Understanding what influences your mental health and wellbeing – 5Ps

If you would like to make sense of your experiences, or if you are struggling with your mental health, there are some key questions you may like to ask.

This booklet is produced by people who use and work in services provided by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) and some of their supporters. It aims to help you to understand what is important to your wellbeing.

It can be helpful to ask yourself some questions about the things that may affect you. For example, the impact of day to day pressures, or things that have happened in your past.

We all experience difficulties and challenges in our lives. Some issues may keep difficult feelings going, for example ongoing pain, being alone, financial or family pressures. All or some of these may play a part in how we think and feel.

This booklet aims to help you to:
• note important events or relationships
• consider what may set off difficulties
• understand what the key mental health issues are
• recognise your personal strengths and the support around you
• find out what can help or hinder your day to day wellbeing
• think about what is important to you
• look at ways forward and next steps: What would help you to make changes?

In CNTW we describe understanding yourself in this way as developing a formulation. This means understanding the following five parts of your life, seeing how they are linked, and making a plan:

Past – What has happened in your past that may be important?

Triggers – What sets things off? What was happening when your difficulties started?

Current – What is happening in your life at the moment? What is good? What is difficult?

Positives – Do you have helpful people in your life at the moment? What are you good at? What is going well?

What makes change difficult? – Things that keep your difficulties going and make change difficult.

Plans – Start thinking about how you want to make changes and enjoy more things in your life.

It can be helpful to make sense of what has happened in your past. Events and relationships from your childhood or adulthood can affect you in helpful and harmful ways.

You may have had activities you enjoyed and were good at that can still help you now.

There may have been health problems for you or your family that affected you when you were younger.

You may have experienced loving relationships that strengthened you, or unkind relationships that left you feeling unloved or alone. You may have experienced or seen violence or abuse in your home – abuse can be sexual, physical, or emotional. Or you may have experienced the loss or death of someone you loved and who loved you.

You may want to make sense of these past issues in order to understand what they mean to you.

Examples of important past issues may be:

• you had health difficulties
• you had to look after people in your family
• you had some good friends
• you had to fight for everything you got
• people bullied you or were unkind
• you were happy at school
• you did things that were helpful
• the loss of somebody you had a good relationship with

Sometimes people find it useful to write down important past relationships and events in their life: the good and the bad.

Have any of these had an influence on your life?
• your family life – relationships with your parents or people who looked after you?
• were some of your relationships empowering? Or disempowering?
• did you witness or experience abuse or violence?
• did you enjoy activities outside school?
• was there bullying in your family?
• did anyone in your family spend time in prison?
• was anyone in your family admitted to hospital for physical or mental health problems?

This can be a useful process to help you understand the impact of your experiences, then and now. This could support you to make connections between your past and current life.

It can be helpful for us to understand what triggers reactions and feelings. Sometimes, the things that make you feel distressed or happy are very clear. Other times, you can get upset or happy and don’t know where it has come from or why, it just seems to happen.

We may call these ‘triggers’.

Sometimes a build up of lots of small stresses can lead you to becoming overloaded, this can impact on your ability to cope with additional stresses.

Examples of triggers may be:
• loss of sleep
• physical injury or assault
• losing your job
• someone you love becoming ill
• a smell or sound that brings back memories
• a significant date
• becoming pregnant or a parent
• difficulties in a relationship now

It can be hard to link some triggers with how you feel or think.

You might like to ask yourself:

• when do things become difficult for you?
• if there have been similar issues in the past, what may have triggered those?
• are there certain times, dates, anniversaries, and/or changes that are important?
• have you suffered abuse or had criticism or rejection from others?
• are services not understanding your needs or the needs of someone you love?
• are relationship problems troubling you?
• has there been a recent loss (death), illness or health difficulty?
• is there the threat of losing your job?
• has something unexpected happened?

Sometimes the combination of different events can trigger distress. For example, you may deal with a major problem like a relative’s illness very well, and then get upset by missing the bus.

Triggers may include exposure to physical, emotional, practical or social challenges. We do not always have control over what happens to us in our lives. It can be difficult when life has lots of uncertainties, and/or when your safety or dignity are threatened.

Problems can be overwhelming, but it is important to think about what has happened, what you’re coping with, and what is important to you. It may be helpful to think about your physical health, your social situation, and/or how you think, feel and behave. It can be helpful to think about the impact of difficulties not just upon yourself but also on those around you.

Examples of current issues may be:
• worrying about paying bills
• anxious about your benefits or pension
• poor sleep or tiredness
• not leaving the house
• loss of a partner or relationship difficulties
• being bullied or racially abused
• health problems

You might like to think about:
• what is going on in your life?
• what are the main worries for you now? Have these things happened before?
• are there concerns that are worse for you at the moment? How do these affect your wellbeing?
• is there something new in your life?
• what needs to change for you to feel okay?
• what strengths do you draw on?
• what are you doing that you enjoy?

Sometimes when we are experiencing difficulties recognising our own positives can be hard to do.

We all face difficult times differently and develop ways of dealing with them. It can be helpful to notice how we have managed so far.

Examples of positives may be:
• friends to have fun with
• hobbies, something I enjoy doing
• someone to talk to
• a job where I am valued
• being physically healthy
• living in a friendly place
• caring for animals
• being a parent, auntie/uncle or grandparent

Positives can be simply eating food or drinking water every day. Or they may be having friends or enjoying interests like watching television, drawing or painting.

You may like to ask yourself:
• what positives have you got going for you?
• what is stopping the problems from getting worse?
• What survival strategies have you used? How are they helpful?
• what personal strengths help you? For example sense of humour, being well-organised
• what is going well at the moment?
• are there people around you who understand, encourage, and support you?
• what are you interested in?
• how have you coped?
• what have your experiences taught you so far?

These are the aspects of your life that can get in the way
of change. These can be physical health problems or social influences that affect your situation and/or the ways you think, feel, and behave. Some ways of coping help in the short term, but not in the long term – like drinking alcohol or over working, these can help us avoid rather than solve problems. Sometimes the systems around us can get in the way.

Examples of what makes change difficult may be:
• not sleeping at night
• too many bills to pay
• the judgemental way the media talk about mental health
• feeling helpless
• being isolated
• nobody around you understands
• not being able to speak about distressing or difficult things
• the wrong intervention/treatment

You may feel guilty about burdening other people so you don’t ask for help or share your problems. You might put on an act that all is well, or hide away from other people.

Questions that you may want to ask about the things that keep your problems going are:
• what are the daily obstacles that may stop life improving, or stop you moving forward?
• is it difficult for you to get the right support?
• how do people around you respond to you, your strengths and your difficulties?
• are there things that are pressurising for you at the moment?
• what do you do to deal with your difficulties?
• how does your health affect you?

It is important to think about what needs to change in your life and what matters to you, both in the short term and long term.

To help you achieve your goals they should be meaningful to you. Your goals might focus on small changes linked to your day to day life – like having a shower, or bigger goals about your hopes to the future – like learning a new skill.

Examples of some goals you may like:
• walk to the shops on your own
• give yourself a nice meal
• answer the phone
• manage your pain better
• move away from your noisy neighbours
• go to college
• get in touch with old friends
• discuss stopping your medication
• understand your feelings better
• drive again
• find safe ways to comfort yourself when you feel distress

You can achieve your goals more easily by breaking them down into smaller steps and making plans.

Think about how you can start taking small steps towards your goal.

For example – walking to the shops on your own may start with:

1. getting dressed every morning
2. practise opening the front door
3. walk outside at a quiet time
4. walk to the shops with a friend (if you prefer)
5. walk to the end of the street on your own
6. walk to the shops

Don’t worry about not making progress as fast as you would like. We all have setbacks and you can start your steps again or re-visit your goals and plans, perhaps with more support. We all have good days and bad days, and there may be ongoing pressures that make change difficult. So be kind to yourself if your plans don’t always work out.

Please ask a member of staff for a printed copy of this form.

Past: what has happened to me?

Triggers: what sets things off?

Current: what is going on for me?

Positives: what supports me?

What makes things difficult?

Goals:

Plans:

Next steps:

Continue on this page to write down what matters to you, your goals, plans and next steps.

“If you can’t fly, run; if you can’t run, walk; if you can’t walk, crawl; but by all means keep moving.
Martin Luther King Jr, 1960 ”

In CNTW we are using 5Ps + Plan formulations as a way of helping you understand your current difficulties, so that you can set goals and have plans to work on. You may want to work on this on your own, with friends, or with a professional.

This booklet won’t provide answers, but will help you to ask yourself key questions to understand yourself and your situation better. This may lead to some next steps for you to try.

Your formulation may change over time or as you discover more about yourself and your situation.

• Make sure that your goals and plans are realistic and important to you, not necessarily anyone else.
• Being active is really important for your mental and physical health, housework, reorganising your wardrobe, going outside for a walk, gardening. Even though it may be the last thing you want to do. It can improve your mood and give you more energy.
• Friendly contact with people can boost your wellbeing. This can be through the phone, social media, or face to face.
• Being curious and noticing what is around you is helpful and gives you a break from overwhelming or negative thoughts. This can also help you appreciate what matters to you.

• Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust – A range of mental health self help guides available to view/download in various formats www.cntw.nhs.uk/selfhelp
• Living Life www.llttf.com
• NHS Inform
www.nhsinform.scot/illnesses-and-conditions/mental-health

• British Psychological Society (2011). Good practice guidelines on the use of psychological formulation. Leicester: British Psychological Society.
• Johnstone, L. & Dallos, R. (2014). Formulation in Psychology and Psychotherapy: making sense of people’s problems (2nd edition). East Sussex: Routledge.
• Easden, M.H. & Kazantzis, N. (2018) Case conceptualisation research in cognitive behaviour therapy: A state of the science review. Journal of Clinical Psychology, 74, 356-384
• ACE Studies www.cdc.gov/violenceprevention/aces/

This booklet is available online at www.cntw.nhs.uk/5P

urther information about the content, reference sources or production of this leaflet can be obtained from the Patient Information Centre. If you would like to tell us what you think about this leaflet please get in touch.

This information can be made available in a range of formats on request (eg Braille, audio, larger print, easy read, BSL or other languages). Please contact the Patient Information Centre Tel: 0191 246 7288

Published by the Patient Information Centre

2023 Copyright, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

Ref, PIC/791/0823 August 2023 V5

www.cntw.nhs.uk Tel: 0191 246 7288

Review date 2026

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