We are all finding things difficult at the moment. We are not alone. We are all struggling with this. Even if it feels like you aren’t, you probably are. We can’t make it go away but we would like to offer you some suggestions.
In this, the first of what we hope will be a series of articles, we offer some simple tips on how we can stay well and support each other as clinicians. This material is developed from the Red Whale Mental Health course and, from the linked podcast, by our LMT presenter and Shapes Toolkit founder, Dr Rachel Morris, with Dr Caroline Walker, NHS Psy-chiatrist, expert in doctor wellbeing and founder of The Joyful Doctor.
What is going on?
At the moment, most of us are in the early phases of anxiety of related to ‘what is yet to come’.
We can use the CBT model below to understand why we are feeling as we are at the moment. You may find it is affecting any (or all!) of your thoughts, behaviours, feelings or physical sensations.
Think for a moment of where you find yourself at the moment. Which area(s) are you struggling with most?
Fight and flight mode
This is not a drill. Our minds are in full ‘threat, threat, threat…’ mode and our amygdalae are going crazy. If you are familiar with The Chimp Paradox, our poor little chimps are screaming in their cages. They need to be heard and we need to soothe them because, for many of us, a big part of our job is listening to and helping soothe the ‘chimps’ (amygdalae!) of our patients – and, at times, our colleagues. So, it is critical now, more than ever, that we practice self-care.
What might help?
Get the basics right
Simple things will make a difference, and they are the very things we are likely to STOP doing at this time, but we need to help each other to make sure we are looking after ourselves. This means we need to:
- Take regular breaks and use them for rest.
- Refuel: drink, eat.
- Go to the loo when you need to.
- Be kind to yourself and each other – situations like this bring our best and worst days.
- Connect with people at work – have a couple of 5–10-minute get togethers each day. Prioritise making it happen. You are not responsible for the whole of society. You can only do so much. (At Red Whale, we have set up a daily virtual coffee break for 15 minutes each day; anyone who is free can bring a coffee and join.)
Control what you can control (your behaviours)
- Social media: reduce the amount overall. Notice how it makes you feel and find your own balance. There is good and bad
- it can be helpful to reach out, connect and find support, but it can also escalate things.
- it can be helpful to reach out, connect and find support, but it can also escalate things.
- News updates: set specific and time-framed periods to look at the news, e.g. 10 minutes twice daily. Consider using the press conferences.
- As far as possible, try to keep your usual routine and participate in usual activities, even if you have to be a bit creative, e. g. virtual coffee with a friend, watching a family film and chatting about it by WhatsApp as it takes place, doing a HIIT workout in the garden or indoors.
- Think of life one day at a time. What can you do to stay in the moment? – use mindfulness techniques (https://www.headspace.com).
- Reach out in our communities to make connections and ask for help if you need it.
Don’t try to stop and control worrying thoughts…it’s impossible
In this situation, worrying thoughts are normal and we can’t suppress them. But we can avoid going down the rabbit hole. Strategies that might help include changing our relationship with those thoughts by noticing them and using strategies such as:
- Distraction (see below).
- Worry time (see below).
- Mindfulness.
- Sharing the thoughts to normalise them: talk to others about your thoughts and feelings. This in itself may help.
- Completing a gratitude journal where you identify 3 things each day that you are grateful for. Gratitude is a great antidote for anxiety as it is (almost) impossible to feel both things at the same time.
- Challenging (re-framing) the thoughts, e.g. my mum is going to die, what if I get it and die, how will my kids cope, what will my funeral be like... Look at the balance of evidence for the REAL rather than mind-created risk. then reframe it, e.g. the story I’m telling myself is: I am going to die and my children will be left without a mother, and compare this with the reality: It is unlikely I will die; I am relatively young and have no other health problems.
Microskill: distraction
Distraction is a useful short-term way of stopping ourselves getting overly caught up in negative thoughts or worries about an unknown future. Use it when you are finding it difficult to stop thinking or worrying. It does not involve try-ing to suppress negative thoughts, but instead helps you to actively focus your attention on a different activity.
Microskill: worry time
Worry time is a way of coping with excessive worrying. It involves learning to postpone worrying, or put it ‘on hold’ until a more convenient time. This will lead to worrying becoming less intrusive and will give us a greater sense of control.
The steps for using worry time are outlined below – it takes practise!
Steps for ‘worry time’
- Choose a worry time: plan a regular period of 15–30 minutes for worrying each day, ideally at the same time and in the same place. Try to avoid doing this just before bedtime.
- Notice when a worry pops into your mind: if you notice that you have started worrying at any time outside the planned worry time, tell yourself: It’s OK to have this worry, but I’m going to put off thinking about it until my worry time. I will have time to think about it later. I will be able to deal with this problem later.
- Note down your worries: you might find it helpful to carry a notebook to quickly write down the worry thought, and then close the book until worry time. Don’t be concerned if the same thought pops back again very quickly. It is very common to experience repeated worry thoughts. Just repeat the same process: accept the thought, write it down and then postpone it for later.
- Focus on your daily life: after noting down your worry, close the book, focus your attention back onto the present moment and concentrate on whatever activity you are carrying out. This will help to let go of the worry until worry time arrives later on.
- Review your worries during worry time: when it comes to your planned worry time, you can look through your list of wor-ries. Cross anything off the list that is no longer a worry for you. Allow yourself to worry for up to 30 minutes. Try to also focus on some problem-solving ideas by asking yourself: Is there anything I can do to help this situation?
- Move on to another activity: don’t spend any longer than planned during worry time. Afterwards, try to move quickly onto another activity that is likely to take your mind away from your worries and lift your mood, such as exercise, listening to music or calling a friend.
Summary of helpful strategies
Have a look at the helpful resources below.
You are not alone. There is support – please do seek it:
If you are usually well and have low-grade symptoms but are functioning reasonably well, try BMA wellbeing: https://www.bma.org.uk/advice/work-life-support/your-wellbeing/counselling-and-peer-support
Telephone: 0330 123 1245
If your symptoms are impacting on your function or you have an existing mental health disorder that is being exacerbated, contact the NHS Practitioner Health Programme https://www.practitionerhealth.nhs.uk
