Dr Andrew Medley, Chartered Clinical Psychologist has written this BLOG looking at the realities of dealing with Covid-19.
Psychological wellbeing is really all about connection. The bonds with family and friends, teamwork with colleagues, linking up with our interests and passions, and indeed self-awareness of our own patterns of thinking, feeling and reacting. The Covid-19 crisis has challenged all of these foundations of emotional resilience. The prolonged uncertainty, abrupt and disorientating changes to work environments, and isolation from the people and routines that usually give us a sense of security.
More than that, for health and emergency service professionals there has been a kind of doubling of the trauma: the challenge of confronting the same personal risks and fears as everyone else, whilst also rising to the responsibility of helping others and keeping them safe. Heroes maybe – but human beings too, so it’s worth a closer look at the vulnerabilities we all share and some simple strategies to help offset stresses like none before.
‘Threat System’ biases
‘Bad is stronger than good’ – it’s a basic survival mechanism in which the brain selectively attends to negative or threatening information and primes us ready to react (Baumeister et al, 2001; Gilbert, 2009). How many times have you done several great things in a day, and then one thing goes wrong… which do you think about all evening? We’re all facing unprecedented challenges with limited preparation and often drastically reduced resources and support. So now more than ever we need to practice a more flexible, forgiving, and compassionate way of responding to ourselves and others – focus on things you can influence, do your best, and don’t demand perfection from yourself or others in a profoundly imperfect situation.
Vicarious trauma… virtually
The emotional toll of responding to others in difficulty is not diminished over a screen or telephone – in fact, it seems the opposite can arise. Health service and 999 colleagues have spoken to me in recent weeks about unexpected effects: the exhaustion of heightened focus and intensity in the absence of usual non-verbal cues; missing the defusing humour of corridor chats between jobs or meetings; and the intrusion of traumatic events and imagery into blurred boundaries between home and work. I’ve heard about feelings of guilt, “I’m so sorry we can’t be there for you in the usual way…”. Notice and challenge this; reflect on all you have achieved in your vital work supporting others through these extraordinary times.
Strategies to sustain ourselves in body and mind
- Don’t forget the basics – schedule breaks and keep well-hydrated. Intentionally wind-down and relax as best you can in the last hour or so before sleep. There are several very good apps with helpful mindfulness-based exercises (e.g. Calm, Headspace, Buddhify).
- Simple body awareness – practice briefly tuning in to areas of your body that are especially sensitive to stress, like a ‘physical barometer’. Focus on balancing your in- and out-breath and slowing down. Doing this regularly throughout the day will improve the efficiency of your thinking and decision-making. One thing I’ve learned from a varied career as a firefighter, psychologist, and RNLI lifeboat crew is that whatever immediate pressures you’re confronting, there’s always more time than you think. Paradoxically, if we slow down, we can speed things up. Dr Alan Watkins explains this brilliantly in his TED talk:
- Managing empathic imagery – it’s possible that we might visualise the traumatic events and stories of others more vividly when listening over the phone or screen. And working from home presents further challenges in terms of boundaries and compassion fatigue. Try focusing more closely on the words of the person you’re helping and stay grounded by periodically shifting your gaze or moving parts of your body. If particular emotional images stick in your mind, you might imagine the picture up on a TV screen with a remote control in your hand to zoom out, reduce the volume, or change the focus. If you notice that you are visualising traumatic stories in the first person, as if it’s happening to you or someone close to you (perhaps more likely in the current ‘shared trauma’ we’re all facing), then consciously step back into the position of an observer, like watching a movie (Rothschild, 2006). Afterwards, let the images come and go rather than try to suppress them, as well as bringing to mind an alternative soothing or relaxing image (perhaps a favourite viewpoint or holiday destination).
- Be careful with ‘over-thinking’ – dwelling on our past decisions or actions is perilous in a novel situation where nobody quite knows the right answers. Watch the “What if?…”, and “If only…” styles of thinking, and set a time limit on your ruminating! If your thoughts don’t lead to a meaningful plan, or if you’re agonising about things beyond your control, then try to let it go. Shift your focus, get up and busy with something else. And relate to yourself with the same understanding, patience and compassion that you would readily offer to others.
- Stay connected – above all else, now is the time to reach out to colleagues using whatever media available. It can be easy to overlook the usual niceties when working through a list of online calls or meetings, but making time for a brief check-in, a bit of laughter and day-to-day nonsense is the tonic that can sustain us. Much better to use a spare five minutes to FaceTime a colleague (other platforms are available!), than get drawn into social media and relentless Covid-19 news coverage. Remember, the anxiety is as contagious as the virus itself.
Finally, it’s worth reminding ourselves of the natural resilience of the human mind. Post-traumatic growth stems from the bolstered confidence and positive outlook that accompanies successful navigation of highly challenging situations (Greenberg et al, 2020). I’m sure we can all bring to mind examples of fortitude and kindness – in ourselves and others – throughout these testing times. The crisis has called upon new and creative ways of working, and perhaps deepened our appreciation that psychological resilience actually exists in the connections between us.
Further web resources:
Baumeister, R.F., Bratslavsky, E., Finkenauer, C., & Vohs, K.D. (2001). Bad is stronger than good. Review of General Psychology, 5(4), 323-370. https://doi.org/10.1037/1089-26126.96.36.1993
Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2020). Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ 2020;368:m1211 https://doi.org/10.1136/bmj.m1211
Longer reads (but worth it):
Gilbert, P. (2009). The compassionate mind. London: Constable & Robinson Ltd.
Babette Rothschild (2006). Help for the helper: Self-care strategies for managing burnout and stress. New York: W.W. Norton & Company.
Bessel Van Der Kolk (2014). The body keeps the score: Mind, brain and body in the transformation of trauma. London: Penguin.