Problem Statements Steve Wood Lecturer Practitioner Underpinning this

Problem Statements Steve Wood, Lecturer Practitioner

Underpinning this is a 4 -systems view of symptoms Thoughts Feelings Behaviour Body

palpitations feeling faint feeling light-headed take deep breaths urge to escape cold sweat feeling smothered images of losing control hot flushes undo buttons numb extremities tingling in extremities fear of going crazy thoughts of impending doom Panic attack symptoms feeling unsteady nausea fear of collapsing/losing control feeling unreal escape from situation open windows sudden intense fear feeling detached from oneself tingling in extremities chest pain or discomfort stomach churning feeling of choking trembling shaking sense of immediate danger

Cognitive Thoughts of impending doom Images of losing control Sense of immediate danger Urge to escape Feeling unreal Behavioural Take deep breaths Undo buttons Open windows Escape from situation Affective Intense fear Fear of going crazy Fear of collapsing/losing control Feeling detached Panic attack checklist Physical Palpitations Stomach churning Feeling faint Hot flushes Cold sweat Trembling Shaking Feeling smothered Feeling of choking Feeling light-headed Numb extremities Tingling in extremities Nausea Chest pain

Loss of energy Agitated behaviour Recurrently negative thoughts Decreased libido Feelings of sadness Suicidal thoughts Excessive or unrealistic fear Excessive guilt Feelings of hopelessness Decreased productivity Feeling physically “slowed down” Pessimistic thoughts Social withdrawal Difficulty setting goals Difficulty thinking Angry thoughts Symptoms depression Feelings ofof worthlessness Feelings of helplessness Somatic anxiety symptoms Mental slowing Brooding about the past Weight loss (without dieting) Crying Feeling physically unable to settle Snapping at people Difficulty making decisions Reduced concentration & attention Loss of pleasure or enjoyment out of life Excessive self-criticism Appetite disturbance Decreased self-confidence Short-term memory problems Sleep disturbance Difficulty solving problems

Cognitive Affective Pessimistic & recurrently negative thoughts Excessive self-criticism Angry thoughts Brooding about the past Suicidal thoughts Reduced concentration & attention Short-term memory problems Difficulty thinking Mental slowing Behavioural Crying Snapping at people Decreased productivity Apathy and indifference Difficulty solving problems Social withdrawal Difficulty setting goals Difficulty making decisions Agitated behaviour Depression checklist Loss of pleasure or enjoyment out of life Feelings of depression or sadness Feeling pessimistic Feelings of worthlessness Feelings of hopelessness Feelings of helplessness Excessive or unrealistic fear Excessive guilt Decreased self-confidence Physical Loss of energy Feeling physically “slowed down” Feeling physically unable to settle Sleep disturbance Appetite disturbance Weight loss (without dieting) Somatic anxiety symptoms Decreased libido

Symptom checklists have their uses. BUT - they do not show links between the symptom domains and don’t reveal what is going on for the person. A 4 -systems view reveals the links between the symptom domains and helps the person make sense of what is going on.

Jean has experienced panic attacks since the age of 19. Her panics are unpredictable and she lives in fear of the next one. At work, on the phone to a customer, she suddenly feels unreal, as if she’s not part of what’s going on. What if I panic? Negative automatic thought I’m having panicking a heart and I can’t control attack. I’m going it. to die Opens Take deep window, breaths rushes to try & slow out ofthings room. down. Scared Panic& anxious Symptoms Thoughts Feelings Behavioural Physical Shaking, heart racing, Shaking, heart breathless, feeling racing, breathless, unreal increase feeling unreal

Paul has had 2 episodes of depression. He lost his job 3 months ago and hasn’t worked since. Trying to keep busy, he starts redecorating the house. While painting the living room, he drips paint on the carpet. . . That’s just like me. I always mess things up. I’m a failure Negative automatic thought I can’t be What’s the point bothered. I in trying? It’ll wouldn’t enjoy it only go wrong. anyway. Avoid doing jobs around the house Avoid challenges Depression Pessimistic Feelings of failure Self-dislike Symptoms Thoughts Feelings Behavioural Physical Lethargy Loss of appetite

Problem statements enable us to add to the information gained from our basic mental health checklist by gaining the client’s perception of their current situation, in relation to their mental health.

Problem Statements Problem statements should focus directly on difficulties that: Have been identified by the client during the semistructured assessment interview Have been written, whenever possible, in the client's own words; this helps reduce the use of jargon and provides meaning to the client Describe the problem in observable behaviours Indicate the impact and consequences the problem has on the client's life-style.

Your task is. . . To work collaboratively with the client to formulate a PROBLEM STATEMENT Start with the initial question – “In relation to your mental health, how would you describe your main problem at the moment? ” When the client replies, ask – “Can you tell me how that is a problem for you? ” Then use appropriate skills of questioning, reflecting, paraphrasing, checking and summarising to develop the problem statement Make sure you finish with a written statement that the client can read back to you.

“In terms of your mental health, how would you describe your main problem at the moment? ” Your task is help the client convert this… “Well, my main problem is that meeting people makes me very anxious”

“In terms of your mental health, how would you describe your main problem at the moment? ” Into something like this… “My main problem is my feelings of anxiety and images of making a fool of myself, accompanied by sweating, muscle tension and nausea and an urge to run away whenever I have to meet unfamiliar people. The anxiety and physical symptoms are quite severe and it occurs at least twice each week. This is affecting my employment, as I have to deal with personal enquiries by members of the public; I have stopped going out socially and my friends have started not to invite me; and it is causing rows between myself and my partner. ”

and this… “In terms of your mental health, how would you describe your main problem at the moment? ” “I worry about my heart”

“In terms of your mental health, how would you describe your main problem at the moment? ” My problem is that I worry excessively about my physical health, particularly about my heart. Whenever I need to do anything that involves exertion I start to worry that it will cause a heart attack. I constantly tune in to my heart, take my pulse, and read everything I can about heart attacks and how to avoid them. My body is constantly tense and I tend to get headaches, which I put down to high blood pressure and this makes me worry even more, in case it’s damaging my heart. I never exert myself – never run for a bus, run with the children, try to avoid sex and so on. It’s getting so bad that some days I hardly get out of the house. It’s affecting life at home, because I don’t do anything around the house; social life, as I avoid doing sport and other things I used to do; it’s causing rows with my partner and affecting my relationship with the kids. Into something like this…