tolerance.
Tips to make sure youre getting enough calories include:

Eat small amounts of food regularly. It might seem easier to face a small meal every
few hours than a large meal in one sitting
Eat soft food as chewing can be tiring. Things like soup, mashed potato, rice pudding
and custard can give calories, but are not much effort to eat
Keep easy to chew meals in the freezer or have tins of food in store. Then you will
have food on hand when you are too unwell to cook
Using sauces on food can make it easier to chew and swallow
Make sure you keep your fluid intake up
Dietary supplements like Calogen or Fortisip can be prescribed by your doctor if you
are underweight

If you are trying to increase your weight you should fortify your food. Ideas include:

Adding butter to vegetables and mashed potatoes

Adding cream to soups, sauces and mashed potatoes
Adding mayonnaise to sandwiches or salads
Cream cheese in sandwiches is high in calories and protein and doesnt take much
chewing
Add pulses to stews or soups
Put grated cheese on top of soups
Have full-fat versions of food like yogurts and cheese

If you are underweight and struggle to gain weight speak to your GP who can refer you to a
dietician if needed.

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How to get a good nights sleep

People may worry about not getting enough sleep, but
worrying only makes it worse. Its easy to overestimate
how much sleep you need, or not to realise that it is normal
to wake briefly each night. The occasional bad patch is
harmless and usually rights itself. It is only of concern if
your sleeping difficulties have been lasting for longer than
a month, as long-term sleep problems may cause physical
or mental health problems.
The average amount of sleep is seven to eight hours a night, but we all need different
amounts, and the amount we need decreases as we get older.

Things that may disrupt your sleep pattern

Snoring that interferes with breathing

Too much stress
Ill health or physical pain
Emotional difficulties, including anxiety and depression
Jet lag or shift work that disrupts our internal body clock
Traumatic events, such as a divorce, redundancy, or bereavement
Going into hospital, a residential home or a hotel
Medicines, such as water pills, steroids, beta-blockers, and some painkillers,
antidepressants, slimming tablets and cold remedies
Withdrawing from certain drugs, such as tranquillisers or antidepressants
Taking street drugs such as ecstasy, cocaine and amphetamines
Overusing alcohol, tobacco and caffeine

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Tips to help you sleep

1.

Establish a regular routine. Go to bed only when you're tired and get up at the same
time each day. Avoid napping during the day

2.

Check your sleeping arrangements. Think about comfort, temperature, light and
noise levels

3.

Learn to de-stress before bed. Dismiss nagging thoughts by writing them down and
leaving the list away from your sleeping area

4.

Have a warm bath, practise a relaxation technique, or listen to a relaxation tape. (But
don't read or watch television in bed)

5.

Dont eat late. Avoid rich, spicy or sugar-rich foods, red meat and cheese. Choosing
wholemeal, low-fat, magnesium-rich foods (green salads, broccoli, nuts and seeds)
may encourage sleep, as may drinking hot milk and honey

6.

Get enough exercise. Fit people are proven to generally sleep better

7.

Don't stay in bed. If you can't sleep, get up after 15 minutes and go through your
relaxation routine again

8.

Try out complementary remedies. Yoga, meditation, homeopathy or herbal

remedies, such as lavender or valerian, may help

9.

Keep a sleep diary. This helps you identify potential causes for your sleeplessness

10. Try some reverse psychology: keep your eyes open and tell yourself to resist sleep
11. Interrupt unwanted thoughts: repeat a soothing word to yourself. Visualise a scene
or landscape that has pleasant memories for you
12. Talk to your GP. Using sleeping tablets on a long term basis may present problems,
but a brief course is sometimes appropriate especially if nothing else is working for
you

Night-time relaxation routine

Relaxing before bed is a good way of de-stressing and getting the body and mind ready for
sleep. People relax in different ways and it is important to find a method that suits you. These
could include:
Breathing exercises
Muscle tension and relaxation exercises
A warm bath
Reading a non stimulating book
Guided/non-guided visualisation exercises
For more information on relaxation exercises look at our website www.firststepssurrey.nhs.uk or call our help line.

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Emotional health and respiratory conditions

Social supports
Social supports (friends, families etc) can be an important way of increasing our mood. When
a person feels low in their mood it is not uncommon for them to reduce their contact with their
friends/family which can lead to social isolation and the associated negative effects on wellbeing.
Increasing our social support is not simply a case of increasing our contact with more people
as not all social contacts are positive. For example, only meeting up with somebody who is
very low and has a number of difficulties of their own may have an adverse affect on your
mood. It is possible to feel lonely even when surrounded by others.
Increasing our positive social contact could be through a number of ways including:

Pushing ourselves to meet up with friends, family or colleagues

Contacting friends via the telephone, internet or email

Doing activities which provide us with the opportunity to meet and choose new friends

Sharing our experiences with the people around us

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Useful contacts
First Steps
0808 801 0325
Monday and Wednesday 10am to 4.30pm and Thursday 11am to 5.30pm. The helpline will
be open on a Tuesday following a Bank Holiday
first.steps@nhs.net
www.firststeps-surrey.nhs.uk

British Lung Foundation

National self-help organisation for
lung conditions
www.blf.org.uk

03000 030 555

Depression Alliance
National self-help organisation for
depression and low mood
www.depressionalliance.org

0845 123 23 20

Anxiety UK
National self-help organisation for
anxiety
www.anxietyuk.org.uk

08444 775 774

SANELine
www.sane.org.uk

0845 767 8000

MindInfoline
www.mind.org.uk

0300 123 3393

NHS Direct
www.nhsdirect.co.uk

0845 46 47

Living Life to the Full

www.llttf.com

Cognitive Behaviour Therapy Self-help Resources

www.getselfhelp.co.uk

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Books
Surrey County Council Libraries have a very helpful list of self-help books. You can find the
list at www.surreycc.gov.uk if you search Reading Well. The books are available online
and in a selection of their libraries. Or additionally, the books are available to reserve via the
Library catalogue.
Many of these libraries also have a self-checkout option, which means you can take out a
book without anyone knowing the book that you choose.

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