Self-help information

Perhaps you feel uncomfortable with the amount of alcohol that you are drinking.
Perhaps you would like to take greater care of yourself, to feel physically as well as mentally better every day, even after a night out.
Perhaps you would like to avoid taking risks which you might regret later when you have drunk too much.
Perhaps you think that you are regularly drinking more than you want to, and would like to drink less, but are unsure how to go about it.
This leaflet suggests some steps you can take to change your current pattern of drinking.  So if you suspect you are drinking too much, and want to drink less, read on …

Step 1
The first step towards change is to know what your pattern of drinking actually is.  Keep a chart of your drinking over the next two weeks.  Be honest about the amounts you are drinking. Suggested chart headings are on the back of this leaflet.   What does the chart tell you about your drinking?  Has anything in it surprised you?

Step 2
Consider why you are drinking as much as you are.
What is influencing your drinking? Do you notice any patterns on your chart that shed light on your current reasons for drinking?
Are you using alcohol to escape from a  problem which you might be able to solve if you faced it?  If so, you may be perpetuating your shyness, anxiety, depression etc rather than dealing with it once and for all.
Make a list of the advantages and drawbacks of your alcohol use which are personally significant to you.

Step 3
Think about the possible effects of drinking too much.
Drink and drugs don’t permanently change our world. They allow us to feel a temporary confidence or happiness, but the effect is usually one of borrowed time.  In fact, alcohol can contribute to a lowered mood because it is a depressant.
Often the unhappiness or anxiety returns even more strongly once the effects of alcohol wear off. So the answer then seems to be … drink some more…Do you feel caught in a cycle its hard to get out of?
Drinking a lot can be seriously expensive, so uncontrolled use can lead to financial problems.  How much is your current level of drinking costing you (be honest!)?
Pronounced drinking tends to define social groups.  Do you think your drinking may be limiting your circle of friends?
Alcohol greatly lessens people’s ability to say no to unwanted sexual encounters which they would have definitely avoided had they been sober.
Alcohol can lower people’s inhibitions against hurting others as well as harming themselves.
Your body, and especially your liver, have to work hard to deal with large amounts of alcohol.   It takes an hour for one unit of alcohol to be processed by your body.

Step 4
If you want to take more control of your drinking, and drink less the following suggestions may help.
Consider what emotions trigger your drinking. Are you using alcohol to help deal with certain feelings - frustration, anxiety, shyness, boredom etc. Can you find alternative means of dealing with these feelings?
Talk to someone whom you trust about your drinking. Ask them if they feel you have cause for concern.
Consider whether you could limit your intake by changing your routine so as not to put you in tempting situations.
Eating before you go out for the evening, or having a meal while you are drinking, can help to reduce the effects of alcohol.
Before you go out for the evening, set yourself a limit, and stick to it.  Drink at your pace, not other people’s.  Don’t get caught up in rounds. Try having a soft drink in between alcoholic drinks.

Try limiting your drinking to certain days of the week, so that you give your body, especially your liver, a chance to recover. If you don’t want to drink that evening, but would like to go out, plan how to avoid getting drawn in to drinking more than you want to:  commit to being the driver; make it clear that you are not drinking any more tonight, and have your reasons ready  (eg because you don’t want to, because you need a clear head the next day to do an assignment, give a presentation, go to an early lecture).

There are many websites giving information about alcohol include:
www.bbc.co.uk/health
www.drinksense.org
www.swanswell.org

If you are concerned about your use of alcohol or drugs, and would like support to change things, then contact the Student Counselling Service, Swanswell (see www.swanswell.org) or your GP.

Anxiety and worry are very fundamental human emotions which everyone will feel at times. Many people adapt to very high levels of anxiety and do not consider it a problem.
Anxiety has a very healthy purpose.  It can motivate us to action.  If we did not feel anxious about certain situations then we would risk falling over cliffs, stepping into fires and so on. Similarly, if we had no anxiety about ourselves in relation to others we might well behave with great insensitivity.

But sometimes anxiety can become excessive and unhealthy. Perhaps it is only at that point that we notice that we are anxious, and that it is causing problems.

Anxiety takes different forms. These include:

• General Anxiety (being anxious about many aspects of your life)
• Worry (continually thinking over a problem beyond what is needed to produce a solution)
• Specific Anxiety (anxiety over a certain situation - e.g. exams; social situations etc.)
• Phobia (an excessive fear of a particular situation or object leading to avoidance)
• Hypochondria (an anxiety about suffering illness)
• Panic attacks (a sudden uncontrollable triggering of physical anxiety symptoms)

Symptoms of Anxiety

People can experience different symptoms when they are anxious at different times. You may experience several of the following, or only one or two.

Physical Signs

• racing heart
• dry mouth
• increased rates of breathing
• increased sweating
• headaches
• disturbances of bladder and bowel functions
• trembling
• disturbed sleep
• tense muscles lead to increased fidgeting, prickling sensations in the skin and stiffness in the joints.

Thoughts
Anxiety tends to increase the amount of thinking we do in the area of concern. Usually the thoughts are selective -isolating and magnifying the worst aspects of the feared situation.

Feelings
Some feelings could be:

• feeling 'overloaded' or overwhelmed, pressured
• experiencing mood swings
• Irritable and dissatisfied with things
• tearful

These feeling interfere with everyday activity and take the enjoyment out of life.

Behaviour
Sometimes, an anxious person can isolate themselves and withdraw from people. Or there can be increased dependence upon others - such as asking repetitive questions, looking for reassurance, or just needing to be in the presence of others to bring about calmer feelings.
We may become more frenetic and over-active, or else frantically tidying up or making lists of things we absolutely have to do straight away - usually impossibly long lists.
We may avoid the source of the worry entirely - sometimes even to the extent of not even allowing ourselves to think it. For example a person who is worried about speaking in a tutorial may decide not only to not do this, but also avoid imagining doing it and may even hide all the lecture notes associated with the subject of the tutorial.

Coping with Anxiety

It can be helpful to find ways of dealing with the most difficult symptoms of it.

Do not immediately consider complete relief as the only solution. Reduction of the level of anxiety may be a more realistic goal, especially as much anxiety is completely survivable and may even help you.

Take an interest in exactly how your anxiety manifests itself.  Keep a diary recording how you react in different situations and which aspects of the situation are particularly worrying.

Look at the situations you are avoiding because of anxiety and  consider how you could begin to expose yourselves to these in small but increasing steps.

Develop a problem solving attitude to allow you to dismantle the large problems into lots of smaller ones and then to resolve them by practical steps. For example small steps to deal with a large anxiety over public speaking could include observing how others cope; making your tutor aware of the problem you have; preparing the subject; rehearsing in private; taping your voice; practising in front of a friend; getting as relaxed as possible on the day; doing it.

Change your breathing, so that it becomes slower: breathe in through your nose for a slow count of three and out for a slow count of five. Try to do this for a few minutes.  Practice it when you are feeling ok, so that when you feel anxious you can do it well.

Relaxation techniques will not banish a specific anxiety, but they may make you generally happier and so more able to deal with the things you find difficult.

For some people medication can be very useful when they are coping with specific crises, or when anxiety needs to be reduced before further action can be taken. If you feel medication might help you, see your GP.  Be very wary of using alcohol or non-prescription drugs to overcome anxiety. They rarely offer more than a fleeting solution, and can make things worse.

Grieving is the natural process we go through in response to losses of many kinds, e.g. death, loss of a job, relationship breakdown, life events and changes. When we are in the midst of grief, we can feel that it will never end, and that we will always feel as we do now.

The loss of someone who is significant to you, through death, but also through separation, may be one of the hardest things you will experience in your life.

Other losses such as the loss of a job, the loss of good health or major life changes can often cause many of the same symptoms of grief. It is important to recognise how these life events affect us and accept that we may need to grieve for them too. Much of what is said here will apply to any loss, not only loss through death.

People respond differently to loss, and often individuals can feel very alone in dealing with the intense personal emotions they may be experiencing. They may wonder if what they are feeling and experiencing following their loss is ‘ok’, to be expected. They might not even realise that their feelings are their own response to grief.

Grief takes time to work through. There are no hard and fast guidelines. It takes as long as it takes, but as a general rule it will take longer than you expect. It is important not to try to 'get over it' too quickly, not to adopt a 'stiff upper lip' attitude. Grief is an inevitable, normal, and human response to loss. We may not seem to grieve much immediately, but may find that weeks, months, later we feel upset and painfully aware of our loss.

Experiences of bereavement and loss are entirely individual. No one can tell you how you will or should feel. Everyone grieves in his or her own special way. Even people in the same family may grieve in different ways from each other, and this can be hard to accept. Some wish to mourn in a way which celebrates the life of the deceased; others make a great and visible show of their grief. Some people are very low key in their response to a death, marking it with a funeral and perhaps a gathering afterwards, but with no recognised period of mourning and often no great show of feeling

Symptoms of Normal Grief

There are however some generally accepted and recognised reactions:

• You may at first feel totally numb, as if paralysed
• You may find yourself unable to believe the person really is dead
• You may find yourself very angry about what has happened.
• You may feel an enormous sense of unfairness
• You may find yourself crying uncontrollably and unable to function as normal
• You may feel guilty about surviving, about not having said goodbye; about leaving things unresolved
• You may feel an aching void, a sense of emtiness, which you feel will never be filled again
• Whether it is expected or a shock, you may feel traumatised, but especially in the case of a death which been in any way violent such as through an accident, suicide or murder.
• When we grieve we experience a whole spectrum of emotions that can leave us feeling worn out, exhausted and confused

The Reaction of Others

You will be aware that people around you will react in very different ways to your grief.

There will be those who very much want to help in practical ways, or by giving you emotional support. It is up to you to guide them as to how they may best help you; whether you need a listening ear, or maybe need to be left alone for a while. Remember, they can't know what will help unless you tell them. Don't be afraid to take up offers of help; it is not a sign of weakness to lean on someone when you need support.

There will be others who are unable to cope with your grief, who may not be able to talk about the death or your loss or even acknowledge it. This may be because it raises difficult feelings in them, or because they feel inadequate because they don’t know what to say to you. This can seem very hurtful if you don’t understand what may be behind this seemingly insensitive behaviour.

How can you Help Yourself?

Here are some suggestions which you may find helpful:

• Recognise that mourning takes its time and you cannot hurry it along. If you feel like crying, then do it. If you don’t want to cry in front of others, find a place where you do feel able to express your emotions safely.
• Do not be afraid to accept whatever help you are offered from friends, relatives, religious ministers etc.
• If you need to talk about what you have lost, even if you need to do so over and over again, allow yourself to do so until the need lessens.
• If you are worried about over-using friends, consider talking to a Student Counsellor or other professional helper
• Looking after yourself is something easily forgotten when grieving, but doing something to make you feel better is especially important. Grief is a major stressor, so take time to relax .
• Think about practical ways of doing something to ease your pain. Would it help to write a letter to the deceased saying what you perhaps didn't manage to say in their lifetime? Would you like to plant a tree or shrub in their memory and watch it blossom? Could you light a candle on special days?
• The first anniversary of the loss is an important milestone and can be particularly difficult. Subsequent birthdays and anniversaries can be poignant reminders of your loss, and you may need to find your own way of dealing with such times by either marking them as special commemorative events or by ensuring you distract yourself while time passes.

And Later.........

The pain gradually lessens. It does happen even though you think it never will. But while we may never forget the loss, eventually we are able to pick up the threads of our lives.

But with that might come guilt and worry about forgetting or letting go of what we have lost. Along the years, although the pain lessens, the memories will never leave you as the loss finds its place in your history and experience. The more easily you can accept the need to grieve, the more comfortably it will rest. And it is right that we move through grieving, to a point where we can let go, and emotionally re-invest in our lives again.

If you think it would help to talk to a counsellor about your feelings, contact the Student Counselling Service.

Just because you are angry does not necessarily mean you have a problem. Most people have been angry at times in their lives. It is after all part of the natural response that helps our survival and helps us to protect others.
Here are some examples of when anger is helpful and healthy:

• It gives us the courage to defend ourselves or those we love.
• It motivates us to improve the world by inspiring social action and justice.
• It confirms our individuality, especially when we are children
• It warns others not to take advantage of us.

The person who is not able to admit any anger risks depression and low self-esteem. In our culture it is not uncommon for children to learn from an early age that it is unacceptable to express or show the emotion of anger.
But frequent or excessive anger is not useful; in fact it is likely to have a negative effect on your health, to spoil your relationships with others and to limit your life experiences and ability to achieve happiness.

Managing anger

There are three steps to anger management:

1. Understanding the pay-offs and triggers
Undoubtedly you will get some short-term benefits from your anger such as:

• I feel so much better afterwards
• It makes people listen
• I feel more like myself when I am angry
• If I didn't get angry about things I'd just cry all the time
• When I show my anger then people know where they stand and that's good
• Anger stops me being afraid
• If I don't show my anger then people will think I am a wimp.

Probably even as you read this you will begin to see that some of these things can be achieved by other more healthy means.

2. Calming yourself down in crisis situations
What can help to calm you down depends on whether you get angry when alone or when in dispute with another. Here are some ways that work:

• Do something else to distract you.
• Describe your room to yourself in purely neutral terms.
• Look at things, not people
• Think of things you have to do today
• Count to 10 (it does work!)
• Repeat what the other person has said and ask for time to consider what your response will be, as in ‘I need time to think about that.’
• Leave if you think you might otherwise lose your temper or be violent
• Take exercise of some form: sit ups, skipping, going for a run or a cycle ride can all help to diffuse the feelings.
• Alter your breathing, slow it down by holding each breath for 5 seconds
• Tense and relax muscles; tensing each in turn, holding for 5 seconds then releasing.
• Change postures and roll shoulders
• Visualise your anger as an object; what does it look like? What would help to make it smaller, less overwhelming, more manageable?
• Imagine a relaxing place where you feel safe and free from anxiety and anger. See and feel the details of it.
• Imagine writing a script of the situation, in which you behave in other ways which worked for you.

3. Learning Strategies to prevent Unhealthy Anger arising in the Future
Experiment to find which of these work for you:

• Cut down/avoid stimulants such as alcohol or other drugs if you know that you are more likely to respond more angrily when using them.
• Develop a more relaxed lifestyle and try to manage stress better.
• Challenge your angry thoughts: why are you really angry? What are you really feeling?
• Beware of disguised anger such as in sarcasm or cruel jokes
• Practice ways to say what you want to say more calmly. You could do this on your own or with a friend.

You might decide that it would be helpful to talk about your concerns about your anger with a counsellor.

Introduction

Being raped or sexually assaulted is a very distressing experience with effects that can be long lasting.

The majority of rapes reported are against women and some of the language used in this information will reflect this. It is however recognised that there are male rapes, of which increasing numbers are being reported. The Student Counselling Service offers support to anyone who has been the victim of any sexual assault.

People who have suffered sexual attacks describe feeling:

• Frightened
• Humiliated
• Confused
• Isolated
• Guilty
• Dirty
• Ashamed
• Grief
• Depressed 
• Numb
• Powerless and out of control.

Sometimes after an attack a person find it difficult to eat or sleep. It is very difficult to concentrate or focus on anything other than the attack and so university life can become very stressful especially with deadlines or exams looming. Each person’s reaction is going to be different, very often emotions and feelings will change on a minute to minute basis.

It is not uncommon, even many years after the event, to experience the whole gamut of emotions over again. These feelings and emotions can be triggered off by any number of events and can very often come as quite a shock. Flashbacks can occur spontaneously or be triggered by a situation, smell, sight or sound.. For healing to take place, it will be important to discover your feelings and to start to express them in a healthy, rather than a destructive, way.

Anybody who has been attacked so viciously may loose their faith and trust in the world. Perceptions change. A period of mourning for the loss of an old life may be followed by a gradual acceptance and a learning to live with the effects the attack has had on your life.

Often it is difficult to talk about what has happened; yet it is healing to have love, support and understanding from those around you. Often it can be useful to talk to someone outside your close network of friends and family. There are trained counsellors available at Student Services If you would like to talk to a counsellor, view the councelling homepage for details.) or the local Rape Crisis Centre (01905 724 514)

Facts about Rape and Sexual Assault

• The perpetrator of the rape may well be known to the woman.
  There is a myth that sexual violence is only carried out by strangers. In fact the majority of offences are committed by a man known to the woman. He may be a friend, a partner, a workmate, a relative, a neighbour or a person in authority.
• Rape is not always accompanied by other physical violence.
  When a woman is sexually assaulted she may react in various ways. Some women scream or fight back; many become quiet - too shocked to speak or cry out. Paralysed by fear, they may be unable to resist. If violence is threatened some may take the decision to struggle less in the hope of getting away with the least amount of physical harm. Consequently, they may or may not have torn clothes or signs of struggle afterwards. Verbal intimidation, threats or emotional blackmail may be used by the assailant. Therefore a woman does not need to show physical injuries to prove she has been assaulted.
• Rape and sexual assault, whether by a stranger or a friend, is never your fault.
  Rape and sexual assault is always more about the use of force or power to humiliate, control, hurt or violate a woman than about sexual desire or passion. There is evidence to suggest that a very large number of attacks are premeditated. The appearance of the woman in terms of status, age, cultural background, occupation, previous relationships is irrelevant; any woman can suffer sexual assault or rape.

What to do After a Rape or Assault

Everyone reacts differently after an incident of this nature. Some people choose to report it immediately, but many women will just try to carry on as normal and not tell anyone for a long time. However, often distress can surface a considerable time after the event. No matter how much later, a person can always seek help from counsellors, GPs etc. Do not feel you have to cope on your own simply because you did not report the incident soon after it happened.

Health Issues
However difficult in the hours after a rape it is important for your future well being to consider your health. Hospitals and GPs are bound by law to see you on a confidential basis. This means that when you receive treatment after a rape or sexual assault they do not report the incident to the police unless you expressly ask them to.
Consider being tested for pregnancy and sexually transmitted diseases. They include:

• Chlamydia
• Syphilis
• Herpes
• Genital Warts
• Gonorrhoea
• Trichomas Vaginalis
• HIV

The Genito-Urinary Clinic local to Worcester University is held at the John Anthony Centre, Newtown Road, Worcester. If you have other injuries that require immediate attention then there is a casualty department at Worcestershire Acute Hospitals NHS Trust.
There is a drop-in Sexual Health Clinic in the Health Centre Woodbury on Mondays, 12:00 - 2:30.

Reporting to the Police
When you go to the police station you can take someone with you. This can be a friend or family member or a professional. Both Rape Crisis and Victim Support will provide someone to accompany you to the police station to give your statement and undergo the medical examination.

Sexual violence is a criminal offence and you can, if you wish your perpetrator to be prosecuted, report the crime to the police. It is your choice. You can do this later if you wish but the reason for reporting a sexual assault immediately is so that forensic evidence can be taken. Evidence will be collected by means of a medical examination by a police surgeon - who will be a GP employed part-time by the police.

If the attack was physically violent the police forensic team may also wish to visit the scene of the crime to collect more evidence.

When you go to the police station you can take someone with you, such as a friend or professional worker. Ask for an officer who has had special training (this would usually be a woman).

Today the police are trained to use tact and sensitivity. No one has the right to ask you to disclose any personal details about your previous relationships and sexual life.

If you have reported a sexual offence you have the right to withdraw the complaint at any time. The police may require clothing to be left for forensic examination. The police station can provide you with other clothing, but it is a good idea to take a change of clothes with you.

If you are very traumatised after the assault you may arrange another time for a statement to be made. If English is not your first language the police can arrange for an interpreter to be present. The police officer will explain police procedures to you and give you advice and information on the next stages including the court process.

Useful Contacts

• Worcester Rape and Sexual Abuse Support Centre
  www.wrsasc.org.uk  01905 724514
• Accident and Emergency Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Newtown Road, WR5 1DD, Worcester
• There are 2 Genito-Urinary Medicine Clinics which are part of the Sexual Health Service in Worcester:
  - John Anthony Centre, Newtown Road, Worcester (01905 351601) 
  - Arrowside Unit, Alexandra Hospital, Redditch (01527 516398)
• Victim Support: 01905 28252
• Rape Crisis: 01905 724 514
• The Samaritans: 01905 21121
• Worcester Police: 03003 333000
• Survivors (Male Rape): 020 7833 3737
• The Glade SARC (sexual assault referral centre): 08081 782058
• National Aids Helpline: 0800 567 123

We use the word ‘depression’ to describe a range of moods, from feeling low to a much more serious state which interferes with everyday life.

You may be uncertain whether or not you are depressed. Everyone’s experience of depression is different, and there are a wide variety of symptoms. Many people feel down occasionally, or go through bad patches, but still have areas in their lives that make them feel good, and can still find things to like about themselves.

For some people, though, life is more of a struggle. They feel bad about themselves and their lives in most ways. At times they feel complete despair. If you feel like this, then you may well be depressed

Causes of Depression

It seems that depression can be due to multiple causes, and for different individuals, at different times, different factors may predispose, cause or prolong depression.

Exogenous depression
This is the term used for depression which is due to external psychosocial factors. It may also be called reactive depression because the sufferer is reacting to a problem outside of themselves, such as a life event like a bereavement.

Endogenous depression
This is the term used for depression which is due to internal physiological factors, such as low levels of certain neurotransmitters, and which may arise from within the personality.

In practice, it is extremely difficult to differentiate between these two types of depression, and they could in practice be combined to produce a depressive state. For example, if you feel sad beause of a loss, you may neglect to eat properly. This could affect your natural levels of serotonin which will then further contribute to your feelings of sadness and 'depression'.

Symptoms of Depression

• Feeling helpless and hopeless
• Disliking or even hating yourself or people in general.
• Feeling useless, inadequate, bad or guilty
• Thinking negatively; always seeing the worst in everything.
• Finding everything a terrible effort, not wanting to get out of bed and face the world.
• Being very irritable.
• Finding it impossible to concentrate for any length of time.
• Sleeping too much or too little.
• Eating too little or too much.
• Heavy dependency on alcohol or drugs.
• Cutting yourself off from others
• Unable to stop crying or unable to release tears.
• Having physical aches and pains

Dealing with depression

With moderate depression there are things you can do to help yourself:

• Keep as occupied as you can with things that interest you.
• Do things which makes you laugh.
• The food you eat does affect your mood, so eat regularly, and make healthy choices.
• Alcohol is a depressant, so consider your use of it.
• Pay attention to your appearance to make yourself feel good.
• Treat yourself from time to time.
• Try to make your living environment as pleasant and comfortable as possible.
• Try telling a friend how you are feeling. People are usually very willing to listen.
• Notice your negative thoughts - especially about yourself. Are you judging yourself much more harshly than you would a friend?
• There is increasing evidence that moderate exercise and physical activity can have a positive effect in challenging depression. This is due to various causes, such as altered body chemistry, improved body function, changed sense of self, changed focus of attention.

Getting help

It may be difficult to put any of the above suggestions into action if you are depressed. If you feel you are depressed, then it is important that you seek help. You do not have to struggle alone.

If you are severely depressed, if you cannot function normally e.g. you are not going to lectures/eating/getting out of bed, and if you are actively considering suicide, it is especially important that you seriously consider getting help to deal with it.

Being depressed does not mean you are weak or inadequate. What is important, and takes courage, is to seek help to strengthen your own resources, and perhaps put new resources in place, so that you can find a way out of your depression.

If you would like to talk to a counsellor about your depression, contact the Student Counselling Service. As well as helping you to look at particular causes of your depression, a counsellor can help you to learn to recognise your own particular set of symptoms which tell you you’re depressed and help you to develop coping mechanisms for managing them.

Don’t be afraid to see your GP if you are depressed. Your GP may refer you to further appropriate help, or may offer medication in the form of anti-depressants.

Medication does not necessarily take away the cause of the depression, but may help to lift your depression enough to enable you to take action in additional ways to deal with the depression

There are many web sites dealing with depression. Useful ones are:
www.studentdepression.org
www.depressionalliance.org.uk
www.mind.org.uk

Bristol Crisis for Women have a national helpline available on:
- Friday and Saturday, 9pm-12.30am
- Sunday, 6pm-9pm
01179251119

The Samaritans have a 24 hour helpline: 08457 909090

Introduction

Stories about dieting and weight sell magazines. The fashion industry uses often painfully thin models, both male and female, to display the latest clothes. The media constantly bombard us with images of celebrities who are apparently very thin. Being thin is equated with being desirable and successful.
Digital imaging techniques mean that images of models and celebrities can be produced where they are shown as glamorous, and ‘perfect’. These images are often also distorted, and it is easy to forget that in real life these people don't actually look as perfect or glamorous as their photos appear.
So it is not surprising that, when there are life experiences which cause distress, one way of making things better can seem to be to take control of what you eat. But if, in doing this, you lose sight of what your body needs to be strong and healthy, then the ‘solution’ itself can have distressing consequences.

Commonly Experienced Eating Problems

There are three commonly experienced eating problems that often have overlaps between them.

Compulsive Eating
Bulimia Nervosa
Anorexia Nervosa

Whatever form the eating disorder itself takes, it is usually a symptom of an underlying emotional or psychological issue. The underlying issues are not necessarily unusual or traumatic incidents in themselves, but may be fairly commonly experienced problems that have built up over a period of time, and have become hard to deal with. The eating disorder becomes one way to cope.

Compulsive Eating
This is where a person finds they have irresistible urges to binge. Often after a binge they might feel overwhelmed by feelings of self-disgust or shame. The binge may follow a period where a rigid dieting regime has been put in place. Thus a diet-binge cycle may ensue. The dieter is often concerned with body size that may fluctuate. Someone who compulsively eats may appear or feel overweight. Eating is often not in response to physical hunger pangs. The eater feels out of control around food. The desire to binge seems to take over and overpower any will to diet and lose weight.

Bulimia Nervosa
This is a cycle of overeating followed by self-induced vomiting or purging with laxatives or fasting. The eating disorder is often kept secret. The sufferers binge or purge alone and appear normal in body size. Those experiencing bulimia are constantly preoccupied with food and body size. They may have lists of high calorie or high carbohydrate foods that are self-forbidden, but these foods become binge products. The disorder is often characterised by secrecy, shame and guilt until help is sought and recovery begins. Sufferers from bulimia may experience one or more of the following:

• Damage to kidneys
• Swollen salivary glands
• Damage to stomach and oesophagus
• Loss of body fluids
• Muscle cramps and weakness
• Fainting spells
• Fits and irregular heart beats.
• The binge seems an automatic response to emotional pain. Often the person feels out of control and unable to resist the desire to binge.

Anorexia Nervosa
Those who experience anorexia may be totally obsessed with food yet diet stringently and deny themselves healthy meals. They are constantly dieting or exercising to lose weight. The most commonly affected are young women in education aged 15-25. Although they may appear very underweight, they will feel fat. Anorexia can be life-threatening - some women starve themselves to death. Sufferers often feel low self-esteem and may vomit or purge themselves of food with laxatives. Women anorexics will sometimes suffer a loss of menstrual periods when their weight falls below a certain level.

Sufferers may feel terribly isolated and may experience the effects of starvation including:

• sleep disturbance
• reduced mental ability
• excess hair growth on body
• poor circulation
• feeling excessively cold
• fatigue
• dizzy spells
• thin bones possibly leading to deformity or
• osteoporosis
• stunted growth
• digestive tract dysfunction
• Possible Ways to Help Yourself

Begin to keep a personal diary - write down feelings and thoughts, stick in photos, draw pictures or diagrams, write lists, - there are no rules about how you have to use the space.

Keeping a food diary can be helpful in seeing patterns in when and why you eat, as well as what you eat.

Think about what food represents to you - is it a response to emotional pain or worry about what is happening in your life? Could you think of other ways to help that?

Your eating disorder has enabled you to cope with difficult circumstances. But perhaps now is the time to see if you can come up with other coping strategies which are less harmful to you.

Learn more about this eating disorder, so that you can understand better what is happening. .Buy a self-help book. Research has proved self-help books can be enormously effective. Some are listed at the bottom of this page.

Do not overly criticise or judge yourself harshly. Over zealous self-criticism will drive the compulsion of the eating disorder. Be kinder to yourself, like you would be to a friend who was suffering.

Books and further information

• Anorexia Nervosa’ by Janet Treasure
• Overcoming Anorexia Nervosa by C. Freeman and P Cooper
• Bulimia Nervosa and binge eating by Peter Cooper
• Overcoming binge eating by Chris Fairburn
• Getting Better Bite by Bite - A survival kit for sufferers of bulimia nervosa and binge eating disorders by J.Treasure & U.Schmidt
• Eating your Heart Out by Julia Buckroyd
• Anorexia Nervosa - A Guide For Sufferers and Their Families by R.L. Palmer
• The National Eating Disorders Association has a helpful website: www.nationaleatingdisorders.org
• BREaD offers local support for sufferers and their supporters:www.bread-eatingdisorders.org.uk

Further Help

If you would like to talk about your eating problem you can contact the Student Counselling Service. In one-to-one counselling you can explore and learn to understand the underlying issues in a safe, confidential environment. You can begin to develop different coping strategies, and learn to manage the obsession with food and body image that might seem to have taken over your life.

If you are supporting someone with an eating problem and would like to talk about its impact on you, you can also contact the Student Counselling Service. It is not easy supporting someone with an eating problem, it can be very upsetting and draining, especially when whatever you try to say or do doesn’t seem to help very much.

If you think it would help to talk to a counsellor, contact the Student Counselling Service
Email: cmh@worc.ac.uk
Phone: 01905 855107/ 855417

It may be that you know from past experience that exams are something you have always dreaded, and felt anxious about. Or perhaps you are feeling anxious about exams for the first time, or more worried than you can remember being about them before. You may begin to worry about them at the very start of the semester, or a month, week or days before they start.

Not many people can face exams without feeling some stress, and, to a certain extent, stress can help you to get things done. But when it reaches a certain level, which varies from one person to another, stress becomes unhelpful

Typical Reactions to Exam Stress

There are various signs of stress which people experience when their level of anxiety has become too high.

Physical Symptoms:
Sleep may be disturbed, short and interrupted, or you may find you want to sleep for ever.
You may lose your appetite, or want more food, especially alcohol, caffeine, or chocolate.
You may feel panicky, possibly waking up feeling anxious and breathless; you may feel nauseous and notice general muscular tension, perhaps focusing in neck-ache, headache or tightness in the jaw.

Thought Patterns
You may be preoccupied with exams even though they are ages away. Some of your thoughts may be very self critical, such as
running yourself down and comparing yourself unfavourably with other students.
You may see the future as bleak with you as a loser - not getting your degree or being inferior to others.
Some people worry about forgetting everything or ‘blanking out’.

Actions
You may find yourself tending to try and block out the subject of exams – avoiding going near exam halls, leaving lectures or switching off when the subject is mentioned.
You may be too easily distracted with very short spans of concentration and your normal functioning at study tasks may be badly affected.

Images
These usually take the form of unpleasant scenes or flashbacks from previous exams. They can be very vivid. You may have nightmares, or thought about the future which are quite bleak.

Effect on Interaction With Others
You may find yourself withdrawing, unable to talk to friends as much as usual. You might feel frightened of what people say about exams. People may seem less reassuring than usual.

Feelings
Your mood is may be just slightly down or quite anxious, often swinging between the two. You may have feelings of terror, or even despair.
Unpleasant though these symptoms are, they are very common and they can be overcome.

How to Deal with Exam Anxiety

1. Stop avoiding the issues.

• Try to face up to what lies ahead and plan for the event.
• Review your revision and exam skills, and plan to deal with any deficiencies.
• Set up a timetable to manage revision more effectively. Be realistic when planning your time; don't be too ambitious about what you can cover in an hour or two.
• Schedule relaxation time in between study sessions (but avoid over-partying!).
• Create an area where you can study effectively ie. good lighting, comfortable chair etc. The area should be free from clutter that might cause a distraction.

2. Learn to handle anxiety more effectively.

• You will keep your stress at a lower level if you have a routine that allows for regular meals and a regular sleep pattern.
• Develop a successful ‘winding down' routine before going to bed. Put your books away, make a list of anything you want to remember for tomorrow, and relax quietly.
• If you begin to feel panicky, concentrate on breathing slowly and deeply: put your hand on your diaphragm and breathe so that you feel it expanding and contracting slowly.
• Picture yourself positively; maybe struggling with aspects of an exam - but doing so competently and successfully.
• Imagine how good it will be when the exams are over, and what a sense of achievement you will have when you’ve done them.

3. Strengthen exam skills.

• To help reduce anxiety, practice answering questions under timed exam conditions on your own.
• Don't be frightened to ask for support from your department, perhaps with examples of the sort of questions you could expect in the exam.
• Sometimes we need someone else's help to get us to face up to a problem, and new skills develop more easily when you have a chance to talk it out with friends or family.
• The Equal Opportunities Centre runs courses on a range of study skills, which includes coping with exams.
• It might help to talk through your worries with someone other than friends or family. If you think it would help to talk to a counsellor, contact the Student Counselling Service.

Leaving home, very often for the first time, can be daunting. There are lots of mixed emotions. Coming away is something you may have looked forward to for a long time and it may have come as a surprise to you that you are feeling homesick.
Missing family and friends back at home is a natural reaction, felt by many people.
Moving away to university is a time of transition. Suddenly, instead of being an important member of a small unit of people, with familiar routines and activities, it can feel that you have become an anonymous person in perhaps the biggest community you've ever lived in. You may also feel that the relationship between you and your family changes dramatically.
Paradoxically homesickness can often ‘hit’ after Christmas, in the second semester, when you come back after the break and the newness of university life has worn off.

Causes
You’ve taken a big step in leaving home and coming away to study. The impact of this decision may hit in the form of homesickness. You have left all that is familiar and come away to work in a new and much larger environment.

Beliefs about homesickness:
These are some of the thoughts which people often have when they are homesick:

• I’m the only one suffering like this
• Feeling like this means that I must be weak/childish/ inadequate.
• I’ve lost part of my identity
• I’ve made the wrong decision to come away
• I’m going to get it all wrong
• Nobody is going to like me here
• I’m not going to fit in at all

It’s important to recognise that these thoughts may be affecting the way you are feeling. Can you change these negative thoughts into more positive and realistic ones? e.g.

• other people will be feeling like this
• feeling like this is quite natural in view of the change in my life

Symptoms of homesickness:
These are normal symptoms of homesickness:

• Tearfulness
• Feeling sad
• Feeling anxious or panicky
• Feeling overwhelmed
• Feeling lonely
• Feeling out of control
• Feeling more irritable than normal/ less tolerant of others
• Being angry with parents or family members
• Being jealous of siblings at home
• Changes in sleeping patterns
• Not being able to sleep
• Sleeping too much and hiding away in bed
• Changes in eating patterns
• Not eating enough
• Overeating
• Feeling generally unwell or sick
• Feeling isolated and lonely
• Not being able to concentrate or focus
• Using drugs and alcohol to block things out

Things that hinder
The list below may highlight things that are making you feel worse:

• Not admitting that you feel homesick to yourself or anyone else.
• Being unfamiliar with your surroundings
• Bottling up your feelings instead of talking it through with friends, family or a counsellor.
• Isolating yourself from others on campus
• Not having any contact with home.
• Having too much contact with home
• Going home too often so you never feel settled in one place.
• Not going home often enough so you feel you are losing all contact with those you love back home

Things that help
By beginning to take control of small things you can begin to help yourself to feel better.
Start with small manageable goals. Think of little things that you could be doing to alleviate some of the symptoms of homesickness. Only you really know what makes you feel better but here is a list of things that others have found worthwhile:

• Bring small things from home that make you feel comfortable in your surroundings
• Familiarise yourself with campus, so that it begins to feel like home
• Try joining in some of the clubs and activities. Although you may not feel like it, it may add to a sense of belonging.
• A lot of people will be in the same boat as you, so perhaps you could make the first offer of friendship in your halls
• Try and keep long term goals in mind; this will help you remember the point of it all
• The Student Union is a good place to keep yourself informed about what's happening in the university.

Homesickness is a normal and real feeling. If you would like support through this time then contact the Student Counselling Service. The Service’s web pages give more information on homesickness and tell you how to make an appointment to see a counsellor.

One of the commonest problems worrying students is the tendency to put things off until the last moment - or to beyond the last moment.

Signs of Putting things off
Are you often waiting for the “right moment” to start or for inspiration to strike you?
Does the need to tidy your room become irresistible whenever you contemplate getting down to work?
Do you stare at a blank piece of paper rather than being able to start writing?

If you answered yes to these questions, you may well have developed the habit of putting things off.

Some Causes of Procrastination

Understanding some of the causes can help you look at constructive solutions.

Lack of self-confidence
Studying is made more difficult if you see the natural problems that arise as a sign that you are not a very good student, rather than just as a sign that the work itself is hard. Perfectly able students can convince themselves that they are “impostors” who do not deserve to be at university at all because they are not finding the work easy. Recognising that it is not meant to be easy, but challenging, can help.

Getting Overwhelmed
If we sit down to write an essay and find there is a lot to research, it is natural to feel a bit swamped.

Unrealistic Expectations
Some people decide they should never get less than full marks and that any grade below a first is a mark of personal failure.
By leaving everything to the last moment we can keep alive the hope that we really could get a first in everything if we just got started.

Breaking the Habit
Putting things off can become a habit, and it can be difficult to take the first step towards breaking it, so…

Do Something ... Anything ... Now
Learning to get started without ceremony is one of the main skills of time management.

• Do not wait for the moment’ to be right’ before you start work.
• Use an odd half-an-hour to read a book and make some notes.
• Start an essay in the middle if this is easier than starting with the introduction.

Don’t Stop Because Something Is Difficult
If you come up against an obstacle, look for a way round it. For example if you cannot seem to get the structure of an essay right, make a rough outline and show it to the lecturer or talk it through with a friend.

Make a List and a Timetable
List what you have to do and make a sensible estimate of how long it will take. Then draw up a squared plan to represent the next few weeks, mark the deadlines and fit everything in. It might be a painful process but it will soon give you a sense of direction.

Set realistic targets
Don’t set yourself up to fail by setting unreasonable and unachievable targets for yourself, and imagining that you can study for very long hours on a regular basis. Give yourself generous time off in your study timetable. This can be a reward if you do well and can be used to complete work if a totally unexpected event has thrown you off course.

Don’t Aim for the Impossible
Work out realistically what standard you can achieve and start working towards that. It might be disappointing to decide you might only get a lower second, but a lower second in your hand is probably distinctly better than the first that exists only in your dreams.

Consider your Lifestyle
It is difficult to organise your work if you tend to sleep in an unplanned way and so cannot predict when your day will start. Staying up late then sleeping late, becomes a difficult cycle to break. The best way is to plan to get up early, irrespective of when you went to bed. Try not to sleep during the day even if you feel tired. This will help you slowly to get your normal daily cycle back.

Aim to Get More Organised
Research shows that the less worrying distractions there are, the better we work. Therefore aim for a clear desk, sorted notes, clear priorities and so on. The more you can focus your mind, the better you will perform. However do not substitute tidying up your room and sorting out your notes for doing some actual work or you will never get started. Keep tidying and listing as a relaxing task to be done at the end of a day’s work.

Find Help if Needed
There is no shame in finding studying difficult. It isn’t meant to be easy, so try not to be too proud to ask for assistance

It can help to talk a difficult piece of work through with friends or peers on your course. They might even welcome it because they are finding it hard too!

Academic staff can help with support and advice if you are confused about a piece of work. It might help to get something down on paper, however brief, before you see them, to remind you of what you are thinking.

Equal Opportunities offer Study Skills support with essay writing and other study skills through their Learning Support Team.

There are useful study skills leaflets in the careers room in Woodbury.

If you feel it would help to talk through things with a counsellor, contact the Counselling & Mental Health Service.

Introduction

Relationships - whether family or intimate relationships with a partner - can be a great source of love, pleasure, support and excitement. However they can also be a source of grief and anguish if they go wrong. The issue is made more relevant for students by the fact that most people in a university are in a period of personal change, which can make them feel less sure of what they want or how they can expect others to react.

 

Successful Relationships

Research into what makes relationships work successfully - whether family relationships, friendships or partnerships - tend to come up with the same few things:

• Acceptance of difference: People in successful relationships do not try to force the others to be exactly like them; they work to accept difference even when this difference is profound.
• Capacity for boundaries: People are aware that there is a point where they stop and the other person begins. Sadly, it is unrealistic to expect others to solve all our problems or meet all our needs – even though we may hope for this at times.
• Operating mainly in the present: Once relationships either focus on repeatedly picking over past events, or else are based only on the hope that things will be better tomorrow, they tend to go off the rails.
• Respect for individual choice: It is accepted that each person has the right to decide their own direction in life: the relationship then adapts to follow this.
• Skill in negotiating: Once each individual has decided what they want, the couple or family are able to work out a way to fulfil these different goals without anyone having to compromise
  totally.
• Sharing positive feelings: In a couple this may be sexual intimacy; however it can also just be pleasantness and kindness, as it is in a family.

The headings come from research carried out by Beaver (1985).

Thus it might seem that a relationship requires quite a lot of individual skill and self-sufficiency which can be a bit off-putting at first. However it is comforting to consider the research of John Bowlby on attachment (1975). He concluded that human beings are innately social and tend instinctively to know how to form close attachments to others.

Relationship problems often arise not because we never learned what to do, but because we have lost touch with this instinctive good sense and become over-anxious about our relationships.

This may be because we have lost our own self-respect and sense of our personal worth; it may be because we are in personal distress and so putting too much pressure on our relationships; it may be because we have had unfortunate experiences in past relationships and so have temporarily lost our ability to trust.

We may have been out of touch with our ability to make successful relationships for so long that we may doubt if we ever had it. However most people seem able to recover these skills if they put their mind to it.

Much work on improving a relationship can start with the individual. If one person is clear and reasoned about what they want and more consistent about how they ask for it, the whole relationship can begin to be put on a different basis.

Dealing with Problems in your Family

Family problems can be difficult to get a handle on as there might be a lot of people involved. Also most of us are not used to looking at our families objectively - we tend to think they are just our family and that is how it is. However a bit of reflection and analysis can take the heat out of a lot of difficult situations.

1. Try and think objectively about what you are trying to achieve. Give yourself the benefit of any doubt and attribute the best motives to your behaviour. Get together all the examples you can of where the plan has worked for others etc. Maybe get a friend to help you. You don't have to write it down, just think it through. If at this point you realise you're doing the wrong thing, you might want to make a strategic withdrawal! However let's assume you end up convinced you know what you are doing and you have a bit of evidence to back this up.
2. Think about why your family is disagreeing with you. There is probably more than one reason. Maybe they don't understand your plan; maybe they had a course of action decided for you; maybe they have some worries and anxieties of their own. Make a real effort to think yourself into their shoes even though their behaviour may be very frustrating to you. Imagine discussing the question with them - think of what you might say and how they might reply. When you've thought of what might be worrying them, think creatively of ways of reassuring them. If it helps, make a list of their worries and reassurances. 
3.  Find some way of discussing it. That's easy if your family are talkers, but many families aren't. However you can still find an opportunity to calmly mention your plans, to give a few examples of others who have done the same, to reassure their fears and sympathise with their disappointment. You may have to drop your points into the conversation over a time. Don't expect a miracle - people rarely change their opinion overnight. Don't feel you have to have total agreement; stop the discussion while the going is still good and come back to it a few days later. If they see you're serious and that some of their worries have been considered they will probably be a bit more agreeable the next time.

This is obviously a very simple example, but a similar approach can help in many situations. Frequently the conflict can be the other way round; many families find a son or daughter leaving for university is the catalyst for them to make changes. Sometimes it can be impossible to find agreement. If you are interested in discussing the situation further or if find you can't use the techniques described in this simple example - maybe the problem is too complex; you find it too upsetting; someone is too entrenched - counselling with the Student Counselling Service may help you to clarify what is going on and to find a way to deal with it.

Suggested Reading

Robin Skinner and John Cleese - Families and How to Survive Them
- A lighthearted book which nonetheless explores many of the dynamics of family life well.

Dealing with Problems in Your Personal Relationships

Large books and lengthy courses have been created to explore the infinite complexity of human relationships. Problems can arise from a large number of sources and it can frequently need some care to help disentangle the mixture of influences. These problems can be intensified by the pressures from others to form or end a relationship and the general pressures from the
media which give an idealised view of couples which is often at odds with the reality many people experience.

Here are some simple guidelines to help you explore and resolve tensions which you may be feeling about relationships.

Do you know what you are looking for in a relationship? There are many different reasons for entering into a relationship - for companionship; for sexual experience; to have a long-term partner; to create a family and so on. Do you know what you are looking for? Have you discussed this with your partner? If not there is a distinct possibility that you may both end up seriously at cross-purposes.

Are you asking too much or expecting too little from your relationship? A good relationship can provide support, sexual expression, companionship and eventually an opportunity to build a
joint life. If you are looking to it to provide more than this - for example to give you a sense of purpose and worth or protect you from some deep personal fear - you may be trying to get a partner to provide things that in fact only you can achieve. If on the other hand a relationship brings you continual grief and unhappiness you may be accepting for yourself a far lower level of interaction than you have a right to expect. In particular no-one deserves to be on the receiving end of physical or sexual violence. Do look for the support you need to change or end a relationship if abuse is happening to you.

Have you got a model for the relationship you are trying to build? Many people find it helpful to picture a relationship that they admire and to which they wish to aspire. It may be the relationship
of someone you know or a fictional one. Consider how the people in this relationship resolve differences and difficulties. If it is not obvious and the relationship is a real one, ask them. If they have never been seen to have any problems, maybe they are not a terribly realistic model after all! Finding such a model can be a particularly difficult and important task for gay and lesbian couples.

Can you talk about problems? In all relationships there are going to be times of serious disagreement, where a conflict of interests has to be resolved. This doesn't mean there is something wrong with the relationship. However, arguing the point out and reaching agreement does take a bit of skill and practice. Many relationship counsellors suggests the best way to resolve a relationship problem is to speak for up to fifteen minutes about your view of the problem. The other person listens carefully, interrupting only to clarify and to help you express yourself clearly. Then you swap over and the other person takes a similar time to explain their point of view. Finally take half-an-hour to talk together to see if you can resolve the difference. If you don't succeed this time, return to the problem a few days later and try again.

If you are not in the habit of talking in your relationship, it might be interesting to give it a try. Relationships are one of the curious features of human existence and can be well worth exploring.

Golden rules for arguing constructively:

Do-

• Know why you are arguing before you start
• Devote some time to resolving the problem
• Sit down and make eye contact
• Speak personally about what you feel
• Acknowledge when the other person makes a valid point
• Agree to differ if you cannot agree
• Stick to the matter in hand
• Cease arguing and separate if there is any likelihood of violence

Try not to-

• Behave aggressively or disrespectfully
• Argue deliberately to hurt the other person's feelings
• Generalise
• Bring up old unresolved disputes
• Walk away without deciding when discussion will be resumed (unless violence threatens)
• Bring other peoples' opinions in
• Argue about something for more than an hour
• Argue late at night or after drinking

There are a great range of relationships and of relationship difficulties.
Counselling can be a great help in helping to clarify complex relationship
problems. If you would like to talk to a counsellor, view the councelling homepage for details.

Suggested Reading

Relate Guide to Relationships - Sarah Litvinoff
- A comprehensive and easy to read guide to all aspects of couple relationships. Includes many case histories and a lot of self-help exercises.

References

Beavers W.R. (1985) Successful Marriages WW Norton NY
Bowlby J. (1979) The Making and Breaking of Affectional Bonds Tavistock Publications. London.

Introduction

Many people, when faced with distressing or stressful experiences, may fail to take care of themselves as they would normally expect to do. They may not eat properly, may smoke or drink too much, drive too fast, spend too much money, make themselves ill through overwork or worry, or practise random unsafe sex. These failures of self-care are ways people use to distract themselves from painful feelings, to numb them, to avoid facing them.
For some people, the depth and intensity of the pain is such that these ways of coping do not seem to be enough, and they may find that more direct self-injury feels like the only way to cope with their feelings.

Self-injury is a term used to cover a wide range of behaviours.
The most common form of self-injury is scratching or cutting the skin, usually the arms or legs, but other parts of the body too. Others can be burning or scalding yourself, picking at the skin, pulling your hair out or hitting yourself against things. These behaviours, which involve causing pain or harm to your own body, are ways of trying to cope with emotional pain.

Reasons why people self-injure

There are always powerful reasons as to why an individual injures him/her self, and the reasons may be complicated, and not entirely clear to them. These are some of the reasons which might make some sense to you:

• It is a way of coping with, and surviving emotional pain. It can put the pain ‘outside’, where it feels easier to cope with.
• It is often linked with depression, low self esteem and a poor physical self image.
• Some people feel that it helps to release unbearable tension, perhaps arising from anger, guilt, or anxiety.
• It is a way of punishing the self, or relieving feelings of shame and guilt
• It may be a ‘cry for help’, a tangible and desperate way of showing that s/he is in pain and is suffering.
• It may be a way of taking control of at least something in that person’s life.
• It can be a way of restoring a feeling of reality, of making the self seem real or ‘connected’.
• It may be due to abuse, whether physical, sexual or emotional, or other painful life experiences.

Common Misunderstandings about self-injury

• It is not a failed suicide attempt. For most people who self-harm, their actions are not about ending life, but trying to cope with it on a daily basis.
• It is not seeking attention just for the sake of it; sometimes it is that person’s desperate attempt to show that something is really wrong. Many people go to great lengths to hide their self-injury.
• Just because a person self-injures, this does not inevitably make them a danger to others. The hurt and anger are being directed at the self, and most would be distressed at the idea of hurting others.
• It is not a sign of severe mental illness, but in fact a sign of someone trying to cope with pain as best s/he can.

Some Practical Things to Do

• Consider your lifestyle: how could you take better care of yourself generally. Are you eating properly? Are you getting enough sleep? Could you drink less? Could you plan your days so that you have time to relax , as well as do all the other things that need to be done?
• If you think you are likely to self-injure, avoid using alcohol or other drugs which may make you harm yourself more than you intended.
• Make sure that any equipment you use is clean; don’t use things which others have used, or which are dirty, as this could make you more liable to infection.
• Make up a first aid kit for yourself and have it ready, so that you can care for any wounds properly.
• After you have self-injured, you may feel upset. So look after yourself by keeping warm, having a warm drink, or something to eat, and, if it is possible, talk to someone who will be there for you.
  Remember that other people will want to help, but they may find what you are doing very upsetting. Choose thoughtfully who to tell, and be mindful of their possible feelings and reactions about what you tell them.

Possible Ways to Help Yourself

• Try to begin to make sense of what you are doing by considering when it began and what was happening then; explore how self-injuring has helped you to survive, both in the past and now. Think about how you feel before and after you have self-injured.
• Begin to keep a personal diary - write down feelings and thoughts, stick in photos, draw pictures or diagrams, write lists, - there are no rules about how you have to use the space.
• Retrace the steps which led to a recent incident of self-injury – events, thoughts, and feelings. Is the urge to self-injure a signal of buried needs, feelings, thoughts, memories? Keeping a diary can be helpful in seeing patterns in when and why you self-injure.
• Think about what your self-injurious behaviour represents to you - is it a response to emotional pain or worry about what is happening in your life? Could you think of other ways to help that?

Your self-injuring has enabled you to cope with difficult circumstances. But perhaps now is the time to see if you can come up with other coping strategies which are less harmful to you. Look for small steps that you could take towards possible alternative behaviours.
For example,

• cutting less deeply or less often
• taking better care of the injury
• avoiding drinking too much if that is when self-injuring most often happens
• writing the feelings down instead
• tearing up bits of paper and making a collage
• painting
• phoning a friend
• to get physical sensation, flick elastic bands on your wrist, hold ice cubes in your hand until they melt.

Supporting Someone who Self-injures

It is not easy supporting someone who self-injures. It can be very upsetting and draining, especially when whatever you try to say or do doesn’t seem to help very much. You may feel angry with them, frightened or helpless. You cannot force someone to stop this behaviour. Remember that they are using it to cope with their own difficulties.

Having someone who will listen sympathetically to them can be very helpful. It might help to suggest that you both do something together, like going into town, to the gym, or having a cup of coffee or preparing a meal together.

But it is important to remember that you are not responsible for someone else’s actions. Think of your own needs too, and do not offer more support than you can sustain. You do still have your own life to live.

Sources of Help

• The Accident and Emergency Dept, Royal Worcester Infirmary, Charles Hastings Way, Newtown Road, Worcester.
• Your GP
• The British Red Cross 0844 871 1111. They have a skin camouflage service, but you do need to be referred by your GP or a consultant.
• Samaritans 08457 909090 - a 24hr line
• Mind website on self-harming: www.mind.org.uk/information-support/types-of-mental-health-problems/self-harm/

Further Help

If you would like to talk about your self-injuring you can contact the Student Counselling Service. In one-to-one counselling you can explore and learn to understand the underlying issues in a safe, confidential environment. You can begin to learn to manage your feelings differently and develop different coping strategies.

If you are supporting someone who self -injures and would like to talk about its impact on you, you can also contact the Student Counselling Service.

cmh@worc.ac.uk
01905 855107/ 855417

Introduction

The term sexual abuse most commonly refers to the involvement of a young person below the age of consent in sexual activity with a significantly older person. It is referred to as abuse since it is assumed in our society that the older person must by definition be taking advantage of the younger one since a person under sixteen cannot give informed consent to sexual activity.
Usually the victim of the abuse cannot understand fully the implications of what is happening at the time; therefore although he or she may appear to consent to the activity, the consent is not truly informed. Although the abuser may also be young, there is usually a significant age difference and/or difference of status between the parties which puts the abuser in a position
of power. This power difference means that even where there is apparent acquiescence, this is usually based on fear of the consequences of refusal and so is not true consent.

The term sexual abuse may also be applied when one person uses the power they have over another adult - usually because they are in a position of trust or influence - to take advantage sexually.

Sexual abuse can be an isolated or a recurrent event. The activities involved can range from inappropriate touching to sexual penetration. The abuse can be disguised as play or it may be a more overt assault. The abuser may be a relative, an acquaintance or a stranger. While the abuse is often frightening and traumatic at the time it occurs, some feelings may not fully impact until a later date when the occurrence is better understood.

Commonly those who are currently experiencing abuse are referred to as victims of sexual abuse; those whose experience of abuse is in the past are referred to as (adult) survivors of sexual abuse. The information here, and on the Rape and Sexual Assault page, is relevant to both current victims and survivors of past abuse.

Examples of Past Sexual Abuse:

• A girl who was sexually abused by her father until her teens when she eventually reported what was happening with the result that her father was tried and imprisoned.
• A boy who was abused by his football coach and thought he was alone with the experience until a number of boys reported being similarly abused several years later.
• A young girl whose teenage step-brother used to play games with her at an early age which she realised when she reached puberty had been sexually intrusive.
• A boy who was regularly abused by a trusted uncle and aunt with whom he was often sent to stay. This abuse took place over a number of years during which he was unable to say why he did not wish to visit these relatives.
• Two sisters who both suffered abuse at the hands of a grandfather but who never spoke about it until many years later.

The experience of abuse is not restricted to one sex and indeed abusers are not always male. Most recent estimates in Britain suggest at least 10% of children suffer sexual abuse at some time, with two thirds of the victims being girls. In over 90% of the cases the perpetrator of the abuse is male.

The Victim’s Experience at the Time of Abuse

Victims report feeling very alone with the experience of abuse. Often they are afraid of telling, because of fear of retribution or the consequences for the family.

Victims frequently feel they will not be believed or taken seriously if they tell of what has happened, and this fear can be confirmed when they do try to raise the matter.

Victims frequently feel guilty. The abuser may suggest they are to blame for the abuse or they may take responsibility upon themselves. Children naturally tend to assume responsibility for
events that are not of their making, and this is particularly true in the case of abuse. The guilt is increased if the child has found any aspect of the abuse gratifying.

Victims commonly report feeling extremely scared and confused by the abusive experience.

The Survivor’s Experiences in Later Life

Sometimes the experience of abuse appears to be wholly or partially forgotten for some years while the survivor continues with their life. It may resurface however when the person is settled in a safe environment, or may be triggered by specific events such as beginning a sexual relationship or becoming a parent.

The memories can bring intense feelings and experiences -

• Flashbacks and nightmares. Recollections of the abusive experience may intrude into the waking thoughts or may recur in dreams.
• Shame and guilt. The survivor may blame themselves; may suffer from low self-esteem or may feel deeply embarrassed about seeking help. They may become depressed, harm themselves and have thoughts of suicide.
• Intense anger. This may be directed at the abuser, and may be linked with a wish to confront or to completely avoid them. It may also be directed at others who seem to have colluded with the abuse or may be more general.
• Disrupted relational patterns. Some survivors find they tend to avoid intimate relationships and are distrustful of the motives of all other people. Others may find they tend to form very intense intimate relationships which can be emotionally draining.
• Fear of the consequences of the abuse. Survivors may wonder whether they will be able to form normal relationships or whether they might become abusers themselves. There may be difficulties in enjoying normal sexual activities.
• Isolation and stigmatisation. Survivors may feel they are totally alone with their experience. They can feel that they have been marked out and that somehow others know of their history without being told and so treat them differently.

As with human response to any trauma, the degree of the reaction can vary widely between individuals. Some people apparently come to terms with very severe abuse comparatively easily; others find the abuse has a lasting effect on them. Neither of these responses is more correct or more healthy than the other.

Helping Yourself

Try not to blame yourself
No matter what the circumstances of the sexual abuse of a child, it is never the fault or responsibility of that child. Even if you are aware that there was some degree of collusion or you feel in hindsight that you wish you had been able to act differently, this does not lessen the absolute truth that is the duty of adults to care for children and protect them from exploitation. Some survivors find it helpful to observe children who are the same age that they were when the abuse took place in order to underline for themselves how great the power difference between adults and children really is and how easy it is for an older person to manipulate the trust, innocence and vulnerability of a child.

Take care of yourself now
The fact that something bad has been done to you is not a reason to deny yourself pleasure, or to punish yourself. It is in fact a reason to care for yourself. If you can learn to treat your body with respect and kindness, you will help the healing process. Therefore look for simple ways to show care for yourself and kindness to your body. If you find you are tempted to harm yourself - for example by starving or overindulging, by cutting yourself or even by attempting suicide - seek help and support so that you can begin to bring this behaviour under control.

Find appropriate outlets for your feelings
If you have been abused you have a perfectly good reason to be very angry and full of grief. It can be hard to know what to do with these feelings. It may not be possible or helpful to express them to the person responsible. Even if you do, he or she may well fail to accept responsibility.
Feelings can be helped by finding others who will listen to your story sympathetically and help you express yourself. Writing down what you feel can help - many survivors find it helpful to write down their feelings in the form of a letter - you don’t have to send it, but don't leave it lying around! Many activities can help relieve pent up feelings of anger - exercise, sport, or simply going somewhere private or noisy and shouting. Grief can be relieved by allowing time to reflect and by expressing the sadness. You may fear that once you allow these feelings to emerge they may take you over. This is a natural fear; however in fact the opposite tends to be the case - once a feeling is allowed adequate expression it becomes more easy to control.

Try and find both support and privacy
Abuse can be a profoundly isolating experience. Even when you do speak about it, people may either dismiss what you tell them or they may over-react. However, as is now recognised, abuse is an all too common experience, so you are certainly not alone in what you have suffered.
There are now many agencies which will offer appropriate support and have much expertise in helping survivors heal themselves. We list some below. Some people have the opposite experience and find that the abuse which has happened to them has become common knowledge, and as a result feel that their privacy has been invaded. Remember you only need to tell the people who you want to tell and it is up to you to decide how much you want to tell them. Certainly no-one will be able to guess what has happened to you if you decide not to tell them and no-one has the right to force their opinions or their advice on you.

Do not despair
Human beings are remarkably resilient and have a vast capacity for healing themselves. You may well feel that you have been irreversible damaged emotionally or even physically; that you may not ever be able to form a functioning relationships or have an enjoyable sex-life; that you will never recover. However this is not likely to be the case. Although you can never change your history, with time and care you can make sense of what has happened to you and can minimise the negative effects.

Further Help

If you have been abused as a child, you might want help to make sense of your feelings and worries. This may be even more true if the abuse is continuing.

It can be very difficult to trust someone with something as personal as this and may require a lot of courage. It may be easier to share your feelings with a stranger rather than a friend. Counsellors are trained to work with people dealing with the effects of abuse, and will not be shocked or embarrassed by anything you tell them. If you would like to talk to a counsellor, view the councelling homepage for details.

Three of the many books have been written on the subject are:

- I Know Why the Caged Bird Sings - M. Angelou - Virago
- My Father’s House - S Fraser - Virago
(both of these are personal accounts which survivors have found helpful)

- The Courage to Heal - Bass and Davis - Harper and Row
(The most common book which many have found useful but which has been criticised in light of the false memory debate for treating many everyday personality traits as though they were clear evidence of past abuse)

There are also many self-help groups where survivors of abuse share their experience in safety and learn to deal with the resulting emotions. The following agencies maintain lists of survivors groups and other sources of help:
Samaritans – 08457 909090
NSPCC – 0808 800 5000
Victim Support – 0845 30 30 900
Rape and Sexual Abuse Support – 01905 724514
Childline 0800 1111

 

What is meant by 'sexuality'?

In its broadest sense the term 'sexuality' describes the whole way a person goes about expressing themselves as a sexual being. Every survey of human sexual behaviour reveals that there is a huge variety of sexual expression - the way we choose to behave sexually is usually as individual and as complicated as the ways we choose to dress or to earn a living. Human sexuality rarely falls into neat categories or lends itself to simple labelling. Human sexuality is a rich and complex area of human experience.

• Biological sex refers to the genitalia (the physical equipment), hormone levels, and the X or Y chromosome combination. The majority of people are clearly biologically male or female, although some people are born with genitalia which are not clearly one or the other.
• Gender role, or social sex role, is about how we are expected to behave as males or females in our culture. This social role is in practice linked with the gender expectations placed on an individual by virtue of their physical genitalia at birth.
• Gender identity refers to the psychological feeling a person has about being either male or female. It may not match biological sex, and is unrelated to sexual orientation. A lesbian woman is biologically female, and feels like a woman, but is attracted sexually to other women. A transgendered person will have the biological sex of one gender, but feel psychologically that s/he is of another gender, and could be either heterosexual or homosexual.
• Sexual Orientation refers to the aspect of sexuality that is about who a person finds attractive.  This involves automatic physiological and emotional responses, and is not the result of conscious choices. Sexual orientation appears to be determined early in life, perhaps from birth, and cannot be changed.  
  There has been a hot debate over recent years about why people's sexual orientation differs. Many theories have been put forward - citing genetic pre-determination, childhood influences and peer-pressure amongst other reasons. However, attempts to find a single cause for individual's choices of sexual orientation have not been successful. Nor have attempts to influence or change an individual's sexual orientation. Like many of our other characteristics, it seems to be largely a chance product of our individual nature which is then further developed by our early interactions. Like many other personality traits, our sexual orientation seems to be formed by the time we reach teenage -- although it may be many years later before we each understand and accept our sexuality. It seems resistant to attempts to radically change it.

Coming out

There is an assumption in society that a person will be attracted to another of the opposite sex.  So if you are not, but are attracted to people of the same sex as you, you may well be gay/lesbian or bi-sexual, and this will mean that you may at some point want to ‘come out’ about your orientation to others.

Before you can come out to anyone else, you have to come out to, and accept, yourself. Some people are certain of their sexuality from a very young age; for others it can happen much later in life. Accepting the conclusion that one is gay, lesbian or bisexual hopefully is easier nowadays than it has been in the past. Attitudes are somewhat more accepting and there are now more people living openly gay and lesbian lives than there has been in the recent past.  But still for some people it is hard to accept that they are not heterosexual.

Most people are brought up by heterosexual parents with the values and expectations of the heterosexual majority.  Families often have detailed, if unspoken, plans for their children and can be very upset when it becomes clear that not all their hopes are going to be realised. Similarly friends and other groups may have their own very definite opinions or prejudices. It is important that you come out to people who will validate and celebrate your new found sexuality as well as to people who may question it.

- Look for sympathetic people to come out to first.
- Follow your own timetable - it's your life and your sexuality. Don't feel you have to tell people until you are ready.
- Don't assume people are homophobic just because they make anti-gay jokes. Often people haven't really thought the thing through, and don't do so until someone close to them comes out. Sadly the opposite can also be true. Some people can be quite fixed and judgmental in their view of gays,  lesbians and bi-sexuals.
- Everyone doesn't have to know. You don't have to share this unless you particularly want to. Many people will consider your sexuality is your own business.
- Don't be too put off by an initial bad reaction. Many people react badly when they are faced with something that has shocked them. Given time, their reaction may change.
- Choose your medium. If you are worried that someone will be very hostile, writing might give them time to assimilate the news better.
- Being gay, lesbian or bi-sexual is not something a person chooses.  We do not have control over how we are so there is no need to apologise for it.

Models for the Coming Out process

Everyone will have their own unique feelings about being gay, lesbian or bi-sexual, and it is important not to make assumptions about how a person feels when s/he chooses to come out.  Feelings of utter relief and excitement in finding a new sense of identity and community previously lacking may be mixed with a sense of loss of all that heterosexuals can take for granted.

There have been various ‘models’ suggested to represent the ‘coming out’ process.  Three are offered here, and they need not be seen as mutually exclusive.  You might recognise feelings in yourself from all these models.

1.  The first is a model based on the concept of romantic attachment.
   Stage 1:  Pre-Coming Out.  General feeling of being different
   Stage 2:  Coming Out.  Becoming aware of homosexual thoughts or fantasies, beginning to make contact with other homosexuals, but may still keep your identity from some others.
   Stage 3:  Exploration.  Experiments’ with new social interactions, with an improvement of self-image.
   Stage 4:  First Relationship.  After a period of sexual experimentation, wanting a more stable and committed relationship
   Stage 5:  Integration.    Public and private identities merge; you are able to be more open and honest about your relationships.
   (adapted from Coleman. E, 19981/82,  Developmental Stages of the Coming Out Process, Journal of Homosexualiy, 7(2/3), 31-43, The Haworth Press.)
2. This model focuses on the concept of loss:  it is likely that there will be a sense of loss which has to be acknowledged, loss of one’s heterosexual status, and of the expectations about the future which were a part of that.
   Stage 1: To accept the reality of the loss of heterosexuality and its privileges.
   Stage 2: To acknowledge specifics of the loss and look for ways to ‘fit in’ to the new community of which you are becoming a part.
   Stage 3: To feel the pain of the loss and to grieve.
   Stage 4: To adjust to life as a gay/lesbian person
   Stage 5: To integrate into the gay/lesbian community, and into the broader heterosexual community as a gay/lesbian person.
   This process is not necessarily tidily linear, and a person can, as in all grieving, move back and forth between the stages.
   (adapted from Alexander,C, (ed), 1996, Gay and Lesbian Mental Health,  212-217,Harrington Park Press.)
3. This model recognizes that coming out as a lesbian or gay person is a long process of self-identification which can take many years to achieve.
   Stage 1:  Identity confusion.  General feelings of being different.
   Stage 2:  Identity comparison.  Awareness of homosexual feelings, thinking that they may be just a phase, or the feelings are attached only to one specific person.
   Stage 3:  Identity tolerance.  Stronger identity of being homosexual and starting to reach out to contact other homosexuals.
   Stage 4:  Identity acceptance.  Increased contact and affiliation with other homosexuals.
   Stage 5:  Identity pride.  Coming out to more and more people, perhaps starting to feel anger towards heterosexuals and devalue heterosexual institutions.
   Stage 6:  Identity synthesis.  Feeling more at ease in both heterosexual and the homosexual worlds, and taking pride in yourself for who you are.
   (adapted from Cass,V, 1979, Homoseual Identity Formation: A Theoretical Model, Journal of Homosexuality, 4(3), 219-235, The Haworth Press.)

Sources of help

Decisions about your sexuality can be difficult, and can create feelings of upheaval and uncertainty.
Some sources of advice are listed below:
• Hereford and Worcester Lesbian and Gay Switchboard 01905 723 097
• Worcestershire Gay Men’s Health Project, tel. 01905 681751
• National AIDS Helpline - 0800 567 123

If you think it would help to talk to a counsellor, in privacy and confidentially, contact the Student Counselling Service.
Email: cmh@worc.ac.uk
Phone: 01905 855107/ 855417

 

 

Most people experience sleep disturbance from time to time. The following are normal forms of sleep disturbance:

• Waking early
• Difficulty in getting to sleep for a period of time
• Prolonged, disturbed and light sleep
• Sleep which is interrupted by shock and fear on sudden waking (night terror)
• Sleep which is interrupted by nightmares
• Small amounts of sleep with cat napping at other times.
• Occasional complete absence of sleep

When you feel you are not getting enough sleep, or that your sleep is disturbed, it can be worrying, and leave you feeling tired and unable to cope with the daily demands of your life effectively.
But for most people it is usually a temporary state, and there are things that you can do to improve the quality and pattern of your sleep.

General Points for Better Sleep

• Try to eat foods that provide you with the chemistry which encourages sleep. Foods containing melatonin may be helpful. Oats, sweet corn, rice, ginger, tomatoes, bananas and barley all contain melatonin. Oats contain most, barley least. Also carbohydrates broadly speaking affect the production of tryptophan. This is a chemical in your body which affects the levels of serotonin in the brain, and encourages a sense of wellbeing and restful sleep.
• Keep sleep to limits; don’t oversleep. Try to re-establish a pattern of sleep by going to bed each night and getting up in the morning at around the same time, even if you haven’t slept well. It may take a few days for your body to respond to this pattern, but it should help once the pattern is established.
• Avoid long daytime napping - if you sleep for an hour or more during the day or in the evening you can normally expect to take longer to go to sleep, or to sleep less at night.
• Don’t magnify your sleepless state, or alarm yourself over it, as this may make it worse. You may go to bed feeling really stressed about whether or not you’ll sleep. It may help instead to see the wakeful hours as a time to relax in a warm and comfortable place. Alternatively, don’t toss and turn for hours in bed. Rather than lie there getting more upset because you cannot sleep, it can help to get up and/or read, or listen to the radio or do light, fairly mindless, things until you feel drowsy again.

Pay attention to your Night-time Routine

By establishing a routine before you go to bed, you are helping your mind to switch off from the day’s activity and prepare for sleep. The following suggestions are ones which may be helpful:

• Reduce mental activity two hours before sleep; try to avoid studying and then going straight to bed, because your brain will take a while to ‘switch off’.
• Reduce light levels two hours before sleep: use a lamp rather than a bright overhead light.
• Create a sleeping environment which is free from work and disturbance. Put books and papers away, even if just on a neat pile on your desk.
• Some people find that having a bath or a shower before they get into bed helps them to relax and switch off from the day.
• Consciously stop yourself worrying at night. Write concerns down so you can put them out of your head and plan to deal with them in the morning. Making a list just before you settle down to sleep of what you want to remember for the next day means that you don’t have to have these things going round and round in your mind.
• Don’t go to bed hungry - some people find that something light, like a banana or a biscuit and/or a warm drink helps just before going to bed.
• Avoid caffeine and alcohol before sleep They are both stimulants.
• Avoid respiratory stimulants before sleep (cigarettes - nicotine is a stimulant)
• Avoid exercise before bedtime (increases stress response chemistry in many people)
• Go to the toilet before getting into bed to avoid being woken by a full bladder. Don’t drink a lot late at night.
• If you are a person who needs absolute quiet to go to sleep, ear plugs might be helpful; some people find that a constant low background noise, like music or the radio, helps.
• Have a range of distractions available for use in the event of being awake for a while: some light reading, a notebook and pencil to jot down things that you want to remember in the morning, a radio.
• Make your bed as comfortable as possible, and try to get the temperature comfortable for you. Sometimes a hot water bottle helps if you feel cold in bed, or wearing socks in bed to stop your feet getting cold. Or maybe a lighter cover if you feel hot.

If there are issues which are stopping you sleeping because you are worrying about them, it may be helpful to talk with a counsellor about them, or about your sleep pattern.

Introduction

You may be consulting this page because you are considering suicide or because you are worrying about a friend who seems to be considering suicide.

The Counselling Service advises most strongly that anyone contemplating suicide seek assistance at the earliest possible time. We would never want to minimise the problems that lead individuals to contemplate ending their lives - often they are problems of great severity which carry with them deep feelings of shame, loneliness and hopelessness.

However, most research and anecdotal experience of carers suggest that the despairing thought which make a person feel that the only way to resolve the problem is by suicide is normally a unsound one. This Service has worked with many students while they are actively contemplating suicide or who have done so in the past - almost invariably when the crisis is past they express relief that they have not acted on their suicidal intentions.

The problems that lead to suicidal thinking are too complex and varied to address here - although some pointers may be found on our other pages. However what we can do is give clear guidance to immediate sources of help.

Immediate Help

• Call 999 if you urgently need medical attention or go to your local Accident and Emergency Unit. The Accident and Emergency Unit at the Worcester NHS Trust Hospital, Charles Hastings Way, Newtown Road, Worcester can be visited at any time.
• Contact your local GP and ask for an emergency appointment or to speak to a duty GP on the phone.
• Contact University Security on 01905 545494 or x5495.

Other useful services include:

• NHS Non-Emergency Phoneline on 111, This is a Free 24hr service.
• Samaritans on 116 123 (UK Free & 24hr) or 01905 21121 (local charges apply, not 24hrs). Their listening service is confidential.
• Firstpoint (during working hours). The staff are very knowledgeable and may be able to help identify sources of help - firstpoint@worc.ac.uk and 01905 542 551 or x2551.

In addition to these services that maintain specific emergency cover, Chaplains, Student Services Staff, Student Union Welfare Officers and Departmental Advisors will all be willing to support a student in times of difficulty or distress.

Useful websites

www.samaritans.org
www.papyrus-uk.org
www.metanoia.org

Helping a Friend

If a friend of yours is in distress and maybe even talking about harming themselves, we would suggest the following steps, sometimes summed up in the acronym COPE.

Be Caring - never ignore or take lightly a suggestion of suicide - research shows most people who attempt suicide normally tell someone else of their intentions first. Ask more and do not be afraid that talking about the threat will put ideas into the person's mind - it is more likely that they will appreciate being taken seriously.

Be Optimistic - as explained above, most human problems can be solved with time, care and expert help no matter how hopeless they seem. You do not have to give up hope just because your friend has temporarily lost theirs. However, do not let your optimism lead you to dismiss or make light of the person's concerns.

Be Practical. Do not leave a person expressing serious self-harming intent alone, especially if the means of self-harm are at hand. Involve others - using the emergency services if necessary. Be particularly vigilant if someone is drunk or under the influence of drugs, if they have made a suicide attempt in the past or if they have a clearly formulated plan. Do not however get drawn into making unrealistic long-term promises of ongoing support that you are unlikely to be able to keep.

Seek an Expert. If the person threatening suicide refuses to involve any of the sources of help listed above once the immediate crisis is passed, consider contacting them yourself in order to plan what steps can be taken to get support for your friend.