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Hello, I’m Dr Emily Shaw, a Clinical Psychologist working with Camden and Islington NHS Foundation Trust. I want to talk to you about breaking unhealthy habits.

The coronavirus pandemic has forced us to drastically change how we go about our everyday lives and continues to present significant uncertainty. At times like this, you might be experiencing difficult feelings more often and more intensely, whether it’s stress, anxiety, loneliness or boredom to name just a few. It’s not pleasant to feel this way, so we’re inclined to search for something that is going to give us some immediate relief and this is just when old familiar habits start to return. Those things that give us a momentary pick me up, a feel good boost or help us to temporarily block out uncomfortable feelings. But they’re also the things we wish we didn’t need to rely on because we know they come with a cost; to our health, our relationships or even waste our valuable time. It may even be habits that you’ve previously been able to overcome that you’ve noticed creeping back in. It might be smoking, drinking too much alcohol, biting your nails, eating junk food, going to bed too late, spending too much time on your screens or maybe avoiding exercise. There’s a whole host of habits we can easily pick up during difficult times.

One of the biggest obstacles to breaking these habits and forming new healthier habits is the mind itself. Habits are formed when we do something enough times it becomes automatic. These behavioural patterns are imprinted in our neural pathways, so it can take a lot of effort and repetition to create new pathways. Particularly during more challenging times, our minds prefer the path of least resistance, seeking out the habitual behavioural patterns that have already been formed. So the mind has all manner of tricks to talk us into returning to our old habits and avoiding any new ones: ‘There’s no point in trying’, ‘Just one chocolate won’t hurt’, ‘You can start again on Monday’, ‘Go on, you deserve it’, ‘Don’t bother, you’re going to fail anyway’.

So if we want to make a change in our life, we have to be aware of our habitual responses.

One way to help you take a new direction is through slowing down and being BOLD.

BOLD is a series of steps that will help you to reprogram your behavioural patterns and create new directions in your life.

Let’s go through each one now. You may want to write them down on a card that you carry around in your purse or wallet, or have stuck on your fridge to remind you of the steps.

B stands for breathe.

By becoming aware that you’re breathing and taking a slower and deeper breath the parasympathetic nervous system will become activated, which is responsible for creating a sense of calm in the body. By consciously breathing you’re also pausing whatever else you’re doing, putting the brakes on your usual automatic habitual behaviours. This small moment of pause can be enough to help break the habit.

O which reminds you to observe.

Here we take another moment or two to simply observe what is happening. Notice what thoughts are here, perhaps some unhelpful ones that try to bring us back to our familiar behaviours. Notice what feelings have shown up that could be important to listen to, and really observe what you’re doing in this moment.

L stands for listen.

Listen to yourself. What do you most want for yourself in this moment? Instead of listening to your thoughts and feelings that don’t always have our best interests at heart, get in touch with what’s important to you right now.

D stands for Do what matters.

Commit to what YOU really want to do and follow through with it.

By slowing down and running through the BOLD steps, you’ll find you’re able to experience a greater sense of ease and respond more effectively when we are drawn towards an unhealthy habit.

Go through these BOLD steps over and over. It takes time for new behaviours to become more automatic. And be kind to yourself along the way. You’re bound to slip back to old patterns from time to time, gently return back to the BOLD steps and try again.

Emily Shaw is a Clinical Psychologist working at Camden and Islington NHS Foundation Trust. Here she speaks about the unhealthy habits we may have turned to during the pandemic to give us immediate relief and how we can reprogram our behavioural patterns by practicing being BOLD.

Hi, my name is Abi Concannon and I’m a new (part time) member of staff working within the Mental Health and Wellbeing Hub for NCL, now known as Keeping Well NCL.  Elsewhere I work as senior lecturer/cohort director for the NHS Leadership Academy’s Elizabeth Garret Anderson programme and have also been working at the Tavi as a 1-1 facilitator on the Practice Supervisor Development Programme.  And I have a small private practice.  So I wear lots of different hats. 

I’m very conscious of the impending string of anniversaries about to cascade – a whole year of not being able to see my clients face to face in my consulting room, a year since the EGA programme was suspended/restarted/suspended to release everyone back into frontline work where necessary, a year since my 20th wedding anniversary trip to Italy got cancelled, a year since we all had to change the way we work and socialise.  A year since the world changed irrecoverably.  A year that has been tougher than many people realised it would be and yet……. A year when many, many people rolled up their sleeves and got down to the  business of supporting each other, thinking together, making decisions in record time, finding creative solutions to previously unimaginable dilemmas.  Everyone’s experience has been simultaneously similar and different – overarchingly similar because everyone has been affected by the pandemic one way or another and massively different because we are unique as individuals, are differently privileged and marginalised, seen or unseen, heard or ignored.  But there is a thread as well, that I’ve seen running through all the different accounts of experiences that I have witnessed which is about support.

Supporting others – to stay well, to make informed decisions, to remain independent, to understand and accept, to let go, to recover, to learn – this is what many of us were engaged in this time last year – supporting the work of others.  And all those people engaged in providing those services, the nurses, therapists, medics, social workers, carers, educators knew that they came to work for a specific purpose which fulfilled the need of the service user/patient/client/student and which also was meaningful for them as an individual – most people having made an active decision to work in their chosen field as a means to enact their desire to support the wellbeing and development of others.  What this year has shown, certainly to me and I think to many others is that while we might be quite good at supporting others, and really engaged throughout the pandemic and thinking together with others about how THEY might adapt behaviours to meet unexpected challenges – turning that attention inwards has not been so good or consistent.

So, for example, I remember having 1-1s with some senior social workers at the beginning of the first lockdown and discussing with them in detail the ways in which they might think about how on earth they and their teams were going to keep a separation between their work and home life now that they were effectively living at work, often homeschooling simultaneously and had completely lost the compression/decompression time that a commute provided.  We co-devised individual responses that included going out the front door turning around three times and entering back into the home to start work.  Sometimes this might include a walk at the beginning or end of the day.  Or for healthcare workers they would take their lanyard on and off to signify their being at work – and this became more elaborate to include specific items of clothing.  Tiny but symbolic acts that signified to the brain that something of the old routine might still be alive and serving a purpose.  We devised ways of managing the tyranny of the online meeting invites inserted into calendars.  We talked about  how colleagues could be drawn into service in terms of accountability for taking a lunch break or finishing work at a certain time.  Really basic stuff.  And all the time that I was doing this work, encouraging managers and leaders to model behaviours to their teams and reports, I was sitting eating breakfast and lunch at my desk, sometimes not going outside all day, taking on more and more work whilst simultaneously trying to ensure my teenage children were engaged with online education – you get the picture?  I definitely wasn’t practising what I was preaching in those early days and it made me very conscious of the need that propelled me originally into this field of work – the desire to help – and that this had gone into a kind of overdrive.  This sense of desperation that there was always someone who needed more and the pull to try and meet that need. 

And so discussions with colleagues began to emerge – about how as professionals we were used to providing support and of course making use of the systems of support in place e.g. supervision and peer engagement that contained and challenged our experiences of undertaking that work but that the pattern had changed.  Whereas a more linear experience existed prior to the pandemic, where a person with a need was matched to a suitably experienced/qualifed professional who could lean into their system (more or less) in order to meet that need , the blurring of the personal /professional boundary when WFH/LAW and the many harrowing stories of those having to leave home to go and work in unimaginable scenarios created a new and different pattern.  More like concentric circles of support – with those in the middle working at the front line and those in subsequent circles providing increasing layers of scaffolding to hold everything in place.  But what happens to the outer circle – where is the support for the people who occupy that space?  The circular model is flawed.  If we work on the premise that everyone, everywhere needs support in some form or other, that the most experienced clinician and the newly qualified social worker both need support, that the carers need support.  That I need support and you need support – if we can accept and embrace that then I wonder what more we might be able to provide for each other.  A network rather than a circle or a line.  In the Keeping Well NCL Hub, this is what I hope to be part of – a network of Keeping Well groups and resources where we can take care of each other and provide spaces for resting and thinking together, reflecting on the past, present and future, providing support and receiving support so that rather than a scaffold, we create an architecture that looks more like a network of fungi which flowers and migrates to where there is a source of, in our scenario, need.   one that can adapt and respond in real time to all the challenges we are able to imagine.  And some that we can’t. 

In the meantime, I go for a walk before starting work.  I take a lunch break.  I put do not disturb on my calendar.  I try really hard to practice what I preach.  I feel better.  I am better at my work and feel less overwhelmed.  I check in with my colleagues.  You get the picture?

Abi Concannon is a new member of staff working within Keeping Well NCL. Elsewhere she works as senior lecturer/cohort director for the NHS Leadership Academy’s Elizabeth Garret Anderson programme and as a 1-1 facilitator on the Practice Supervisor Development Programme at the Tavistock and Portman. Abi’s podcast emphasises the importance of everybody, recognising and accessing support in very ordinary ways, either self-care or through the support of others. It is really about our need to not just be thinking about how we give to others, but also being ready to notice when we ourselves might need support, ask for support or be ready to accept it when it is offered.

Hello, my name is Andrew Cooper. I work as a social worker and Professor of Social Work at the Tavistock Centre in London, where I also practise as a Family Therapist.

During the pandemic I’ve been facilitating reflective groups for frontline social care workers and managers, and meeting with experienced social workers every day as part of the training programmes I work on.

This is an unbelievably hard time. One thing that social care workers say a lot is how unrecognised they feel their contribution is at the moment. All the media and public attention is on the nurses and doctors, the crises inside the hospitals. It’s as though social care in all its forms is invisible, out of mind, and I sense this is damaging people’s morale, at a time when they are working so hard, taking risks with their own lives, putting their own families at risk and coping with death on a daily basis.

At worst it seems to be true that social care staff, post discharge facilities, and residential homes are once again a kind of dumping ground for the hospital system as it rushes frantically to create capacity for the inflow of terribly ill people. The inter-dependence of the two systems of care is forgotten, expelled from mind; discharged patients are often scattered far and wide as capacity in the care system itself is overwhelmed. I’ve heard social workers describe how they can’t keep track of patients and service users’ movements, and so it’s impossible to do a good job. The hospitals need social care and can’t function without you, but at present there are so many critically ill people that all attention is turned on them.

Those of you working with children at risk and vulnerable adults often can’t come close enough to them to know how things really are inside the home or placement. This is leaving people with a burden of worry and anxiety. Referrals are on the rise everywhere. I heard a CAMHs manager speak about the huge increase in eating disorders among young women, the lack of options for treatment, but also how children’s wards have been taken over to accommodate Covid patients. Again all this is somehow ‘out of mind’ in the public domain.

People everywhere are angrier at the moment I think. Anxious, worried and bereaved families of service users will often project their feelings at people like you. They often feel helpless, and may leave you feeling the same.

Our own managers and organisations are struggling too. Everywhere, I pick up a feeling that staff don’t feel ‘held in mind’ in the way they might have been a few months ago; under intense pressure we can all close down, shut off from the needs of others around us, depleted as we are by our work which ironically is all about giving out to others, listening, understanding, working in their interests. Many people are describing symptoms of burnout, and the most distressing of these is when they realise with a kind of horror that they’ve stopped feeling as though they care any more. ‘But that’s not me’ they say, and of course it isn’t because we all came into this work because we find fulfilment in the task of caring. It’s just the place our minds and bodies end up in when we’ve been overextended for too long and need some care ourselves.

Through all this I see and hear social care staff showing amazing resilience, determination, commitment, loyalty, dedication. There isn’t enough recognition or appreciation of your essential contribution, but everyone should remember to feel proud, and to help one another hang onto the fact that you are continuing to behave professionally and compassionately in the face of it all. If there are heroes in this terrible time, there are so many more unsung heroes.

So what can you do to help yourself, and others, as we wait and hope for relief? This series of podcasts provides all sorts of good ideas for looking after yourself individually. But you can also join together with your colleagues. A group of home working social care staff I was supporting, who were finding the isolation, the lack of anyone to share anxieties with or get advice from about the constant policy changes very difficult, decided to organise their own weekly check in online for an hour. In the office environment we rely on each other all the time for ideas, support, thinking, and comfort. The workers approached their manager for permission to meet within working hours and she readily agreed.

We can hold each other in mind in an active way in our teams and groups. This is happening in all sorts of ways all over the country in communities, workplaces, streets. Mutual aid is springing up to fill the gap left by our struggling professional and organisational systems. People are organising themselves rather than waiting for a response from further up their hierarchies.

And we can remember to say thank you to one another, as often as possible. It’s a way of making other people’s small acts of giving and compassion meaningful, recognising one another’s achievements and each others’ distress, appreciating one another. These are some small, everyday gestures that can make all the difference in this horrible period.

I wish you all well. I’m proud to be a social care worker, and proud and moved by so much of what I’ve witnessed lately.

Thank you for listening.

Andrew Cooper is a social worker and Professor of Social Work at the Tavistock Centre in London. He reflects on the experience of social care workers and managers during the pandemic, informed by his work facilitating reflective groups for frontline social care workers and managers, and meeting with experienced social workers as part of the training programmes he works on.

Hello, my name is Henry Smith, and I’m a Principal Practice Tutor for an organisation called Frontline. Frontline is a social work charity that trains students in social work practice a qualified route into social work. We mainly focus on children and family social work. And I support units of students based in children’s services departments.

So the changes that came as a result of COVID-19 happened very quickly for our students and for me. When Boris Johnson announced a lockdown, we suddenly went from seeing families face to face, and me meeting them face to face, to everything being remote. We had to adapt very quickly to a lot of new technology, and suddenly I was meeting participants via apps like Zoom and Skype. And a lot of our participants, the students on the programme would be, would have relocated for the programme and many were living in shared houses, and would be really working from their bedrooms, particularly a small number of participants who were isolating and wanted to continue with the programme. So we felt enormous duty of care in terms of supporting them through this very difficult time and, and helping them progress with the course that they wished to continue.

So I think for the participants on the programme, there was a sort of, lots of mixed emotions, there was a kind of fear for themselves due to the impact of COVID and that they might catch it, for the families that they were supporting and for their own families, but also a fear of what might happen to the programme, would they be able to complete their social work programme. They were nine months through their qualifying year when this struck, and there were lots of uncertainties, uncertainties that we couldn’t initially provide solutions for and we had to have a number of conversations around trying to sit with this anxiety of not knowing while we worked with social work England and the local authorities they were placed in to work out how we could get them to qualify.

And a couple of practitioners, the practice educators who worked with the students reflected to me that it was actually very hard for them in terms of they were worried about families and their, they would want to help families and that’s a lot of their professional self as a family, as a social worker would be to help families and to support them, but they could no longer do this because of being isolated in the lockdown. And they were reduced to contacting families via phone and feeling a little bit inept, and I think they found this very difficult and big challenge to their professional selves.

So how do we react to this, both me as a practice tutor, tutoring the students, and as an organisation? Well, very much the attitude was the show must go on. We are the largest qualifying routing to social work and to reduce that flow of social workers into the system at such a crucial time, when we are probably going to need more social workers, would have been very counterproductive. And the participants were very keen to proceed as well. So I had weekly meetings with my participants, particularly as some were so isolated, and were really, as I say, in bedrooms and in shared houses with people they didn’t know that well, unable to see the families. We made some social events, we did quizzes, I upped my pastoral support, we did some extra teaching, sticky stuff around the Black Lives Matter movement that was happening at the same time. We took time to share the technology we were using with families, programmes like Jamboard and TikTok, my participants were doing some fantastic work with families around that and making sure we weren’t breaching any data protection.

So what we saw was some great creative work and actually many of the families that had been due to close to the children and family social work teams actually requested that they, their families were kept open in order to provide extra support through COVID, and what I saw was social work students helping families make sense of some of the confusion and advice around COVID-19, supporting families with routines now that school is not in place, and particularly for parents who hadn’t had a good experience at school and didn’t feel very comfortable teaching their children, helping them, sending them educational resources and supporting them with how to manage that.

As well, these families who were still open, there were risks involved and there were concerns about the family’s welfare and just making sure we weren’t getting false positives from online visits and talking with children over digital platforms in terms of their wellbeing. But happy to say that the programme is close to completing and all the participants have passed the programme and I’ve seen some great social work along the way. Thanks for listening.

Henry Smith is a Principle Practice Tutor with Frontline. Henry discusses how Frontline have supported social work students during the pandemic, and the way students and colleagues creatively adapted to new ways of working.

Hello, my name is Jane O’Rourke. I’m a Child, Adolescent and Family Psychotherapist, and a yoga and mindfulness teacher. This exercise called the Box Exercise is really good for helping you steady and ground, and also to do before you go to sleep.

So I’m inviting you to either lie down if you’re preparing to go to sleep, or you really need to rest, or to find a comfortable seated posture. If you’re lying down, get yourself nice and comfortable, perhaps by putting a cushion underneath your head and allowing the body to settle. And if you’re sitting up, then finding a posture where you can let your spine rise nice and tall.

And then I’m inviting you next to put a hand on your heart and a hand on your belly. And just start to engage with the steady rhythm of your breath. Perhaps notice in your hands rise on the in breath, as your belly rises and your chest rises. And then on the outbreath, the belly releasing and the chest releasing, so tuning into the rhythm of your breath. Feeling the steadiness of the floor, if you’re sitting up, that’s beneath your feet, or if you’re laying down feeling the whole body underneath you, being supported by the earth, feeling the steadiness of the earth, connecting with that, so that you can feel your whole body starting to relax. The breath starting to deepen and soften.

So in your mind’s eye we’re going to imagine the breath going around like a box shape. So, breathing in for a count of four and then we’re going to be holding it for a count of four, breathing out for a count of four and then pausing for a count of four before we begin again. So on your next in breath, breathing in for a count of 4, 3, 2, 1, holding the breath for 4, 3, 2, 1. And then breathing out 4, 3, 2, 1, and holding the breath for 4, 3, 2, 1. Breathing in 4, 3, 2, 1, holding 4, 3, 2, 1, breathing out 4, 3, 2, 1, holding 4, 3, 2, 1.

Breathing in… Holding… Breathing out… Breathing in… Holding… Breathing out… Holding… Breathing in 4, 3, 2, 1. Holding… Breathing out… And holding… Breathing in… Holding… Breathing out… Holding… Breathing in… Holding… Breathing out… Holding…

Last round, breathing in… Holding… Breathing out… Holding… And then just allowing the breath to move in and out at its own pace, not controlling it in any way. Feeling the steady rhythm of your own breath…

And you can stay here longer if you’re now going to sleep. Or in your own time allowing yourself to gently come back into the room in your own time.

Perhaps taking some time to look around, to centre yourself, taking in the room around you and gently coming back. Perhaps stretching, giving yourself perhaps a little shake if you need to re-energise before you can go on with the rest of your day.

Box breathing is a practice that has been taught all around the world to people working in frontline jobs.

Jane O’Rourke takes us through this practice as a way of helping the body and mind to calm at times of stress or to help us sleep. Jane is a yoga and mindfulness teacher and a psychodynamic psychotherapist with children young people and families. She teaches yoga for trauma within the trauma service at the Tavistock and Portman NHS Foundation Trust.

Wellbeing Quiz Profile: #MoreFrantic #RelivingTrauma

Hello, my name is Jane O’Rourke. I’m a Child, Adolescent and Family Psychotherapist, and I’m a yoga mindfulness teacher.

This is an opportunity to find the resources that are always there for us within side ourselves. The breath is an incredibly helpful way to find space and steadiness, to find a connection to our true selves.

So finding a comfortable seated posture, or you can remain standing if that feels better. And allow yourself to feel the contact with the floor if you’re standing, perhaps with your contact with your feet on the floor, or if you’re sitting then finding your sit bones so you can rise nice and tall.

Allow the shoulders to drop. Allow the face to soften, so the jaw to unlock, the root of the tongue to soften, the space between your brows to soften and just starting to notice where you feel the breath most prominently. It might be at the tip of your nose, perhaps feeling the soft breath touching your nostrils, or it could be in the chest gently rising or maybe in your belly.

And just for the next couple of minutes, we’re going to be focusing on that, just where you feel the breath most prominently. And of course your mind will wander off as minds do, it is their job to be curious about what’s going on around you. But the practice is just to gently, when you notice your mind has wandered off, to bring it back. Gently bring it back to this focus of your breath. Giving yourself permission to not be distracted by anything else just to do this for the next couple of minutes. I’m gonna be mostly quiet I might just give a little reminder or two. But for the next minute or two, just leaving you in quietness with your breath.

Gently bringing your mind back. If it’s wandered off, back to your breath.

And then becoming aware again of my voice. Feeling how your breath is now, perhaps it’s steadied a little… and staying here for longer if you need more time to study. Otherwise, whenever you’re ready, gently coming back into the room in your own time.

Being able to use the breath is a good way of finding an anchor when storms arise in our lives or if we just need some steadying. Jane O’Rourke leads us through a short practice to help us find a resource that is always with us, our breath. Jane is a Child, Adolescent and Family Psychotherapist, and Yoga and Mindfulness teacher. She teaches Yoga4Trauma in the Trauma Service at the Tavistock Clinic.

Wellbeing Quiz Profile: #MoreFrantic #RelivingTrauma

Hi, my name is James and I’m a registered mental health nurse. For the past year I’ve been working across three wards in an acute mental health setting just outside of London. Initially I was working on an all female ward, but the strain that Covid put on the NHS caused on resources and staff, forced us to reduce our capacity. As such we’ve now condensed to have two mixed gender wards.

In mental health nursing, one of the first concepts that we learn about is unconditional positive regard. Put simply, this is the belief that anyone is capable of positive change. Our patients frequently don’t see any light at the end of the tunnel, any hope that things could change for the better. Which is why it is so essential for Nursing Staff to keep this glimmer of hope alive for them when they aren’t capable of seeing or believing it for themselves.

Recent global events have made staying true to this value so much harder, for staff and patients alike. We’ve all faced disruption in some form or another, as staff we’ve been separated from the ward and teams that we know and trust. Our patients have endured further constriction in a setting that is already fraught with restriction. Visits by family’s and loved ones have only just begun to return for those unable to leave the ward due to their status under the mental health act. Even these visits are few and far between and heavily regulated. Any capacity for leniency or making exceptions has disappeared.

Life on the ward is very different now. Many workers deemed unessential, like activity staff, chaplains or even advocates are unable to come and visit, to break the monotony of life within a small ward. New patient are confined to their bedrooms for the first few days of their admission while staff wait for Covid results to come back. Most importantly, the staff members who are interacting with them in their time of crisis are often wearing face masks, losing the most important form of communication, facial expression.

Further to this, patients who are recovered to the point of being ready for discharge are faced with impossible choices to make. Housing associations and step down placements are at capacity, community services are severely limiting face to face visitations and family homes they could have returned to have become unviable due to loved ones shielding.

Our patients who experience psychosis or delusions of another nature have been influenced by the events unfolding on the television each day. Many tearful individuals have told me that they believe that they are to blame for the pandemic, and that the guilt is killing them. Similarly, patients with religious, conspiratorial or outright racist tendencies have openly expressed their support for the virus in the communal areas of the ward, claiming that it will purge the world of sin, or that this is the first step in an apocalyptic plan

So how do overstretched and under resourced staff members hold hope that their working conditions, and more importantly, their patients can improve now? It is entirely unclear when we will be able to get back to “business as usual” or whether what we considered to be normal will ever be a state we can return to. I wish there were easy answers to these questions. For their part, hospital management have attempted to be as transparent as possible about ongoing plans for the unit, and what support staff can expect to receive, but we are all aware that there is no magic wand to fix these problems. As would be expected, the already high turnover of staff has increased further, and long-time staff have elected to take an early retirement.

For my part, I have been truly inspired by the students who continue to come and work diligently on the ward in these difficult times, who continue to care and develop their skills despite not being paid to be here. Their courage and commitment gives me hope the next generation of nurses.  As for the permanent members of nursing staff, it’s undeniable that a tole is being taken on us. The policies we work with change on what feels like a weekly basis, each time we enter the ward it feels as if we’re walking into the unknown and the inevitability of staff burnout feels close at hand. But through all of this, we have rallied together to take care of each other. No matter how overwhelmed we feel, we still turn up on time and leave our personal baggage at the door. We take the time to look after each other, whether that be a debrief after a bad shift, covering duties for each other to make time for our breaks or bringing in a coffee round and treats to share in the morning. No amount of pressure will stop us from trying to bring laughter, smiles and love onto our ward each day.

As hard as it gets I still hold on to my fundamental principle, my belief that all my patients are capable of making meaningful recoveries and improving their lot in life. This past year has made an already difficult job feel impossible to achieve, and while I’m still hopeful, achieving a good standard of care in services as they’re currently structured becomes harder and harder each day.

James Ollerenshaw is a Mental Health Nurse working in acute inpatient care. Here he discusses how life on the ward has changed during the Covid crisis, and how staff maintain hope for their patients, and for themselves.

Wellbeing Quiz Profile: #FeelingHopeless

One of the complicated things about the current and ongoing situation created by the global pandemic, and maybe especially at the moment,  is that it both creates new strains and challenges for us, but also may subtly magnify strains and challenges that were there already. And equally, while some of our responses to what has been and is happening may be new, for the most part they will connect to   who we are already and  our particular ways of processing and responding to things. Some responses to a potentially traumatising experience may seem more obvious and understandable; sadness, shock, tiredness. But what do we do if we are someone, or work closely with someone, whose particular way of responding to the challenges posed by the pandemic is to be more irritable, grumpier, more prone to anger? It’s hard enough at the best of times to remember that when somebody is angry or bad-tempered it may be that there is an underlying anxiety, fear or sadness, but just at the moment it may be even more difficult when there is so much strain around for so many, and where, if remote working is part of the mix, it’s harder to read some cues that might help.

As with so much that can happen to us at a time when there is so much stimulus to take in, and much of it potentially very unsettling, one of the most important things to be able to do is to notice what you are feeling. Just that. It is easy to settle into being fed up and grumpy, and in a modern NHS or social care setting to find lots of reasons to explain it that are outside yourself, but it may be very helpful just to pause, and notice if you are more short-fused than usual, or that anger is harder to step away from. And at that moment to ask yourself whether it’s possible that your state of mind might be in some way related to the extreme situation that is unfolding, even if you are not aware of being specifically angry about that. This isn’t a pass to behaving unkindly to colleagues, or to allowing yourself to get really filled up with anger, but it is a way of just reminding yourself of the context, and of the need for compassion.  There can sometimes be a bit of a luxury in getting filled with righteous irritation, but the cost to working relationships can be high, so taking that moment to see whether there might be something happening beyond the immediate apparent cause of your anger can be an important break in the cycle.

There are of course practical things you can do. Taking a few minutes out, a walk, a conversation with a colleague, or if you need something more focussed, a breathing exercise or calming technique. But of course, sometimes when we feel filled up with something, it’s hard to do what we know would be helpful or good for us, and so it might also be that one of the most helpful things we can do is after the fact; some recognition of the strain we are under, and some leeway in the expectations we have of ourselves – so basically, it won’t help to beat yourself up if your usual calm manner  isn’t sustainable, and the important thing is to pause and go forward.

Of course, the thing about grumpiness rather than more obvious distress, is that it can have an impact on how we feel about each other; the email that gets sent too quickly, the impatient tone that we wouldn’t normally have. So while it is still reasonable   and important to expect basic standards of courtesy between colleagues, it may also be helpful to use a little imagination if someone is less patient than usual, more prickly. Ideally, this won’t just mean suffering in silence and   sympathy but might mean an opportunity to check in with each other, but sometimes that won’t be possible or the right space, and then it might be enough just to pause before getting too stuck in a view about someone to think about where their irritation is coming from, and whether some of it, even if it doesn’t feel justified, is just coming from the wider situation.

 I think it can be particularly hard, if you are the person feeling angry, if you aren’t aware of having had an experience over the past 6 months that has been obviously a source of upheaval, so you haven’t been ill, haven’t been working in an acute context, haven’t lost anyone close or had your livelihood threatened – and yet you are still stirred up in this way. But you are also a member of a society that has and is going through experiences collectively that are a source of sadness, powerlessness and fear. So it may well be that at moments, some of this gets into you, in an ordinary way but still in a way that can feel really uncomfortable unless you find a way to understand and forgive it, in yourself and others.

That isn’t to say that there aren’t things to  be angry about, to claim justice for, and to raise with your organisations if they need challenging – and we have seen that in relation to the inequities highlighted by Covid-19 as well as by the issues re-exposed through Black Lives Matter. But taking the time to sift through anger that can be useful and creative in making change where it’s needed, and anger that might get in the way of good working relationships and your own ease of mind is really important at the moment, and is likely to continue to be for the foreseeable future.

Lydia Hartland-Rowe is a Consultant Child and Adolescent Psychotherapist and Portfolio Manager for Psychological Therapies for the Tavistock and Portman NHS Foundation Trust. Here Lydia discusses something we are recognising about where we are in relation to the pandemic and in the face of what is coming, an increased tendency towards irritation and anger, or as the podcast say, grumpiness. Feeling that way at times, at the moment, makes sense and while it might at moments make things difficult, grumpiness is known to be something that shifts and lifts and that we may need to make space for in ourselves and others at the moment.

Wellbeing Quiz Profile: #MoreIrritable

Hello, my name is Jane O’Rourke, I’m a Child, Adolescent and Family Psychotherapist and a yoga and mindfulness teacher.

So let’s begin by getting a nice, comfortable posture, so where you can find your sit bones, so maybe putting a cushion underneath what you are sitting on, whether you are sitting on the floor, and sitting nice and tall if you are in a chair. So allowing the shoulders to slide down the back and keeping your neck nice and long. And then begin to soften the face, releasing any tension in the jaw, allowing the route of your tongue to relax, and allowing your hands to soften in your lap. And then begin to notice your contact with the floor, feeling the steadiness that is there for whenever we need it, and if you like on the next in breath drawing up that steadiness all the way through your body, and then on the out breath a releasing and letting go back down to the earth. So breathing in steadiness and breathing out and letting go, releasing any tension. Doing this a couple more times, filling the belly on the in breath and then a slow releasing and letting go on the out breath.

And now start to connect your attention to the breath where you are most feeling it in your body, so that could be in your belly, in your chest, or maybe at the tip of your nose. And your attention might wander off lots of times, our minds often keep us very busy and distracted, so just gently bring back the attention whenever this happens. And just focussing your attention on the physical sensations around the breath, so the rising and falling of the belly over the soft texture of the breath at the tip of your nose and all the while keeping a steady connection to the earth, keeping us anchored…

Keeping your attention on each flow of the breath, on the in breath and then on the out breath, noticing the little pause before you draw the breath and the little pause before you breath out. And noticing the cycle of the breath, perhaps give us a little extra gratitude for our life force, for the life we have been given. Our breath is our constant companion from the day we are born until the day we die, and just cultivating appreciation for this very simple thing, this very essential thing, our breath. It can be a wonderful practice to help us be in the moment and to give gratitude for our lives, and so before we leave this practice it might be that you want to draw attention to anything else that you are grateful for in your life alongside this breath. And just noticing how you feel as you bring attention to maybe some very small things in your life, or maybe some big things, some special people, or any aspect of your life that you are grateful for…

And just taking a few breaths here in this practice before we finish, a few extra moments to ground and settle… And stay here for as long as you wish, or gently opening your eyes and coming back into the room in your own time.

Jane O’Rourke offers a breathing practice to help relaxation and gratitude. Research shows that cultivating gratitude is helpful for stress and anxiety and for appreciating the good things we have in our lives, whatever the difficulties. Jane O’Rourke is a Yoga and Meditation Teacher, and a Psychodynamic Psychotherapist with Children, Young People and Families. She teaches Yoga4Trauma within the Trauma Service at the Tavistock and Portman NHS Foundation Trust.

Wellbeing Quiz Profile: #MoreFrantic #RelivingTrauma

Hello, my name is Neelam Solanki and I’m an Assistant Psychologist working at the Tavistock and Portman NHS Foundation Trust. I work primarily within the National i-THRIVE Programme Team, however, I was redeployed at the beginning of lockdown to work on a few different projects within the Trust, one of which was here at Together in Mind.

I started at the Trust in February 2020 and was working in my role for about four weeks before we went into lockdown, and my experience from there on has been a little bit “all over the place” to say the least. I found that I was only working for about two sessions (a day) per week in terms of my actual job role, and otherwise I found that I was being asked to help whoever needed it for whichever project, whenever they needed it. Initially this was really exciting and it meant that I got to know a lot of people within the Trust who otherwise I may not have met, but after a while it became exhausting and anxiety inducing as I felt more and more that I did not really have a place, a purpose, or a defined role.

Over the last 6 months, I have been reflecting on what it means for me and others in a similar position as a relatively junior member of staff, and the unique tasks and asks we’ve had which we may unlikely have the experience, the training or the foundation of knowledge to prepare us for. But then, there’s the catch-22, because the fact that we’re not particularly tied to a job role and don’t have a particular job to do that no one else can do, we can be more flexible about supporting other teams and projects. COVID has enabled me and so many others to become sort of a ‘jack of all trades’ but of course the other half of that phrase is ‘master of none’. I am so grateful and genuinely excited about the new experiences that have been presented to me, but it has been difficult to feel settled or like I fully know what I’m doing. And I’m certain that this isn’t just the case for more junior members of staff, COVID has meant that everyone has felt unsettled and lost at some point.

Another consideration is that as an Assistant Psychologist who intends on applying for clinical training later this year, everything that I do in my job is for the purpose of giving me the relevant experience and skills and knowledge and confidence to be an attractive candidate. Although there is some safety in the knowledge that all of the other hopeful assistants in the country are likely feeling the same way, there is still that feeling of dread that we don’t have a safety net. Developing my psychological skills hasn’t been a focus over the last period, so then what do I talk about in my application? What does this mean for my future?

It’s hard not to think about the 5,500 final year medical students who had to graduate early to join the workforce, as the need to manage COVID was, and still is, so high. I cannot begin to imagine what the impact of suddenly transitioning from student to doctor would be, particularly on their confidence and feelings of preparation, and what a hit their mental health and wellbeing could have taken.

During these times, things like inductions, training, support, and supervision have understandably taken a backseat because there are more pressing issues, however the impact of this is that the more junior workforce lack the confidence in themselves and the feeling of ability to do the tasks we are being asked to. For me, and in particular after taking the wellbeing quiz on Together in Mind, my profile came out as ‘More Frantic’ which made complete sense. The panic of feeling displaced, not particularly useful but also feeling as though I’m giving 110% to multiple teams all day every day took its toll.

But it is not all doom and gloom. The opportunities have been amazing and truly insightful, and although it might have taken a few months, the relationships that I’ve been able to build with such a huge range of people from different teams, divisions, disciplines and organisations feel positive and strong. I do not think that I’m particularly qualified to advise anyone who may be feeling this way at all, but to keep to the trends of the last 6 months I’m going to do it anyway: always ask for feedback. Talk to your line manager when it feels like too much. Say no if it’s not manageable. Resist the urge to want to prove yourself at every opportunity – it’s exhausting. Take breaks! Take that FULL lunch break away from your screen.

The point of being a junior member of staff if that eventually we hope to be senior members of staff. It’s hard to forget our goals when everything is so unsettled but the one main take away I’ve learnt is to use every experience to my advantage and learn, learn, learn. And to have frequent pet breaks. And to never run out of milk for tea. And have a really well-stocked snack cupboard.

Good luck to everyone and well done for coping as well as you have. Thank you for listening.

Neelam Solanki is an Assistant Psychologist working within the National i-THRIVE Programme Team at the Tavistock and Portman NHS Foundation Trust, and has also been working on Together in Mind. Neelam shares her experiences of being a relatively junior member of staff through periods of great change and uncertainty, and its impact on her wellbeing and future.

What are podcasts?

Podcasts are regular, short messages from wellbeing and mental health practitioners within this network. They will be directly responding to what we are hearing from you through both the Wellbeing Quiz and the ‘How Are You Today’ survey, as well as offering more specific presentations for targeted staff groups, for example social workers.

Once you have completed the Wellbeing Quiz, keep an eye on the hashtags underneath each of podcasts to help identify those which might be most helpful for you.