Welcome to the grief and loss support program

Grief and loss support program

The seven modules in the program are:

• Module 1: Coping with grief and loss
• Module 2: Communicating effectively with others
• Module 3: Connecting with others
• Module 4: Your mental health
• Module 5: Your physical health
• Module 6: Life skills for optimal health and wellbeing
• Module 7: Key points from the program

Grief and loss support program

Tell us what you think

At the end of each module, you are provided with an opportunity to rate the module and give us your feedback.

Test your understanding

There is a short quiz at the end of each module to enable you to check your understanding of the program content.

Go at your own pace

Each module has activities for you to explore. Some of the activities might be appropriate for you to complete now, and there might be others that you would like to come back to at another time.

Module 1: Coping with grief and loss

This module is designed to support people in coming to some understanding of the impact of suicide. The strategies in this module will also be useful for people who are caring for someone who is at risk of suicide, which can be an ongoing traumatic life experience. Carers, as well as friends of people at risk of suicide, need support.

Grief and loss is a part of life and the impact is unique to each person. We experience grief in relation to life events such as loss of health, the loss of a friend, the end of a relationship or the loss of income.

When someone dies

Grief is a normal process that is a response to a difficult life circumstance. Grief affects us all differently and there is also no fixed time schedule with grief.

Some people adjust to life without the person who died after some months, but for others, it can take years. The grieving process for people who are bereaved by suicide can also be compounded by the fact that it is a suicide.

Many people find that they have days which are quite difficult. Certain times of the year, for example, anniversaries and birthdays, can remain difficult occasions for many years after someone close to us has died.

Carers

Caring can cause ongoing grief and loss because there can be:

• A loss of relationship, as you shift from being a partner / lover / sibling/ parent / child to the role of carer
• A loss of self and your ability to have your own needs met. For example, it is harder for you to take time out for yourself, because the focus is on the person of concern
• Grieving for what was or the way things used to be. For example, before the person developed a mental illness or a disability
• Ongoing trauma associated with the carer role. For example, having to deal with uncertainty, isolation, feelings of powerlessness and hypervigilance (you may be constantly on the lookout for signs that the person will suicide)
• A lack of personal and professional support for carers, because there is crisis after crisis for the person at risk of suicide

Symptoms associated with sudden loss

Shock and disbelief

Going into a state of shock is common when finding out someone has completed suicide. This shock can be further intensified by the trauma of finding the body or witnessing the suicide. It can be very hard to accept that someone who you may have known for many years has died. It is common to expect the person who died to walk through the door or call you, for some time after their death.

When in shock you may feel overwhelmed and exhausted. Experiencing shock is different for everyone, however common physical effects of shock include nausea, stomach pain, sleep difficulties and chest pain. Sometimes people experience memory problems and abuse alcohol or other drugs.

Guilt

You might experience guilt about several things related to the person who died. For example, guilt that you did not spend enough time with the person who died, that you did not say or do certain things together or guilt that the death could have been prevented. Sometimes people bereaved by suicide think that they should have detected signs of suicidal behaviour prior to the death.

Symptoms associated with sudden loss

Blame from others

Sometimes people are blamed for the suicide by family members or friends. This can be very difficult, especially at a time when you could use the support of other people.

Anger

You might feel angry or resentful about losing a friend or loved one. You may feel angry with medical staff, with God, with yourself, or with the person who has died because they have left you.

Relief

In some cases the person may have made repeated suicide attempts and have been suffering for some time. You may have felt weighed down by their pain and now feel relieved that you don't have to worry any more. Sometimes this relief is accompanied by guilt.

Shame

The pain of grieving can be further intensified by the stigma attached to suicide. You may be unsure of what to tell people because you fear that they'll judge you or the deceased. You may struggle with the person's choice to suicide.

Fear

Loss can lead to feelings of anxiety, helplessness and insecurity. It can generate fears about our own mortality and a fear of facing life without the person who has died.

Physical symptoms

Grief can involve a range of physical symptoms including fatigue, sleep problems, nausea, lowered immunity, weight loss or weight gain and aches and pains (such as stomach aches and headaches).

Post traumatic stress symptoms or anxiety and depression are also common. Read about these problems in module 4 of this program.

More about symptoms of grief and loss...

It is important to get support when grieving

See your Doctor

Let your doctor know about your loss. Tell your doctor how you are feeling and about the reactions and symptoms you are experiencing. For example, tell your doctor if you are having problems sleeping.

Your doctor might recommend short-term medication to help you cope. The decision to use medication is always up to you and you can talk to your doctor about any concerns you may have in regard to taking medication.

Counselling

Consider seeing a counsellor such as a psychologist who has training and experience working with people who are grieving.

As grief is a very individual experience, you may also decide to seek counselling several months or years after your loss, particularly if you did not seek counselling at the time of the person's death.

Additional support

There are things you can do to help you grieve. You might like to join a support group. If you follow a religion, you may find comfort in going to a service or speaking to a member of your religious community.

You might also spend some time with family and friends who you find supportive. Take some time off work and if possible, consider going away for a break and change of scenery.

Explore bereavement support in your community:
http://www.suicidecallbackservice.org.au/online-resources.html

Community services database:
http://www.crisissupport.org.au/jigsaw/

Consider online bereavement support:
http://forum.suicidecallbackservice.org.au/

Support for carers

If you are a carer it is important that you look after yourself. Given the ongoing and traumatic nature of caring for someone with a mental illness and or someone who is at risk of suicide, carers can forget or feel too overwhelmed to take care of themselves.

Remember that carers have needs and rights too!

Find some support

It can be extremely useful to talk with others who have been bereaved by suicide or who are caring for someone who is at risk of suicide.

Consider online carer support:
http://forum.suicidecallbackservice.org.au/

Explore carer support in your community:
http://www.suicidecallbackservice.org.au/online-resources.html

Community services database:
http://www.crisissupport.org.au/jigsaw/

Understanding grief and loss

The early days after the death

In the days following the death you may feel as though you are operating on automatic pilot, that is, just going through the motions. An example of this is that you might not remember who came to the funeral. You might find you are caught up in thoughts and feelings and have trouble sleeping.

The fight or flight response

Upon hearing the news that someone close to you has died, your body may interpret this as a major stressful event or threat. The body's response is to release the hormone adrenaline to help you deal with this threat. Your heart and breathing rate will increase and the body will release other chemicals to help numb your pain.

You may feel worse several weeks after the death. This is because the chemicals in the body are returning to their normal levels and the pain of your grief is felt more intensely.

Control

When someone close to you dies, you may experience feeling a loss of control or helplessness. Feeling a lack of control, or being out of control, is unpleasant, however, there are things you can do to regain some sense of control at this difficult time.

Grief versus depression

The symptoms of grief and depression are similar. However, grief involves a mixture of good and bad days, whereas symptoms of depression are usually more constant.

Symptoms that may indicate depression and not just grief include:

• An intense, pervasive sense of guilt
• Slow speech and body movements
• Inability to function at work /school or home
• Seeing or hearing things that aren't there
• Feelings of hopelessness or worthlessness
• Thoughts of suicide
• Loss of motivation
• Loss of appetite

The following questions will help you figure out if you are currently experiencing symptoms of depression.

Depression checklist

Complicated grief

The emotions associated with loss usually become less intense over time. Although we all have our own experience of grief, we generally work through the following phases:

• Acceptance of the reality of our loss
• Allowing ourself to experience the pain of our loss
• Adjusting to a new reality and life without the person who died

If the pain of your loss is constant and you feel that your grief is getting worse over time, you may be experiencing complicated grief. Symptoms of complicated grief include:

• Intense longing and pining for the deceased
• Numbness or detachment
• Preoccupation with your sorrow
• Excessive anger or bitterness over the loss
• Avoiding things that remind you of your loved one
• Trouble carrying out normal routine activities
• Intrusive thoughts or images of the deceased
• Denial or problems accepting the death
• Feeling that life holds no meaning or purpose
• A total absence of grief where you carry on exactly as you did before the person died

When you visit your doctor consider taking a list with the following information with you...

The effect of complicated grief

Complicated grief can affect you on all levels - physically, mentally and socially. Without treatment, mental and physical health problems can develop including:

• Depression and or anxiety
• Suicidal thoughts or behaviours
• Post traumatic stress disorder
• Increased risk of heart disease, cancer and high blood pressure
• Smoking and drug abuse

If it's been several months or years since your loss and your emotions remain very intense and debilitating, it is important to seek help. Specifically, you need to seek help if you:

• Feel as though life is not worth living and you are having thoughts of taking your own life
• Blame yourself for the loss or believe that you could have prevented the death
• Wish you had died with the deceased
• Have lost your sense of purpose in life

People bereaved by suicide can be at heightened risk of suicide themselves.If you are at immediate risk of harming yourself, please seek help now:

Looking after yourself

If you are thinking about suicide, it helps to tell someone.

Make sure you look after your physical health. For example, work on getting enough sleep, eating well, and exercising. Some people who are grieving turn to alcohol or drugs to try to block out the pain of grief or lift their mood. This is not helpful, as a tolerance for drugs can develop rapidly and can cause additional health problems.

Plan for challenging times

• During certain occasions (e.g. anniversaries and birthdays), memories and feelings are likely to resurface. It is completely normal to feel very emotional at these times
• If you can, share these occasions with family or friends. Talk to them in advance about your feelings about the upcoming anniversary or event

Activities for working through grief

Here are a few activities for working through your grief. Some activities may be more suitable for you than others.

Activity 1: Dealing with change

Make a list of all of the things that are currently worrying you, in order to write a daily 'to do' list. This can help you deal with strong emotions and feelings and gain some control over your grief.

Activity 2: Writing about your loss

Writing is one way of exploring, understanding and processing emotions related to grieving. It can also help you to clarify thoughts and assist you in coming to terms with your loss.

Activity 3: Remembering the person who died by making a memory book

Making a memory book can help you capture your thoughts, feelings and memories about the person who died. It's another helpful way to process emotions related to grieving.

Making a memory book can help you capture your thoughts, feelings and memories about the person who died. It's another helpful way to process emotions related to grieving.

More ideas for working through grief:

• Consider ways to remember the person who died that involve family or friends. For example, you might plant a tree together, cook a favourite meal or go somewhere together (e.g. to a park, the beach), possibly to a place which holds a special memory
• Decorate a small box and store memorabilia related to the person who passed away. This might include a book they loved, a poem, some music or a piece of their clothing
• Go to a place that was special to both of you. Spend some time enjoying your memories, and then say good bye to this place
• Visit a quiet place in nature, such as a forest, the beach, or a park. Consider taking a good friend with you for a quiet walk together
• Make a CD of their favourite songs, or an album, or have a photo enlarged
• Celebrate their birthday, for example by going to a restaurant that you both liked
• Walk or run in their memory at fund-raising or charity events
• Write a poem or make something that expresses something about the person who died

Check your understanding of this module - take this short quiz:

1. Grief is a very individual experience and not everyone experiences the same stages of grief.

TRUE FALSE

2. When someone close to us dies, it can challenge our assumptions about life and our beliefs about the way life 'should' be.

TRUE FALSE

3. During certain occasions (e.g. anniversaries), memories and feelings are likely to resurface and it's normal to feel very emotional at these times.

TRUE FALSE

4. There are things that you can do to work through grief.

TRUE FALSE

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Module 2: Communicating effectively with others

When we are experiencing grief and loss, we can find it hard to communicate with our friends and family. Even if other people in our family are also grieving, we can feel isolated in our grief.

Sometimes we will want to talk about our loss, and sometimes we won't. Sometimes certain members of the family may not want to discuss their thoughts and feelings, or they will try and change the subject if you bring them up.

You might have a partner that wants to give you comfort and affection, but won't actually talk about his or her loss. These are all things that you may need to address with your loved ones.

This part of the program suggests some ways that might improve the way you communicate with others at this difficult time. We'll also cover some ideas regarding anger management and assertiveness.

Active Listening

When spending time with someone who is grieving, often what they want is someone to listen to them, and not to provide any advice. Active listening is a communication skill that helps people to feel that they are being understood and supported.

One way that you can show someone that you are really listening to them is to repeat back what they have said in your own words. For example, you can begin your sentence with phrases like:

Are you saying you feel...

Are you saying you think...

Or

Let me see if I understand you... It sounds like you think...

What gets in the way of active listening?

Advising - giving advice is not part of active listening. An example of this is when your partner tells you that they feel depressed. You acknowledge how they are feeling, but then try to give them advice on how they might cope with their depression.

Filtering - you only listen to some parts of the conversation. For example, you might pay attention when the other person is talking about their feelings and you might tune out if they start talking about your behaviour or a bad habit, such as how you don't offer to do the dishes after dinner.

Disputing - you disagree or debate. You take a position and stick to it regardless of what the other person says. For example, every time your partner suggests that you are not talking about your feelings, you disagree.

Is it a good time to talk?

Validating people's feelings

A good communication habit is to acknowledge and validate feelings. If you are talking to someone who is quite upset, let them know you have heard them and acknowledge how they are feeling. For example,

• "I appreciate that you are worried about me feeling depressed."
• "It must be upsetting to hear how your (e.g. sister / aunt) took her life."
• "I think you are being quite hard on yourself; you are doing the best you can at this time."

Positive feedback

Give positive feedback to others. When you let others know that you appreciate what they do for you, it strengthens your relationship. You are also likely to continue getting the help and support you need. For example,

• "Thanks for listening to me. You are a great friend. I appreciate your support."
• "Thanks for cooking dinner tonight. I am really grateful."
• "I think it's great that you took the day off work to spend time with your sister today."
• "I like the way you are being more assertive - it means that I know what you want."

Clarification

Ask for clarification, especially if you are not sure what someone is trying to tell you. This is important so that you don't assume to know what someone else is thinking or feeling. For example,

• "When we first talked about going out this Saturday you seemed really keen. Now you don't sound as excited. I'm wondering how you are feeling and if you have changed your mind?"
• "You are really quiet today. Is something upsetting you or on your mind? Have I said or done something to upset you?"

More good communication habits...

Talking to others about your loss

You may find some people such as work colleagues or friends of your family, are quite inquisitive about the person who died. You may feel uncertain as to what to say, especially in the early days after your loss. Ultimately, it's up to you how much you choose to tell people.

As a guide, answer people's questions in an open and direct manner. It's alright to say, "Yes, s/he did take her/his own life. It's very sad isn't it?" and leave it there. Don't be concerned about the silence that might follow such conversations. This is likely to be related to other people's discomfort about the topic of suicide. Remember that you are not responsible for how other people feel.

If someone asks you for specific details, such as where the person died, how they died and who found them, remember you do not need to provide these details and you can politely refuse to give them. This is a time when you can practise being assertive. We will cover assertiveness later in this module.

Anger

When someone ends their life by suicide, it is common for family and friends to feel angry. As you know, everybody's grief is different. You may not feel angry right now, but it is possible you will feel angry months, or even years after your loss.

There is nothing wrong with feeling angry. However, it is important that we have a way of dealing with anger, because anger can really impact on our relationships. Anger can affect our behaviour, causing us to lose our patience, act impulsively, and say things we later regret.

Feeling angry with the person who died

Towards the end of Module 1 on grief and loss, was activity 2: Writing about your loss. This can be a useful exercise. You might start your sentence with

• "I feel angry with you because..."
• "I feel angry with you for leaving me..."

Keeping a journal can be very therapeutic. You also might like to write an "unsent letter" which is a written letter to the person who died that expresses what you might not have had a chance to say before they died.

The unsent letter might cover thoughts and feelings you had about the person during their last couple of years of life. For example, if you had a difficult relationship with the person who died, you might express how hard it was to communicate with them, and write down any thoughts and feelings that you have about them now. You might also write to them about any anger or frustration that you experience with other people in your life.

Download this form to get you started.

Feeling angry with family, friends or others

Sometimes we can feel angry or frustrated with our friends and family. For example, they may say or do something that is insensitive or perhaps they just don't seem to understand what you are going through. Here are a few strategies for dealing with this type of anger:

Recognise feelings of anger

Know the signs that you are becoming angry. You may notice physical changes such as tense muscles (e.g. tight shoulders), feeling hot in the face, or that your heart and breathing rate have increased.

Take a few slow breaths

When you start to feel angry, turn your focus to your breathing. As you breathe in, say to yourself 'I am breathing in' and then as you breathe out say to yourself 'I am breathing out.' Repeat this for a minute or so. An alternative is to count slowly to three as you breathe in, and count slowly to three as you breathe out.

Relaxation exercises

Relaxation techniques such as the slow breathing, progressive muscle relaxation and mindfulness meditation exercises, which we will cover in module 5, can help you reduce physical tension and prevent anger from escalating. Taking some time out and listening to relaxing music can also be helpful.

Physical activity

Regular physical activity, for example, walking or cycling, is a great way to release feelings of anger and frustration and can help you let go of tension. We cover activity planning in module 3 and exercise in module 5 which may give you some ideas of ways to be physically active.

Anger and our thoughts...

Remember...

Assertiveness

When we are assertive, we openly and honestly express our opinions, but at the same time we listen to and respect the rights of others. When we are not assertive, and don't communicate openly and directly, we can become frustrated, distressed and angry.

It's good to avoid being aggressive or overly passive in the way we communicate with others. When we communicate aggressively we put our own rights ahead of others, and ignore or reject what other people need or want. Our focus is more on getting our point of view across or winning an argument, which can cause a lot of problems in our relationships.

If we communicate in a passive way, we are usually indirect or even apologetic about our own views and opinions. We may try to avoid conflict to please others, and it can mean putting other people's rights ahead of our own and devaluing what we have to say.

There are benefits of communicating more assertively...

How to communicate assertively

• You have an even and firm tone of voice that is loud enough to be heard
• You use "I" statements that take ownership of your thoughts and feelings, for example:
• "I don't agree with you on that point"
• "I feel attacked and upset when you speak to me in that tone of voice"
• You speak clearly, rather than rambling, for example:
• "I would like to sit down with you this afternoon and talk about this", rather than "I have been thinking about what you said and I was wondering if we could sit down at some stage and have a chat about this, but only when you are free"
• You keep focused on what you would like to achieve from the discussion, rather than blaming or accusing the other person, for example,
• "I think what you are saying is that I am not doing enough around the house" rather than "You're always telling me to do more, you think I'm lazy don't you?"
• Ask about the other person's needs, wants or beliefs, for example,
• "Are you feeling up to visiting your parents this weekend?"
• "Is there something else you would rather do?"
• You explore possible solutions that consider both people's needs, for example,
• "We could share the driving, and maybe stay somewhere overnight before coming home"
• "We could visit them next weekend, rather than this weekend if you would prefer."

Being assertive also means....

Being assertive and asking for what you want

Mike is feeling frustrated because he hasn't expressed to Kelly what he really wants. They had an argument because Mike stewed over the fact that Kelly was working and not able to spend time with him.

Earlier that day, Mike could have said "Hey Kelly, I know you have work to do, but how about we go out for a quick lunch?" Kelly might have said no, but at least Mike would not have felt so frustrated. Also, they might have been able to address the need to spend some time together, by making some other plans.

Mike could have also followed the following formula:

• 'When you told me you had to work this weekend' (the nature of the problem),
• 'I felt a bit sad and annoyed' (how it affects you)
• 'I understand that you need to get some work done this weekend and that it's important to you' (how you feel about it)
• 'I would like it if you were able to set aside time for us to be together' (what you would like to change)'

Being honest

Healthy relationships are based on honest communication. Sometimes people lie to protect other people's feelings or because they are worried that if people know the truth, they will get angry. Being dishonest can break down trust and prevent people from dealing with the real issues at hand. Being honest is usually the better way to go.

Telling children about a suicide

Telling children about suicide is not easy. When someone has died, the best approach is to tell children and use the word "died." It is better not to use words such as "passed away" or "gone to sleep", as this can confuse children and also create anxiety, for example, about sleeping. Know that it is alright to let children see that you are upset or sad. They need to know that it is alright to be upset and sad when someone has died. Here are some other things to keep in mind:

• Use language that is appropriate for the child's age and level of development
• Encourage children to ask questions and answer their questions honestly
• Let them know if you don't know the answer to their questions
• Let them know you are there to support them and they can always come to you with questions or worries
• Encourage children to work through their grief, for example, by writing a letter or a poem to the person who died

If things are not going well...

Check your understanding of this module - take this short quiz:

1. Active listening is a communication skill that helps people to feel that they are being understood and supported.

TRUE FALSE

2. We can use body language to show someone that we are really listening.

TRUE FALSE

3. We need to find ways to manage frustration and anger, for example, by practising relaxation techniques and exercising.

TRUE FALSE

4. Communicating assertively means that we express our opinions without being concerned about the opinions and rights of others.

TRUE FALSE

Please take a moment to tell us what you think:

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Module 3: Connecting with others during grief and loss

When experiencing a major loss such as someone dying by suicide, some people surround themselves with friends and family and try to keep busy with lots of activities. However, others feel like spending time alone and may be hesitant in seeking the support of other people.

Some people are reluctant to ask for help at a time when they actually need it the most. In addition, their friends can be hesitant to contact them during this difficult time, for fear of not knowing what to say or do.

You may need to educate your friends and family in how they can support you at this time. Don't be afraid to tell your friends and family how they can best support you.

What do you need from your friends?

Sometimes people can feel a bit awkward when spending time with someone who is grieving. They might struggle with what to do or say.

Let your friends and family know that they can:

• Acknowledge the situation and use the word "died." For example, "I am really sorry to hear that your Dad died"
• Offer their support and their time, for example, they can offer to take you out for dinner or to a movie or just stop by for a visit once every two weeks
• Ask how you are feeling each time you catch up, as you might be feeling different each time you see them
• Ask you if you would like to talk about your loss. If you do talk about your loss, let them know that the best thing they can do is listen and not try and offer advice. However, if appropriate, they might like to share a special memory or brief story about the person who died
• Offer practical assistance, for example, cooking a meal, offering to do some housework, picking up children or minding them so you can go for a walk, doing errands such as paying bills
• Acknowledge significant dates such as the birthday of the person who died, and mention the deceased person's name around holidays or festive times such as at Christmas

Educating your friends about grief

Nurturing your relationships

When you are experiencing grief and loss, it can put a strain on your close relationships. As people struggle to come to terms with their loss, they can sometimes push away the very people they care about the most.

Has your loss put a strain on your relationship with your partner or other family members? Consider the following ways to nurture your close relationships at home:

• Get photo albums out and have a look at the places you have been and things you have done together
• Discuss your day, and any upcoming events such as a birthday or holiday
• Leave notes for one another describing things that you admire or appreciate about each other
• If you have children, find a babysitter and go out for dinner, a drink or a movie together
• Support your partner with everyday tasks. For example, mind the children while your partner goes shopping
• Have regular family time, for example, take a walk in a park together, plan a trip to a beach or a picnic lunch on weekends
• Reduce TV and computer time, so that there is more time for creative and physical activities

Do you feel as though you need to make some new friends? Here are a couple of ideas...

Activity planning

When we are going through a difficult time, we can stop doing things that we used to enjoy or find pleasurable. Activity planning is a way to look at your current level of activity during the day and plan extra things to do that you may enjoy or that give you a sense of achievement.

The idea is good to plan a proportion of activities that give enjoyment (pleasure activities) as well as a proportion that give a feeling of achievement (mastery activities).

Pleasurable activities might include:

• Calling and visiting friends and family
• Exercising
• Enjoying the sun
• Listening to music

Mastery activities might include:

• Shopping
• Preparing a meal for yourself or a friend
• Walking a dog
• gardening
• writing letters
• replying to mail

Think about...

Did you know...

Download the PDFs below to see a list of activities to help you get started and a diary that you might like to use.

Problem solving

When we have worries or problems, we can spend a lot of time thinking about them, without actually taking any steps towards solving them. Structured problem solving is an effective way to find a solution to our worries and problems.

We'll take you through the steps and then provide you with a worksheet so you can start working on your problems.

Step 1 Identify the problem

The first step in problem solving is to identify your problem.

Think about the following:

• Is anyone else involved?
• What happens?
• What do you do?
• How do you feel?

The clearer you are about the specifics of your problem, the easier it will be to come up with an effective solution.

Problem solving

Step 2 Outline your goal

Is there a goal behind your problem? What do you want to achieve? Make your goal as realistic and specific as possible, so you can know if you have achieved the desired outcome. For example, 'improve my social life' is a vague goal, whereas 'going out for a drink once a fortnight with a friend' is a more specific goal.

Set SMART goals. SMART stands for:

S = Specific

M = Measurable

A = Achievable

R = Realistic

T = Timely

Problem solving

Step 3 Brainstorm ideas

Step 3 is to generate a number of strategies that can help you achieve your goals. List as many possible ways of achieving the goal as you can. Don't worry about the feasibility of your strategies at this stage; the aim is to get your ideas on paper.

Step 4 List the advantages and disadvantages of each strategy

What are the positive and negative consequences of these strategies?

On the basis of this, select what seems to be the best strategy to try out.

Step 5 Try out a strategy

List any resources and action needed to implement a strategy and try out your chosen strategy. Down the track, you can evaluate the effectiveness of your strategy by asking:

• Did it achieve what you wanted, or other goals?
• What still needs to be achieved?

If the strategy has not been a success, go back and select a different strategy and put that into practice.

Download the example from Alice and your problem solving worksheet below.

Check your understanding of this module - take this short quiz:

1. When we experience grief and loss we might hesitate in asking our friends and family for support.

TRUE FALSE

2. We can reconnect with people by scheduling in some 'family time' or take up a new interest such as joining a club or doing volunteer work.

TRUE FALSE

3. Activity planning is about doing more during the day, particularly if we are not very active, for example, not getting much exercise.

TRUE FALSE

4. The correct order of the steps involved in problem solving are to define the problem, outline your goal, brainstorm strategies, try out a strategy and list the pros and cons of each strategy.

TRUE FALSE

Please take a moment to tell us what you think:

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Module 4: Your mental health

Many people, including carers, experience anxiety or depression, or low mood because of grief and loss. It is important to look after yourself at this time.

This module covers the main symptoms of anxiety and depression. There are practical strategies that people who are experiencing depression can do, for example, getting some exercise and planning what to do each day. The strategies in modules 5 and 6 will help you manage depression and anxiety.

In this module we also explore what to do if you are feeling suicidal and how to stay safe. There is information on the reasons people may feel suicidal and strategies for helping someone who feels suicidal.

Anxiety

Anxiety is feeling uneasy and apprehensive, for example, about your health, future events or your family. Anxiety can get out of hand, especially when we are under a lot of stress. Anxiety is commonly experienced following a sudden loss or traumatic event. What makes people anxious or stressed can be different from person to person.

Anxiety affects our physical and mental health. This table lists some of the common symptoms of anxiety:

Anxiety disorders

Some of the common anxiety disorders are:

Generalised anxiety disorder (GAD) - worrying about lots of things (e.g. family, your health, your relationships), including what might happen in the future, not being able to cope, performing well, and world concerns, for several hours (or more) during the day.
Read more about GAD.

Panic disorder - the experience of panic attacks (distinct periods of intense anxiety, fear, or discomfort that start suddenly and often happen spontaneously or 'out of the blue'). It includes feeling apprehensive and being frequently worried about having another attack.
Read more about panic.

Obsessive compulsive disorder (OCD) - having unwanted intrusive, recurring and persistent obsessions (e.g. fears about contamination or germs) and or compulsions (e.g. doing things over and over again like washing your hands and checking that all the appliances are turned off).
Read more about OCD.

Social anxiety disorder - frequently worrying that you will do something embarrassing or that others will think badly of you when you are out in public. Many people often stop going out as much because of these worries.
Read more about social anxiety.

Post traumatic stress disorder (PTSD) - very high levels of anxiety as a result of a very stressful situation or traumatic event, such as witnessing the death of someone or encountering a life-threatening situation.
Read more about PTSD.

Signs of Depression

Depression is different to just feeling sad and flat. Sometimes people experience a much deeper and/or longer lasting sadness that colours everything they think about and do...

The following questions will help you figure out if you or someone that you know is currently experiencing symptoms of depression.

Depression checklist

If you are feeling low or depressed:

• Wait until you are feeling better before you do things that you find particularly difficult or unpleasant
• Get some sunshine for about 15-30 minutes a day. Sunshine is important for everyone, not just those who are feeling depressed. It facilitates a natural biological day-night rhythm and the production of vitamin D. Spend some time in nature and fresh air, for example, at a park or, if possible, the countryside
• Spend some time with people who are not depressed. Reducing the amount of time you spend alone can be helpful
• Make sure you eat and don't skip meals. Not eating will affect your mood and make you feel worse. Avoid foods high in sugar and fat
• Go for one or two short walks a day. Exercise is a proven way to improve our mood because it stimulates hormones such as endorphins that naturally make us feel better
• Put together a schedule or plan of what you will do each day. Cross off each activity as it is completed. This can help you to feel more in control and that you are getting things done
• Plan to do at least two activities a day that made you feel good before you started feeling low or depressed. For example, listen to music, write about how you are feeling, work in the garden, or play with a pet. See our activities list in module 3 if you would like some more ideas. Remember to schedule pleasurable activities, not just achievement-oriented ones.

When feeling low, looking after yourself is really important

• Avoid using drugs and alcohol when you feel depressed
• Set yourself small goals to help you feel better and in control. We cover goal setting in module 5
• See your doctor to discuss what you can do about your symptoms
• Put any items that you could use to hurt yourself away or give them to a trusted friend
• If you think you might take an overdose, give your medications to someone who could give them to you one day at a time
• Get together with a friend, even if you don't initially feel like it

Why do people feel suicidal?

The leading cause of suicide is untreated depression. We cover the symptoms of depression earlier in this module.

Suicidal thoughts often have an underlying cause such as mental health issues (e.g. depression, trauma) or experiencing major life problems that may seem to have no solution or end in sight.

Mental illnesses can be treated with psychological treatments or medication or a combination of the two. To find out more about the treatment of mental illness, talk to your doctor.

Common triggers for feeling suicidal can include:

Read more about signs of risk here.

Feeling suicidal - what can you do?

If you are at immediate risk of harming yourself, please seek help now.

If you are thinking about suicide, it helps to tell someone.

Keeping yourself safe

Check your understanding of this module - take this short quiz:

1. Symptoms of anxiety include sweating, nightmares and difficulty concentrating.

TRUE FALSE

2. Untreated depression is not a leading cause of suicide.

TRUE FALSE

3. If you are feeling low or suicidal there are things you can do to look after yourself.

TRUE FALSE

4. Low energy, trouble sleeping and withdrawal from family and friends are not signs of depression.

TRUE FALSE

Please take a moment to tell us what you think:

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Module 5: Your physical health

When we experience grief and loss, we can feel anxious and stressed. We might not get much sleep or not sleep very well. Sometimes we don't eat regularly and don't get enough exercise.

In this part of the program we cover relaxation, sleep, nutrition, exercise and setting goals for making changes to improve your mood and overall wellbeing. There are four audio files to help you relax and lots of practical suggestions.

Did you know...

Relaxation

Think about the things you used to do to relax before your loss. For example, perhaps you were a keen reader, listened to music or walked regularly in a nearby park. If it's hard for you to do some of the things that you used to do, it might be useful to try something new.

When you feel ready, you might consider learning yoga, tai-chi or meditation, which can be excellent ways to reduce stress. If you think you might be interested, contact your local council or community centre, or search online for more information about these types of activities.

On the following pages you'll find audio instructions that will guide you through four relaxation techniques: slow breathing, progressive muscle relaxation, mindfulness meditation and deep relaxation.

Another way to relax is to watch and listen to relaxing scenes, for example, of waterfalls and beaches. The sound of waves crashing at the beach can be very soothing. We have included a video of a waterfall and the beach, to prompt you to think about pleasant and relaxing places that can help you relax.

Remember...

We have provided you with a relaxation monitoring form, so you can keep track of how you feel before and after you practise relaxation. Download your relaxation form below plus an example of how to complete the form

Slow breathing

Our breath is our life-force and we breathe differently when we are anxious or stressed compared to when we are calm and relaxed.

Often when we feel tense we breathe more shallowly from the chest, rather than breathing from our abdomen.

When we learn to consciously breathe slowly, we learn to breathe from the abdomen, and the air flows smoothly in and out of the lungs. Our breathing also becomes easier, rather than feeling stuck or caught in our chest and we feel more relaxed.

When starting to practice slow breathing

We recommend that you try to practise this exercise when you are feeling relatively calm. This will make it easier for you to do slow breathing if you start to feel anxious.

Progressive muscle relaxation

Before you begin:

Try to practise during set times. If you are practising PMR when you know you should be doing something else, you may feel distracted and anxious.

Find a quiet place to practise. Sit in a comfortable chair which supports your back. Alternatively, you can lie down (e.g. on a bed). As you tense each muscle group, try to keep the rest of your body still.

With practise, this exercise can help you feel more relaxed. It's okay if you have distracting thoughts during the exercise, just notice the thoughts and then come back to practising the exercise. It doesn't matter how many times you are distracted. It is the fact that you come back to the exercise that is important.

Below is an audio where you will be guided through a PMR exercise.

Mindfulness

Mindfulness is much more than a relaxation technique. In fact, if practised regularly, it can greatly enhance our whole experience of life.

Automatic pilot

When we experience grief and loss we often find that we have a busy mind. For example, we might be having lunch and at the same time, we are thinking about the past, reminiscing about times shared with the person who died, or we might be thinking about our future without that person.

When we are distracted from what we are actually doing, we are operating on 'automatic pilot'. Mindfulness is the opposite of being on automatic pilot. Being mindful means that we are focused solely on what is happening right now. For the example above, we would focus on eating our food, and thinking about the food rather than giving attention to our thoughts about the past or future.

Click here for some more examples of being on automatic pilot (or non-mindfulness) and mindfulness

Mindfulness

If we learn to be more in the 'here and now', that is, in the present moment, we can reduce tension in our body and prevent further stress. We are likely to find enjoyment in doing just one thing at a time.

Being able to be more mindful takes time to develop. However it is worth the effort, as it is a way to break habits such as worrying too much, or getting stuck with repetitive negative thoughts.

Practising mindfulness meditation

Your audio instructor will ask you to pay attention to your breath and then to the sounds around you. If you don't feel relaxed during or after the exercise, remember, it takes time to gain benefits from it, so try it out a few times over the next few weeks.

Download the mindfulness meditation audio below.

Read more about mindfulness...

Deep relaxation

In deep relaxation all you have to do is lie on your back, and listen to your guide who will take you through a series of steps. First, you will be asked to become aware of your breath. Next, you move your awareness to different parts of your body while keeping your body still. You then return to awareness of your breath. You will also be asked to think of a personal goal that you have or would like to achieve in life.

During the deep relaxation exercise there are periods of silence which will give you time to complete an instruction, for example, time to think of your personal goal.

Deep relaxation can be used as a way to relax the body before you practise meditation. You may find that you fall asleep during deep relaxation, however, over time, you are likely to find that you can stay awake for the exercise.

Practise using the audio below.

Visual imagery

Watch both of the video clips below and allow yourself to take in the sights and sounds of each scene.

If you know of a relaxing place close to you, such as a peaceful park, a lake, or a beach, make time to go there and sit down and quietly observe the sights and sounds.

Alternatively, listen to some relaxation music. Relaxation CDs are available from bookshops. They have sounds such as ocean waves, forest noises (e.g. birds) and sounds found in outback Australia (e.g. Kakadu national park).

To view the video clips below, click on one of the video names to the bottom of the video screen: waterfall or waves.

Improving your sleep

When we experience grief and loss we can have trouble sleeping.You might have trouble getting to sleep or problems with staying asleep. Not getting enough sleep affects our mood and makes it hard to make decisions and get through the day. Obtaining the right amount and quality sleep is important.

Keeping a sleep diary

Sometimes it can help to keep a record of your sleep routine. This can help you understand factors that may contribute to the amount of sleep you get and allow you to then make changes to your sleep routine.

Download the forms below to see an example of a sleep diary and obtain your own sleep diary.

Here are several strategies to help you get more restful sleep:

Keep regular hours

Try to go to bed and get up at the same time each day. In particular, try to keep a regular waking time. Changing your wake times by 1 or 2 hours twice a week is okay, but it is best to stick as close to regular hours as possible.

Go to bed when you are tired

Going to bed when tired is helpful because sleepiness tends to come in waves of 60-90 minutes, so if you stay awake through your sleepiness it may take some time before you feel like going to sleep again.

Keep your bedroom for sleep

If you keep your bedroom for sleep it becomes associated with going to sleep. If you find it helps to read in bed before going to sleep, keep this to a minimum (e.g. 10 minutes) or read in another room.

Establish relaxing evening routines

Getting into a wind-down routine prior to going to bed, can help prepare you for sleep. For example, have a warm drink of milk, take a bath, do a relaxation exercise, or some light, non-work related reading.

No stimulants before bed

Avoid caffeine, heavy meals and hot or spicy foods close to bedtime. Alcohol can cause you to wake up during the night and can make snoring and sleep apnoea worse. Similarly, if you smoke, avoid smoking close to bedtime.

More tips to improve your sleep...

Nutrition

When experiencing grief and loss, your appetite may change. Feeling low or depressed can lead to:

• Poor appetite and weight loss, or
• Increased appetite and weight gain, if overeating becomes a coping strategy for painful or uncomfortable thoughts and feelings

Being mindful of what you eat and eating nutritional meals on a regular basis can improve our mood and physical wellbeing. It also reduces our risk of developing chronic diseases such as hypertension, diabetes, obesity and some forms of cancer.

For more information about healthy eating, see The Australian Guide to Healthy Eating

What is a healthy diet?

A healthy diet does not need to be complicated. In fact, a healthy diet is simply one which consists primarily of freshly prepared (not pre-packaged) meat, seafood, fruit and vegetables. Try to:

• Enjoy a wide variety of nutritious foods
• Eat plenty of vegetables and fruits
• Enjoy cereals in moderation (breads, rice, pasta and noodles), preferably wholegrain
• Eat fresh red meat, fish, and poultry (unless you are a vegetarian of course - see further information below)
• Drink plenty of water

Download the PDF below to read more about a healthy diet and some tips if you are vegetarian.

Alcohol

Sometimes people turn to alcohol or binge drink to cope with grief, symptoms of anxiety or a lack of sleep. Binge drinking is when a person drinks a large amount of alcohol, over a very short period of time, resulting in immediate and severe intoxication. This would be 4 drinks for women and 6 drinks for men, consumed in a four hour period.

The short term effects of alcohol include increased risk of road accidents and personal injury (e.g. having a fall when intoxicated). The long term effects include heart and liver damage and high blood pressure as well as problems with sleep, concentration and memory. Binge drinking can lead to toxic damage to the small bowel which causes diarrhoea, headaches, and stomach problems.

Recommended alcohol consumption

Factors such as gender, age, mental health, drug use and existing medical conditions influence how we are affected by alcohol.

For healthy men and women, drinking no more than two standard drinks on any day reduces the risk of harm from alcohol-related disease or injury over a lifetime.

It is recommended that women consume no more than 14 standard drinks over a seven day period and men consume no more than 28 standard drinks, over a seven day period. A standard drink contains 10 grams of pure alcohol.

For more information about alcohol consumption, see Alcohol.gov.au

The problem with too much caffeine

Exercise

When we experience grief and loss, we can lose motivation, become more inactive and do less exercise. Regular exercise is important as it can reduce symptoms of depression and help us to feel more in control of anxiety and worry.

Exercise also reduces our risk of developing cardiovascular disease, diabetes, stroke and some forms of cancer.

Recommended amount of exercise for adults

• 30 minutes of regular, moderate-intensity physical activity on most days of the week

This can be done in bouts as short as 10 minutes. The exercise should lead to a slight increase in breathing and heart rate, but still enable you to maintain a conversation.

Exercise need not require major changes to our routine.

• Can you go for a 15 minute walk twice a day?
• Do you own a bike that you could ride?
• Is there someone who could walk or ride with you?
• Could you walk or ride to the shops instead of driving or catching a bus?

Planning to do more exercise

Think about the following:

• What do I enjoy? What sorts of activities lead to positive experiences for you?
• What opportunities do I have to be active? Consider opportunities during your day to include small bouts of activity (e.g. walking to the train station, using stairs, doing gardening or housework)
• Set goals. Set goals for exercise, then use sticky notes, a diary or calendar to remind yourself of your goals and reward yourself for being active (e.g. with a soak in the bath, a small purchase)

Physical activities

The following activities might get you moving......

More about exercise...

Setting goals for making changes

Setting goals helps us have a clear plan of what we want to do each day, or week to week. The best goals are those that are clear, so that we know if we have achieved them.

We can make clear goals by setting SMART goals. SMART stands for:

S = Specific

M = Measureable

A = Achievable

R = Realistic

T = Timely

An example using SMART...

Check your understanding of this module - take this short quiz:

1. Relaxation techniques, practised regularly, can help us deal with anxiety and stress.

TRUE FALSE

2. Mindfulness is about thinking about the past or the future.

TRUE FALSE

3. Alcohol consumption often increases when we experience grief and loss.

TRUE FALSE

4. Eating a balanced diet and exercising regularly are healthy strategies to help us cope with grief and loss.

TRUE FALSE

Please take a moment to tell us what you think:

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Module 6: Life skills for optimal health and wellbeing

During difficult times, there are usually many negative thoughts running through our mind, and we can struggle to do things that need to be done, such as shopping and cleaning. We can also lose pleasure in activities that we once enjoyed, like doing things for other people.

The information in this module includes strategies that can help you start to feel more positive. We'll show you how to challenge unhelpful thinking and we explore factors that contribute to our happiness, such as our relationships, helping others and engaging in pleasurable activities.

You might like to do some of the activities in this module now, and there might be others that you could come back to at another time.

Cognitive therapy

Our thoughts and beliefs about particular situations determine how we feel and behave.

Think about how you would feel if one of your closest friends did not call you for some time? Would you feel really angry, or would you feel mildly annoyed or even indifferent?

The power of negative thoughts

Sometimes we can actually make ourselves quite upset by thinking in a very negative way. For example, say another two weeks go by and your friend has not called you. You might start to think "What if she doesn't like me anymore? Maybe she doesn't want to be my friend?" These types of thoughts can lead to really unpleasant feelings.

What do we know about our thoughts

We have hundreds of automatic thoughts every day. Automatic thoughts are those thoughts that just seem to pop into our head without us being really aware of them. They usually come into our minds very quickly, and at times, they can be overwhelming, depending, of course, on what they are about, and whether any strong emotions are involved.

Examples of automatic thoughts related to grief and loss might be:

"Wow I just can't believe they are really gone"

"I am going to miss their sense of humour very much"

"I feel sad that we will never get to spend time together again"

Unhelpful thinking styles

We can develop certain thinking patterns that colour or taint the way we think about ourselves and the world around us. We may not be aware that we have unhelpful thinking styles. Thinking styles can result in very negative and distressing emotions.

Challenging our thoughts

It is important that we understand that it is our thoughts that lead to particular feelings, not an actual situation.

A helpful way of challenging our thoughts is to ask ourselves questions such as:

• What evidence do I have for and against this thought?
• How reliable is my source of information?
• Do I know that the thought is true, or is it just that I feel that it is true?
• What would I say to someone else who had this thought?
• Is there another way for me to look at this situation?
• How accurate is this thought? Will it help me to solve a problem? Am I avoiding doing something if I think like this?
• What are the advantages and disadvantages of my thinking this way?

Monitoring and challenging our thoughts

Writing down our thoughts and examining them can be very helpful. It's best to write down your thoughts around the same time that you feel an intense emotion, such as sadness, anger or anxiety.

Download an example of monitoring and challenging unhelpful thoughts below. There is also a blank monitoring worksheet for you to write down and challenge your thoughts.

Coping statements...

Coping statements are short statements that you can write on cards and carry with you, for example in your wallet, and pull out and read when needed. They provide a fast way to offer youself some support during difficult times.

For example, if you get anxious your card might have the following statements:

"Just breathe, and allow this feeling to pass."
"This is uncomfortable but I will get through it."
"It's OK that I feel this way."

When feeling particulary sad, your statements might be:

"Sometimes my grief is going to overwhelm me."
"What would they say to comfort me if they were here right now?"
"It won't always be like this."

Positive psychology

Positive psychology strategies aim to help us to feel more satisfied, to explore our purpose in life and to help us to feel more connected with others. In this part of the program we look at the factors that influence happiness and health, give you a chance to take a look at your own strengths, and consider kindness and gratitude.

Despite the hardships we face, it is still possible to explore happiness. Explore what you can do, both for yourself and others, to make you feel happier, more often.

Positive people

Do you have a grandparent, great uncle, aunt or another family member who is positive, happy and optimistic?
Have you ever asked them how they stay positive and what is important to them in life? Have you asked them how they have coped with challenging times over the years? Consider asking to them today.

Happiness and our health

Happiness might not be a topic that you feel like exploring right now. However, we have included it for a very good reason. We all want to feel happy, regardless of the challenges that we face in life.

There seem to be key factors that affect happiness - our relationships, our financial situation, the work we do and the extent to which we feel connected to a community and have friends.

Factors that can influence happiness and health

Make relationships a priority - although it may be hard to spend a lot of time with other people right now, nurture your relationships and make time to be with your friends and family.

Do pleasurable activities - is there pleasure in your life? For example, the pleasure of being with friends, eating good food, relaxing in the bath, working in the garden or watching a funny movie.

Work on your level of stress - happy people are more likely to be able to deal with stress. They can remember that if they don't finish a task, the world won't come to an end. They practise strategies for reducing stress, such as the relaxation techniques in module 5 of this program.

Be in the present moment - Can you enjoy the present? Can you enjoy a walk in the park, the fresh air on your skin, or a meal with a friend, without thinking about something else, such as what you will do next?

Explore your spiritual self - finding meaning in life, being with like-minded people and developing faith can lead to deep satisfaction and gratitude. Spirituality does not have to be an involvement in religion.

Identify your strengths

What do you think you are good at?
Do you have particular talents or abilities?
Do you have any strengths that you would like to develop further?

Drawing on our strengths can help us develop a more positive outlook and cope during difficult times. Download the PDF below and place a tick next to each of the strengths that you think you have. Sometimes other people see our strengths more than we do. You might ask a friend or family member to check if you've missed anything.

Acts of kindness

Being kind to others and helping other people has a positive impact on our sense of wellbeing and can make us feel good about ourselves. Acts of kindness can include a smile, offering your seat on a bus, thanking someone, and helping a friend or a neighbour. The more frequently these positive exchanges occur, the stronger our relationships with friends and family become.

How have other people helped you over the years?
How do you help others?

Helping others and contributing to your community

Being involved in our community is beneficial for our health and can lead to happiness and satisfaction. It can protect us from problems such as depression and stress. We can all make a contribution in our community whatever our age may be.

Some ideas for contributing in your community:

• Tutoring young children
• Cleaning up a park
• Volunteering e.g. collecting money for charity, working with people who are homeless or people who have a disability, walking other people's pets
• Visiting and spending time with an elderly neighbour

Gratitude

Being aware of the good things in our life and showing appreciation for the things that we are grateful for can help us feel better about ourselves, and help us to maintain a healthy outlook on life. It can also help us take the focus off our troubles and worries.

Is there someone who has touched your life in some way?
Have you told them how grateful you are?

Check your understanding of this module - take this short quiz:

1. Cognitive behaviour therapy emphasises that how we think affects how we feel, and the way we think and feel can affect our behaviour.

TRUE FALSE

2. We can challenge our thoughts by asking ourselves questions like:

• What evidence do I have for and against this thought?
• What would I say to someone else who had this thought?

TRUE FALSE

3. There seem to be very few factors that affect happiness.

TRUE FALSE

4. By developing our strengths, being kind to others and exploring gratitude, we can make positive steps towards improving our health.

TRUE FALSE

Please take a moment to tell us what you think:

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Summary

We hope that you have found this program useful. Coping with grief and loss is not easy. We all have to find our own way to summon the courage to keep going, to reconnect with people and to keep using strategies that good for us.

If you have not done so already, please give us some feedback on the program at the end of each module. Your feedback can help us to improve our service.

Summary of the program

On the next few pages you will find key points from each of the modules. This is only a very brief overview. Please remember that you can reread each module at any time. Also, download the relaxation audios and save them to your computer if you have not done so already.

Module 1 - Coping with grief and loss

Grief is a very personal experience. Grief affects us all differently and there is also no fixed time schedule with grief. Some people feel better after weeks or months, and for others, it can take years.

Counselling

Consider seeing a counsellor such as a psychologist who has training and experience working with people who are grieving. You can find a psychologist in your area by visiting Australian Psychological Society.

As grief is a very individual experience, you may decide to seek counselling several months or years after your loss, particularly if you did not seek counselling at the time of the person's death.

Additional support

There are things you can do to help you grieve. You might like to join a support group. If you follow a religion, you may find comfort in going to a service or speaking to a member of your religious community.

Spend some time with family and friends who you find supportive. Take some time off work and if possible, consider going away for a break and change of scenery.

Module 2 - Communicating effectively with others

Active listening

One way that you can show someone that you are really listening to them is to repeat back what they have said in your own words. For example, begin your sentence with phrases like:

Are you saying you feel...

Are you saying you think...

Talking to others about your loss

You may find some people such as work colleagues or friends of your family, are quite inquisitive about the person who died. You may feel uncertain as to what to say, especially in the early days after your loss. Ultimately, it's up to you how much you choose to tell people.

As a guide, answer people's questions in an open and direct manner. It's alright to say, "Yes, they did take their own life. It's very sad isn't it?" and leave it there. Don't be concerned about the silence that might follow such conversations. This is likely to be more about other people's discomfort about the topic of suicide. Remember that you are not responsible for how other people feel.

Module 3 - Connecting with others during grief and loss

Let your friends and family know that they can:

• Acknowledge the situation and use the word "died." For example, "I am really sorry to hear that your Dad died"
• Offer their support and their time, for example, they can offer to take you out for dinner or to a movie or just stop by for a visit once every two weeks
• Ask how you are feeling each time you catch up, as you might be feeling different each time you see them

Activity planning

When we are going through a difficult time, we can stop doing things that we used to enjoy or find pleasurable. Activity planning is a way to look at your current level of activity during the day and plan extra things to do that you may enjoy or that give you a sense of achievement.

Problem solving

When we have worries or problems, we can spend a lot of time thinking about them, without actually taking any steps towards solving them. Structured problem solving can help us find a workable solution to our worries and problems.

Module 4 Your mental health

Sometimes people who are grieving experience depression. Strategies for coping with depression include:

• Making sure that you eat and don't skip meals. Not eating will affect your mood and make you feel worse. Avoid foods high in sugar and fat
• Going for one or two short walks a day. Exercise is a proven way to improve your mood because it stimulates hormones such as endorphins that naturally make you feel better
• Planning to do at least two activities a day that made you feel good before you started feeling depressed. For example, listen to music or work in the garden. Review the activities list in module 3 if you would like some more ideas

Module 5 Looking after your physical health

Relaxation

Think about the things you used to do to relax before your loss. For example, perhaps you were a keen reader, listened to music or walked regularly in a nearby park. If it's hard for you to do some of the things that you used to do, it might be useful to try something new. Review module 5 and try slow breathing, progressive muscle relaxation, mindfulness meditation, or deep relaxation if you have not already done so.

Improving your sleep

When we experience grief and loss we can have trouble sleeping, for example, trouble getting to sleep or staying asleep. Not getting enough sleep affects our mood and makes it hard to make decisions and get through the day.

Establish relaxing evening routines Getting into a wind-down routine prior to going to bed can help prepare you for sleep. For example, consider having a warm drink of milk, taking a bath, doing a relaxation exercise, or some light, non-work related reading.

No stimulants before bed

Avoid caffeine, heavy meals and hot or spicy foods close to bedtime. Alcohol can cause you to wake up during the night and can make snoring and sleep apnoea worse. Similarly, if you smoke, avoid smoking close to bedtime.

Module 5 Looking after your physical health

Work on maintaining a healthy diet

A healthy diet is simply one which consists primarily of freshly prepared (not pre-packaged) meat, seafood, fruit and vegetables.

Get some exercise

When we experience grief and loss, we tend to be more inactive and do less exercise. Regular exercise is important as it can reduce symptoms of depression and help us to feel more in control of anxiety and worry.

Recommended amount of exercise for adults

• 30 minutes of regular, moderate-intensity physical activity on most days of the week

Set goals for making changes

Setting goals helps us have a clear plan of what we want to do each day, or week to week. The best goals are those that are clear, so that we know if we have achieved them.

Module 6 Life skills for optimal health and wellbeing

We have hundreds of automatic thoughts every day. Automatic thoughts are those thoughts that just seem to pop into our head without us being really aware of them.

Unhelpful thinking styles

Thinking patterns can colour or taint the way we think about ourselves and the world around us. We may not be aware that we have unhelpful thinking styles.

A helpful way of challenging our thoughts is to ask ourselves questions such as:

• What evidence do I have for and against this thought?
• How reliable is my source of information?
• Do I know that the thought is true, or is it just that I feel that it is true?
• What would I say to someone else who had this thought?

Module 6 Life skills for optimal health and wellbeing

Positive psychology - happiness

There seem to be key factors that affect happiness - our relationships, our financial situation, the work we do and the extent to which we feel connected to a community.

Make relationships a priority - although it may be hard to spend a lot of time with other people right now, nurture your relationships and make time to be with your friends and family.

Do pleasurable activities - is there pleasure in your life? For example, the pleasure of being with friends, eating good food, relaxing in the bath, or watching a funny movie.

Work on your level of stress - happy people are more likely to be able to deal with stress. They remember that if they don't finish a task, the world won't come to an end. They practise strategies for reducing stress, such as the relaxation techniques in module 5.

Explore your strengths

Drawing on our strengths can help us develop a more positive outlook and cope during difficult times.

We wish you all the very best for the future.

Useful resources

Bereavement support in your community:
http://www.suicidecallbackservice.org.au/online-resources.html

Community services database:
http://www.crisissupport.org.au/jigsaw/

Online bereavement and carer support:
http://forum.suicidecallbackservice.org.au/

Australian Psychological Society - find a psychologist page
http://www.psychology.org.au/FindaPsychologist/

NALAG National Association for Loss and Grief
http://www.nalagvic.org.au/