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I’m Robyn Vesey, Organisational Consultant at Tavistock Consulting, talking in this podcast about leadership and management in health and social care during the COVID-19 crisis.

Building on much of what has already been said in this series of excellent podcasts I want to highlight a few of the areas particularly relevant for leaders and managers, and for each area offer practical pointers for leaders and managers in their role.

First of all, we know this is an unprecedented, intense period of time, with a range – a kaleidoscope – of different feelings, particularly feelings of anxiety, grief, and helplessness. All of us are managing our personal feelings about our own family, friends and living situations, and many people’s work in health and social care has been hugely impacted.  Redeployment into new roles or having new staff join a team, usual routines and expected career plans disrupted, not being able to support people in the usual way when working remotely, and – most painfully – witnessing the distress and suffering of people, whether in intensive care with pneumonia, grieving for a lost family member, or someone struggling with their mental health now that face to face services are on hold.

At a time of such real crisis, the role leaders and managers play in practically supporting their teams is paramount, and in this communication is key.  Leaders need to be able to listen to staff concerns, especially where there are inevitable difficulties in the system and failures to provide what is needed, such as, in some trusts, PPE.  Leaders need to be transparent about what is happening, why, what is being done to address the situation, and tell staff when they will next be updated.  Responding to concerns, even when leaders are not able to provide the response they, and their staff wish, is crucial, so that staff can see what it is leaders and managers are doing to support them, and make some sense of the wider systems in place, as challenging as these may be.

Secondly, in this context of a global health crisis, the function of leaders and managers as emotional containers cannot be underestimated.  Many leaders and managers know and understand this, and that it will be managing and holding a particularly intense emotional load at this time. Leaders and managers need to continue to be aware of this crucial role and keep in touch with whatever they need to enable them to feel contained and supported themselves.

In particular leaders and managers need to be present and responsive to staff’s emotions, model empathy and kindness, validate what staff communicate and listen to difficult things without becoming defensive or retaliatory.  In doing so leaders and managers can create an environment where others feel safe to talk about the challenges and worries they are facing, so that staff teams feel more supported and connected to each other.

Leaders and managers need to give staff a message that their work – whatever it is – is valued, and to support staff in what they need in order to maintain relationships and feel connected. For example helping a member of staff to take part in a team meeting with their usual team, even if redeployed

And leaders and managers need to resist the urge to do, to rush, or to fix things out of anxiety, and instead seek the support that the time that is needed. For example, taking the time to think, talking something through with a colleague. Recognising one’s own limits in this way models self-care and means that better decisions are made.

Finally, leaders, like staff can recognise that they are operating in an imperfect system, and resist the pressure to be a heroic leader.  One helpful idea, especially in the time of a global pandemic – is that of tolerating the contradictions, and dissonance that are thrown up in this situation.

Just because there is anxiety, loss and even overwhelming feelings, does not mean there isn’t effective and productive work.  Every day people are carrying out important and valuable work across health and social care.

Just because there is conflict or anger doesn’t mean there isn’t collaboration and solidarity, with staff able to support and follow leaders and managers.

Just because there is helplessness and guilt about what cannot be achieved doesn’t mean there are no spaces where decisions and actions can helpfully be taken.

And just because leaders do not know what the next steps are, does not mean there cannot be trustworthy and competent leadership, responsive to the reality of the current context.

The more leaders and managers are able to bear the uncertainty and tolerate the contradictions, the better they and their teams will be able to work within the uncertainty and challenges of this crisis, with less need to take up unhelpful ways of functioning and so being able to continue to do their work effectively.

Robyn Vesey is an Organisational Consultant at Tavistock Consulting. In this podcast Robyn offers practical pointers for leaders and managers in their role during this challenging time, and how they can support their teams as well as themselves. To accompany this podcast we have added three resources; Managing Anxiety, Keeping a Gratitude Journal, and Coping With Nightmares And Sleep During Covid-19, we hope you find them useful.

Wellbeing Quiz Profile: #LessInterested

Hello my name is Jo O’Reilly. These are extraordinary times and our health services are under great strain. The wellbeing of an organisation is fundamental to the staff that work within it and to their ability to carry out their work. I’m going to be talking in this podcast about how all staff can contribute to supporting the mental health trust in a simpler way as possible during the coronavirus pandemic. In ordinary times, anxiety is managed and dilemmas are thought about in discussions with colleagues, supervision, meetings from clinical teams to trust board level. In a well-functioning organisation there is a hierarchical framework of activities, proving containment for anxiety in a multi layered way, which enables staff to perform their specific roles within their team. Support for the process of thinking is embedded within the fabric of the organisation, through these activities. These are extraordinary times however; COVID-19 brings a unique fear and level of threat related to survival. There is no blueprint to draw from; we are learning as we go along; there are few certainties.

The place of work and contact with our patients has become a potential source of danger. The ability of the mental health trust to manage anxiety has never been more important. So what can help the mental health trust to function in a healthier way as possible during the current crisis? I have 10 points to suggest.

  1. Anxiety and emotional distress at this time permeates every level of the organisation and challenges the ability to think. This affects all staff. It’s important to establish a culture and activities such as buddy schemes within which all teams and all staff check in with themselves and others about how they are doing. These can normalise anxiety and distress as entirely understandable responses, affecting us all. Identify particular vulnerabilitors and stressors within yourself and colleagues and have a low threshold for seeking further support. Increased uses of defences against anxiety may become problematics. Omnipotence is a common defence in healthcare professionals, in which we carry on as if we are invincible. This can place us at unnecessary risk of infection or emotional strain. All staff need to be realistic about their vulnerability. Look after your own health, follow precautions, use the protective equipment as advised and point out to colleagues when they are not doing so. Projection and splitting also increase when anxiety increases, which may mean uncomfortable feelings of helplessness or inadequacies may become located in others. This creates divisions between teams when we need unity. Avoid terms such as “non-essential services” or other urges to behave in such ways which may exacerbate such splits. Excessive projection in to managers to “do something” can also leave other staff losing their own agency and ability to contribute to the crisis. We are all in this together and we have something to contribute.
  2. Avoid the urge to “do” as a response to anxiety. Immediate and precipitative actions can create further anxiety in the long term. A degree of anxiety is inevitable and understand and we need to find ways to stay with this. Check that your decisions and behaviours are coming from a place of thought, rather than as an overreaction to anxiety or are based on panic. Running decisions by a colleague to think through usually helps. A word about emails; because of their rapidity and their wide reach, emails can be powerful vehicles to discharge anxiety into others. Take care when you write to people and watch out especially at times of peak anxiety, when writing a quick email may be an attempt to release anxiety within yourself and can create anxiety in others.
  3. Maintain, attend and support usually activities as much as possible. The organisation functions in some ways like a living organism, in which a change in one part of the system affects the whole. Closure or suspension of services causes further destabilisation and strain elsewhere and can make staff and patients more anxious. Education activities should continue in adapted forms where possible. There are opportunities for new learning and this also demonstrates that the senior staff and supervisors are not overwhelmed, which contains trainees and other staff.
  4. Maintain and increase opportunities for thinking and emotional containment. Excessive anxiety paralyses thought and leads to fight-flight modes of behaviour and decisions becoming led by anxiety, anxiety becomes the tail that wags the dog as it were. Increased anxiety in staff needs increased opportunities in the organisation to address it, reflective practice and opportunities to think about the emotional impact of the work and the dilemmas which arise should be continued and increased throughout all levels of the organisation, using remote platforms. These support staff to tolerate the discomfort of anxiety without becoming overwhelmed and enable them to perform their roles, whilst limiting contamination with anxiety from other parts of the organisation.
  5. Maintain differentiation of staff roles as much as possible, staff are not equally exposed to risk within the organisation and this needs explicit acknowledgement. It may be unfair, it is role dependent, and is a reality which cannot be avoided if staff more exposed to the virus are to have their specific needs attended to. Guilt in staff not working in the hot-spots of the organisation is increasingly and understandably being expressed. All staff can be helpfully reminded that they have skills to offer which will be needed at different stages of the crisis and they can best contribute from their areas of expertise. Unless acknowledged, guilt may lead to staff taking unnecessary and unrealistic risks, or putting themselves forward for roles they are not equipped to do.
  6. Leadership. The leadership of the organisation is crucial in setting the emotional tone and supporting staff to do their work. It is also having to make some very difficult decisions at the current time and needs the support of the staff. Establish regular, open and consistent channels of communication from the senior managers and use this to show that the leadership really wants to know where the areas of difficult lie. It’s really important that staff feed back to the leadership team and that they see how their feedback is contributing to decision making. It is also really important that the senior managers recognise helplessness and loss of control in the workforce as contributing to anxiety and to try to mitigate this as much as possible. Avoid overly positive messages which turn a blind eye to difficulties and which can undermine trust and increase anxiety within staff. The leadership team also model an attitude of curiosity and learning from experience when things go wrong. A hallmark of healthy functioning is not that the organisation and its staff make mistakes, we all do, it’s how the organisation responds when it gets things wrong.
  7. Team and colleague relationships are key to how we perform our tasks. Redeployment leads to loss of usual peer relationships and new teams are being rapidly created in which staff are carrying out new tasks. Don’t give up activities such as supervision and team meetings because the teams have changed. They are of even more importance in new teams where staff may be carrying out unfamiliar tasks and need peer support more than ever.
  8. Triggers and blind spots. Encourage all staff to be mindful of their internal states. Fear and threat trigger reactions based on previous experiences of trauma and loss, and teams will have their triggers and blind spots reactivated by anxiety. A team recently traumatised by patient suicide for example may have particular anxieties about further deaths in their patient group and may need additional support. Making these links helps to unpick anxiety and to process it, relieving some of its effects.
  9. The need for unity. Be kind to one another. Functioning during a crisis calls for unity. Increased stress will hit upon pre-existing tensions in the organisation. Expect this, it can be addressed later, and is best not done so in the heat of a crisis.
  10. Start preparing for recovery. This will not last forever; recovery will require opportunities for staff to process their experiences at work and should be negotiated with teams. If not addressed, challenging and traumatic experiences are likely to continue to exert their influences within the organisation. Loss and mourning for the workplace as being able to protect and adequately care for its staff will need to be openly worked through, to prevent ongoing grievance which can prevent psychological recovery. New ways of working, creative solutions, increased working across teams and cutting back of unnecessary tasks will also have emerged from this. The organisation will also have had an opportunity to learn about itself, its strengths and limitations, which can be taken forward as the basis for its continued development.

Dr Jo O’Reilly is a Consultant Psychiatrist in Medical Psychotherapy at the Camden and Islington Psychodynamic Psychotherapy Service. She is also a member of the British Psychoanalytic Society. Jo talks here about the kinds of familiar and potentially unhelpful processes that get going in organisations at highly challenging  times like these, with some suggestions about how we can try and respond from wherever we sit in the organisation. Her starting point is a mental health trust, but the difficulties are shared across working settings and being better prepared to manage them can make a big difference. To accompany this podcast we have added three resources; Using Controlled Breathing During Covid-19, Using Grounding Techniques During Covid-19 and Coping With Anger And Irritability During Covid-19, which we hope you will find useful.

Wellbeing Quiz Profile: #MoreFrantic #MoreIrritable

Hello, I’m Irene Henderson, Race Diversity Champion at the Tavistock. I just wanted to make a few brief observational comments about Coronavirus and race. It is really interesting to note how many people have very entrenched views around this pandemic, including how the virus came about and who is responsible, especially bearing in mind that so little is actually known about the virus, its actual origins and its eventual lasting legacy on us all as individuals, but also the wider society.

Who is this pandemic affecting the most?

The current ever changing statistics clearly suggest an increased prevalence of Coronavirus related deaths in the black, Asian and minority ethnic (BAME) community, with the Guardian Newspaper this week quoting “that people from minority groups appear to be over-represented among the coronavirus deaths, by as much as 27%” (Source: The Guardian 22nd April 2020, 8pm). A very worrying trend if accurate, with no obvious answers as to why the BAME community are so disproportionately affected in this way.

There are of course many possible reasons for the virus to be affecting these specific communities such as:

  1. Professionals on the frontline of Coronavirus in hospitals and other care settings, doctors, nurses and the entire supporting staff teams
  2. Higher percentage of BAME staff in public facing and service industries such as bus & rail transport systems
  3. More intergenerational extended families living together in BAME community
  4. People proximity – higher percentage of BAME people in cities and these are more densely populated areas
  5. Some cases will undoubtedly be due to poor housing or other forms of social deprivation

BAME people are heavily represented in most areas of public service and healthcare, so perhaps it is not so surprising when a health crisis hits, this community is firmly placed in the frontline.

It is encouraging however, to hear that the government is planning research in this area.

Has this pandemic increased the airing of racist views and how will this impact on healthcare staff? 

I would argue that it has, as many healthcare workers are from minority Asian communities. It seems Coronavirus is the new Brexit, fear fuelling racism. 

There have also been many recent reports of racist attacks on people who others assume to be Chinese and therefore ‘responsible for this pandemic’, including the widely reported attack on a young Singapore national on 24th February, who was physically attacked and beaten up by a group of men, on Oxford Street, Central London in broad day light. A very sad state of affairs.  (Source: BBC and online 4 March 2020)

The media too must take care with its language when reporting on this crisis.  More than ever, people need to remember how very powerful and potentially dangerous their words can be and that their words have the power to help or hinder. 

The World Health Organisation (WHO) advised those in positions of power or influence, against using divisive or clumsy language especially when on the world stage, and still we have seen very derogatory difficult language used by some world leaders, which is extremely unhelpful and can set the tone to enable open racism. 

When this language goes unchallenged at international level, it can filter down and set the scene for what is played out in our work places, on public transport, in shops and throughout the few remaining social interactions permitted.

So what can we do when we encounter racism?

I think the task remains the same – Don’t be silent – call it out. Record and report all incidents of racism wherever you encounter them. A brave but necessary path.

We can try and think about how we are treating other people. I noticed when I was catching the last rescue flight home from Spain in early March, how quickly things change. The usual local staff smiles enjoyed by holiday makers were replaced by hard stares as we became the potential carriers of a living viral infection, who were therefore no longer welcome. A natural but sad reaction – maybe in itself not obvious racism, but connected to the same roots that stem from fear.

Early years teachers are to be encouraged to teach children empathy for all, intended to reduce the growth of racist views – a big ask really considering children are only in school for a very short while, and most of their social conditioning will be done in the formative years at home. And in adult work settings too, showing and encouraging empathy can still educate.

Here at the Trust there are numerous ways you can register a concern around racism, including:

  1. Speaking to your line manager or HR
  2. Speaking to the Trust Speak Up Guardian or Race Diversity Champion
  3. Seek help from the staff confidential counselling service
  4. Keep checking the NCL In Mind project for updates and information

Out in the community, there are numerous resources available online including Citizens Advice and in extreme cases it is essential to report incidents of racism to the police.

Of course seeking information online has its own issues. During these unprecedented times social media has played an amazing role in enabling people to keep in touch with friends, family and the outside world generally.  However, online anonymity can also enable a platform or dangerous tool for those previously without a voice, to get their hate fuelled speak publicised. 

Try not to expose yourself to this and do not respond to trolls or negative comments.

It is important to check your posts before sharing – know who and what you are promoting.

The old adage remains, if you can’t say something nice, don’t say anything at all!

The Coronavirus pandemic has highlighted how much society depends on our healthcare system and those who provide it and this is an opportunity to ensure the services we have now recognised to be vital to the core of our society’s wellbeing, are well supported going forward. 

I would also hope that the contributions of BAME citizens within the healthcare and public service sectors are acknowledged and reflected equally when covered in the media offering the nations’ thanks.

It is more than ok to be afraid, it is only natural for us to be afraid, but it is not ok for us to be racist! The virus does not discriminate and neither should we.

Thank you.

Irene Henderson is the Clinical Governance & Quality Manager and Race Diversity Champion at the Tavistock and Portman NHS Foundation Trust. Irene shares some observations about where race and racism seem to have featured in the unfolding story of COVID-19, and some ideas about what any of us, whether from a BAME background or not, can do to challenge assumptions and practices about race when we see them.

Hello, my name is Sally Higginbottom, I’m a GP at the James Wigg Practice in Camden. I was asked to put together a few thoughts about our emotional journey during this difficult time. I’ve been really struck by the strength of my own emotional reaction to the work we’re doing and the impact it’s having on us. It feels like the pace of change is just completely overwhelming. The way we work one day will be very different to the next day; an email you sent a week ago will no longer be in any way relevant because everything has changed; there are new IT systems at the rate of several a week; and the way we relate to our patients seems to be changing in front of our eyes.

In all that it feels I have been going through something of a grief process and it feels like that’s something that’s been happening to me individually and also through the system. It felt initially like there was a denial phase where it felt like we decided things were different in China, it couldn’t possibly happen here, we wouldn’t go into lockdown like Italy. Yet here we are with 20,000 people who have died in hospital and we estimate many, many more outside of hospital.

I feel I’ve been very unreasonably angry with family and with colleagues, because they are the only people I can get to talk to at the moment and because I’m angry with the situation. I feel very sad about what we’ve lost. It feels like some aspects of primary care are never going to go back to how we were, a sense that we would have face-to-face interactions as our primary means of work has probably gone forever and that feels like a huge loss to me and it feels now like I’m bargaining with family and with colleagues about how we go forward from here.

There are other feelings too. I feel guilty about not being closer to the frontline, whatever that might be, and being removed from my patients’ frontline because I’m not with them and I’m only communicating, or overwhelming communicating, over the phone or by video. I feel really disconnected from what’s going on in their lives and also concerned for my hospital colleagues. I feel a loss of identity really as a doctor, who am I if I’m not seeing patients? What do I do when I go to work and it’s just an endless telephone list? It feels very odd and I think there’s been a big challenge to our boundaries consulting from home as many of us have done, either intermittently or on the medium term, it’s very difficult, it makes it much more difficult to contain your emotions, contain patients emotions, without immediate access to our colleagues, and in your living space it’s very difficult to have some of these consultations.

We’re also not saints and I feel very uncomfortable about the applause on a Thursday night. It feels better now that it’s more widely focused at the whole range of keyworkers who are keeping the country going at this very odd time. I think I’m a professional who is paid to do a job, which I’m doing to the best of my ability, but I think the way the NHS is currently being seen, it’s like a pendulum has swung radically to a slightly deification, and I’m not sure that’s very helpful for the NHS. I think it’s possibly helpful for the country as it enables people to feel a bit safer if the NHS is omnipotent but I’m not sure it’s very helpful for us.

It’s really tricky, because the path forward isn’t clear and that makes us uncomfortable, and the number of unknowns across all of our personal and professional lives are now huge. We’ve all probably been through our diaries crossing things out over the next few months but we don’t know when that will stop, when do we start experiencing some things we would consider to be ‘normal’ in life? It feels much more unknown than I have ever experienced, I think that’s true for a lot of us.

I think it will be helpful to think about the light at the end of the tunnel and it’s hard when you can’t see exactly where that is, because we don’t know how long the tunnel is and we don’t know quite what the world is going to look like on the other side, but someone much wiser than me suggested that just because we cannot see the light at the end of the tunnel, doesn’t mean it’s not there, but just that perhaps it’s round a corner. And I wonder if that’s where we are, that we will come out the other side of this, it will be different, but we don’t quite know how and that does feel uncomfortable. I think it’s just best to say that it feels uncomfortable and then that perhaps will help us to get on with our day. Bye bye.

Dr Sally Higginbottom is a GP at the James Wigg Practice in Camden. She is also the Programme Director for the GP SPIN Scheme and a trainer and appraiser. Sally shares her thoughts about our emotional journey during this difficult time, from the perspective of General Practice.

Hello, my name is Jane O’Rourke, I’m a yoga and mindfulness teacher as well as a child, adolescent and family psychotherapist and today I am going to show you how to do a simple breathing exercise to calm your mind and body.

How we breathe has a big effect on our physical and mental health. Whatever we happen to be doing, our breath is automatically responding all the time. For example, if we are feeling quite rushed the breath quickens, and if we are feeling in a panic the breath shortens, and if we are feeling relaxed the breath lengthens. So whatever we do or feel, our breath is responding to it. I like to think of the breath as our constant companion on our life’s journey, and we can use this constant companion to help us change how we feel emotionally and physically by watching the breath as well as using techniques that have been developed over thousands of years in ancient wisdom traditions. So breathing well helps the body regenerate itself by receiving good amounts of oxygen, and it enables our mind to be calm and present. It also reduces the bodies stress chemical, cortisol.

So this breathing exercise I’m going to show you helps slow down the heartrate, which allows the body to begin to relax and release tension.

You can sit on the floor and perhaps use a cushion so you can sit nice and comfortably, or you can use a straight backed chair. Having a good posture is important to breathing well and this will allow the breath the flow really well, so sit tall and imagine a golden thread at the top of your head being gently tugged so your spine grows a little and the chest expands, or you can lie down on the floor and keep your knees bent and your feet flat on the floor so you can feel your back is nice and relaxed.

Now bring your attention to your shoulders and allow them to soften and relax, soften the jaw, soften the root of your tongue and allow your gaze to soften, or you can close your eyes. This technique is called Four Square Breathing or Box Breathing, it helps balance your nervous system and so helps us calm by breathing in and out in equal proportion. You breathe in fully for a count of four, you hold it for a count of four, then you breathe out fully for four seconds and also hold for four seconds again. I’ll show you now.

So on your next in breath, breath in for a count of 4… 4, 3, 2, 1, hold the breath: 4, 3, 2, 1, breathing out: 4, 3, 2, 1, pausing: 4, 3, 2, 1, breathing in: 4, 3, 2, 1, holding: 4, 3, 2, 1, breathing out: 4, 3, 2, 1, pausing: 4, 3, 2, 1, breathing in: 4, 3, 2, 1, holding: 4, 3, 2, 1, breathing out: 4, 3, 2, 1, pausing: 4, 3, 2, 1.

We are about half way through.

Breathing in: 4, 3, 2, 1, holding: 4, 3, 2, 1, breathing out: 4, 3, 2, 1, pausing: 4, 3, 2, 1, breathing in: 4, 3, 2, 1, pausing: 4, 3, 2, 1, breathing out: 4, 3, 2, 1, pausing: 4, 3, 2, 1.

Last time.

Breathing in: 4, 3, 2, 1, holding: 4, 3, 2, 1, breathing out: 4, 3, 2, 1, holding: 4, 3, 2, 1.

Now just allow the breath to just flow as it likes, not trying to change anything, and just noticing how you are feeling… and give yourself a few moments here if you like just to be able to relax, and give yourself some time just to be alongside yourself. Allowing the breath to just flow in and out. And then whenever you are ready coming back into the room in your own time.

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. How we breathe has a big impact on our mental and physical health. Jane guides us through a breathing exercise called the ‘box technique’ to calm the body and mind.

Wellbeing Quiz Profile: #MoreFrantic #FeelingHopeless

Hi there, my name is Dr Sarah Appleton and I am a Clinical Psychologist working in Employee Health for Central London Community Healthcare NHS Foundation Trust. I am currently helping to shape the psychological support for trust staff in light of COVID-19. Throughout my conversations with staff members, and mirroring my own personal experience, I have become increasingly aware of how difficult feelings such as stress and anxiety can overwhelm an individual and make it difficult to identify a way to move forward. I therefore wanted to share with you some strategies to help you regulate difficult emotions, allowing you to engage the “wise mind” and move forward with what is most effective.

So, with that in mind, I wanted to start by reiterating that these are unprecedented times. As clinicians, we are likely to experience intense professional consequences of COVID-19 that may include a change to our job roles which bring new feelings of uncertainty or inadequacy, managing larger caseloads or holding greater risk, navigating difficult ethical decisions, or witnessing greater loss of life. 

Moreover, in addition to the professional impact of COVID-19, we are not experiencing these changes in isolation. We cannot simply “step into” our professional role and “step back out” to “normal” life; our normal has changed. Returning home may no longer be a safe place. We may find that our personal lives are now invaded with new anxieties for our own safety or the safety of those around us, with COVID-19 news offering a relentless reminder of the challenges we face, with financial uncertainty, or with personal bereavements.

Listening to Ravi Rana’s most recent podcast on “COVID-19 Information Overload” I found myself reflecting on how difficult it can be, during a time of high threat, to actually be able to see the wood through the trees and identify a helpful way forward. We may feel so overwhelmed, or so on autopilot trying to cope, that it can be difficult to even recognise our own distress let alone navigate the wealth of “support” that is made available to us.

I therefore wanted to create a podcast with this in mind. To offer an understanding as to why feeling overwhelmed is a “normal” response, and to offer some support on how to best regulate these difficult emotions to allow you to effectively identify and connect with sources of help.

Understanding our “Threat Response” System

Drawing upon emotional regulation literature, we know that when we encounter times of high threat our innate “fight, flight, freeze” response is activated.  This is our evolutionary response to threat that was designed to keep us safe. If you think of our ancestors encountering a lion, they would either need to get ready to fight it, flight (run away) or freeze (and hope the lion didn’t see them).

When this “threat system” is activated we experience a downturn in emotional processing. That is, our higher level executive functions (responsible for planning, reasoning and complex problem solving) go offline. This is not our fault. If you think back to the lion, it was not helpful for our ancestors to plan their escape or to consider the impact that their response would have on the lion – they just needed to get out of there.

However, whilst the activation of our “threat system” is not our fault, we can see that recurrent activation of the “fight, flight, freeze” response in our current circumstances can cause some problems. In our current circumstances, this might look like us snapping at those around us (fight), avoiding work or distracting ourselves with less pressing tasks (flight), or feeling so overwhelmed that we find it difficult to make decisions (freeze). This can also look like us “freezing” with knowing what, or how, to access sources of support.

Creating a Moment of Pause

So what do we do? Whilst this response is not our fault we have a responsibility to notice and work against this, actively slowing down and allowing our logical “wise mind” to come back online. In creating a moment of pause between a stimulus and our response, we can help to effectively regulate our emotions and identify/pursue what is most helpful to us.

Dr Russ Harris outlines a helpful tool for slowing down that can be described using the acronym “ACE”:

  • A: Acknowledge your thoughts and feelings. Try to do this without judgement or fear, recognising that we need to experience the full range of emotional experiences – good and bad. Try to make room for this, fostering a sense of compassion for the distress you may be experiencing.
  • C: Come back into your body. Bring attention back into your body by taking a few deep breaths, pushing your feet into the floor or pressing your fingertips together
  • E: Engage in what you are doing. Bring your attention back into the room by focusing on your five senses, or five different things that you can see. Now bring this full attention to whatever are you doing.

Committed Action: Focusing on What You Can Control

Slowing down and naming your emotional experience allows you time to acknowledge and validate the distress that you are feeling. Once you have acknowledged your emotional experience, and allowed a moment of pause to regulate the “threat” system, you are better able to recognise what support might be most helpful.

I have split the potentially helpful committed actions that I have noted from personal and professional observation into three steps.

  1. Focus on what you can control: The more we focus on what we cannot control, the more overwhelmed we feel. We can’t control COVID-19, and we can’t eliminate our normal emotional reactions to it. What we can do is focus, moment to moment, on the choices we do have.
  2. Remember your strengths: COVID-19 means that you are likely to be experiencing increased distress without access to your full range of previous coping strategies (e.g. going to the gym, distracting yourself with work, or meeting up with friends or family). It’s therefore not surprising that you might feel somewhat ill-equipped to deal with the current pandemic. Whilst COVID-19 brings new challenges, remember that you have effectively navigated times of difficulty in the past. Take a moment to remember how you coped historically. Write a list of what helped and then try to adapt these strategies to your current circumstances.
  3. Seek support where helpful: These are unprecedented times and we may all need to access additional support at one time or another. Once you have got used to naming your emotional experience, see what themes come up regularly (e.g. anxiety). You can then visit the “Resources” tab for helpful links to appropriate psychological support, clicking on whatever psychological presentation is most present for you.

Dr Sarah Appleton is a Clinical Psychologist working in Employee Health for Central London Community Healthcare NHS Foundation Trust. Sarah shares strategies about how to best regulate difficult emotions to allow you to effectively identify and connect with sources of help. Two blogs accompany this podcast, one entitled ‘Why we’re all grieving’ written by Sarah and the other ‘Suffering during a time of crisis’ written by her colleague Neal Gething.

Wellbeing Quiz Profile: #LessInterested #RelivingTrauma

Hi Everyone,

My name is Lucy Swift, and I am an occupational therapist working with patients who have chronic musculoskeletal pain. Like many people, I am currently required to work from home, and I am finding that I’m spending a lot more time in front of the laptop, or looking at my phone for WhatsApp messages, and not moving as much as I’m used to.

After 3 weeks of working from home, I have noticed that I am feeling more lethargic, my eyes are sore and my joints are getting stiff.

So I’ve given myself a talking to, and decided I should probably take some of my own advice.

Firstly, I have set up a comfortable workstation. We don’t have the luxury of a separate office in our flat, so each evening the workstation has to be dismantled and return to being a dining table. This is a good thing, because it means I pack away the laptop at clocking off time, and I’m not tempted to work into the evening.

Now, I know what a comfortable workstation should look like.

But at home I thought a table and dining chair would be just fine. However, after a few hours I found that the chair I was using was too low, which meant my shoulders were elevated, creating tension. I put a firm cushion on the chair and that has made a big difference. My shoulders are now more relaxed.

I made sure there was plenty of legroom under the table. Sometimes I use a footrest (aka encyclopaedia – who even has encyclopaedias these days?!)

I have a separate mouse so my right arm and shoulder gets a bit of movement.

What I don’t have is a laptop stand. Ideally the top of the screen would be level with my eye height.  Then my neck wouldn’t have to work so hard to hold my head up! Maybe I’ll use a box file or some books to raise my laptop, and see if I can source a separate keyboard. I would use a separate monitor if I had one. Or maybe the TV.

I have popped a small cushion behind my back as a lumbar support. It’s not perfect but it’ll do.

But probably more important than all of the above, is how often I move. I wish I had a height adjustable desk, but I don’t. I don’t even have a desk raiser. Then I remembered that thing I talk to patients about ALL THE TIME.

Pacing. Changing position or demand on your body BEFORE your body tells you to.

Pacing is hard. I’m not gonna lie to you. Even when your back, neck and shoulders are on fire, you’re still thinking “I’ll just finish this sentence….” before you stand up and stretch.

Luckily there are loads of things to help with this. Before we get into the technological assistance…

I have found that if I plan my day carefully, it can prompt me to pace it better. I stretch before I sit down. (I may do “5 minute Yoga with Adrienne” on YouTube if I’m really good).  I try and stick to my usual work hours, which means I take a lunch break at 12.30. I schedule video or phone meetings mid-morning or mid-afternoon if possible, and I walk around while talking. That’s easier to do than in a meeting at work (I just need to remember to do it!). After I finish a call with a patient (which may have been intense. And tense), I stand up and stretch before writing the notes. If it’s been a particularly challenging call I might throw in a downward dog. I also drink A LOT of tea. Loose leaf green tea is my current preference. I also have a pea sized bladder (hurray!) which is conducive to pacing.

While sitting, neck stretches and shoulder rolls are essential. When I’m at work I’m frequently turning to chat to colleagues. And I wouldn’t constantly be at the computer. So I go and do some laundry or unload the dishwasher, or just dance around the kitchen. I find wrist rotations are also good, and I have a vertical mouse which I sometimes use for better positioning.

I’m also a huge fan of meditation, for many reasons. I could say a lot about mindfulness, but for the purposes of this podcast I will just say – take a short break mid-morning to meditate for 5 or 10 mins, and you won’t regret it. That email can wait!

So on to technology… of the several mindfulness meditation apps I have tried….

I keep coming back to my absolute favourite, Headspace. It has some free stuff, but it’s worth subscribing to. Calm is also very good (but you have to subscribe if you want Matthew McConaughey reading you a bedtime story). Oak is totally free, and includes sound effects.

Now on to the apps for pacing:

Firstly, the Stand Up app (for IPhone). This is so simple – you choose the sound you want it to make, to remind you to get up frequently. Mine is currently set to the “duck typing” noise every 20 minutes.

Then you have Break Time (the same thing for android phones).

Now for the computer:

Work Rave (for Windows) – this app is the absolute dog’s whatsits. A free reminder to take micro breaks, tea breaks and set your daily limit (includes stretches and eye exercises).

If you have a Mac, try Time Out or Stretchly.

There is also an app called “Stretching Exercises at Home – Flexibility training”

I like to have a soothing screensaver (I had to cancel the trip of a lifetime to Japan, so I’ve tried to bring Japan to me on my screen).

What else have I found helpful?

I go into the garden for lunch/breaks. I have that all important one walk a day as soon as I log off. I have also tried to bring the outside in by having several plants in the room.

Plants absorb carbon dioxide and release oxygen. They also soak up toxic chemicals. According to NASA, the top 10 air-purifying plants are:

  • Peace Lily
  • Golden Pothos
  • English Ivy (use with caution!)
  • Chrysanthemum
  • Gerbera Daisy
  • Mother-in-law’s tongue
  • Bamboo Palm
  • Azalea
  • Red-edge Dracaena
  • Spider Plant

I’m a real novice gardener, but if these can help, I’ll get them all!

And finally…. I try and snack every couple of hours and drink plenty of water. (Sounds obvious but it’s so easy to shut off from these basic needs when you’re in work mode).

So hopefully all of the above will make working from home a bit more pleasant. Stay safe everyone and look after yourselves.

Lucy Swift is an Occupational Therapist at the Royal National Orthopaedic Hospital NHS Trust working with patients who have chronic musculoskeletal pain. Lucy provides advice about how to manage screen time while working from home and shares information about some helpful apps that can support you with this.

Wellbeing Quiz Profile: #MoreFrantic #DoingOkay

Hi there, my name is Dr Sarah Helps, I am a Consultant Clinical Psychologist and Consultant Family Therapist at the Tavistock Clinic in North London. I am recording this soundbite to go along with the help sheet regarding family communication during COVID-19. The guide is designed for parents and carers who are thinking about, and planning having tricky conversations with their children regarding being a keyworker over this time.

I want to start off by addressing the issue of how you usually talk to your child about tricky things; are you a family who talks a lot or a little about difficult issues? What are your beliefs culturally, spiritually, regarding religion that you draw on when you are talking about difficult issues? How have you talked about things that are sensitive or upsetting or stressful in the past? You can learn a lot from reflecting on your past experiences about having tricky conversations in terms of what works and what you might do differently in this current, very stressful, and very complicated context.

When you think about talking with your child and answering questions they might have about working during COVID-19 it is important to first think about your own emotional posturing, your own emotional tank. It is important to think about what questions you are most worried about having to answer from your child. It is important to rehearse the kind of answers you might give to those tricky questions, and we all know that kids are very good at asking the questions we least want to answer. If you are worrying about how to answer difficult questions practice your answers, and practice them with a friend or a colleague, or use the NCL helpline to think through how you might respond to difficult questions.

As a psychologist and family therapist, and as a mother of teenagers, I know that not all conversations go well but it is much better to try and talk about difficult things, to fail, to get it wrong, to be clumsy, to review and to go back again. We know that tricky conversations take practice and that you will learn together and get better at talking about difficult things together.

Over the past few weeks in clinic, and indeed within my own family, children have asked some really complicated questions of their key working parents. The have asked; is it safe to go to work? Will you catch COVID if you go to work? Who will look after me if you get sick? Will you die if you catch COVID? Why do you have to be a key worker, why can’t you stay at home like my friend’s parents? Kids have asked whether it is safe for them to go to school, whether they have to go to school, particularly that’s a tricky issue for teenagers. Teenagers have also asked if it is ok for them to go to school, why isn’t it ok for them to go out with your friends? Kids have asked do their parents have enough PPE (Personal Protective Equipment), does their workplace sufficiently ensure that they are safe in doing their jobs? And all kids are asking when is this going to end, when can we get back to ordinary life? These are questions that have complicated answers, the answers are complicated on the basis of the age of the child, the developmental stage of the child, and the way that you and your children are understanding the evidence and information that currently exists.

As I said before, there are no straightforward answers to these questions, think through the most challenging questions that your child might ask you, and do some rehearsal of the answers that you might give. You might need some help with this rehearsal, ask for it from friends, family, or the NCL helpline if you think that would be of benefit. The most important thing is to carry on talking, even if that feels difficult. I wish you the best of luck in this.

 

Sarah Helps is a Consultant Clinical Psychologist and Consultant Family Therapist at the Tavistock Clinic. This podcast accompanies a help sheet regarding family communication during COVID-19. Sarah speaks about the guide designed for keyworker parents and carers to support them in talking to children about being a keyworker over this time.

Nowadays we have access to information and the ability to share that information on a scale that is truly amazing. We have fantastic opportunities for learning, and sharing what we are learning during this pandemic and many of us have already felt the benefits of this.

But this epidemic is beyond the experience of most of us, and I think it’s not unfair to say that anxiety, if not the virus itself, has infected most of us. Many of us feel out of our depth and in unknown territory, very quickly we can begin to feel unconfident and as if we have no skills to deal with what’s in front of us.

So we look for more information to steady ourselves, regain our balance and get some understanding of this new situation and challenges. This is a normal and adaptive response to discover everything we possibly can to give us an advantage, to get ahead of the threat at our backs.

We look for direction and to what we should we do under these new conditions.

And there can be an immediate sense of relief when new information comes in. It feels reassuring that someone out there knows what’s going on, like someone is in charge, and that someone has an answer that will relieve us of all this uncertainty.

But while there is reassurance in knowing that people are thinking about this, and even better, thinking about this collectively, there is another side to this burgeoning wealth of information. And I want to talk a little about that, and the potential indigestion and indifference that many of us are beginning to experience in the wake of the information explosion in response to the COVID-19 pandemic.

As this crisis unfolds more and more information floods in, there are helpful fact sheets about just about every aspect of our lives – how to eat and sleep, what sort of exercise to do in our confined spaces, how to socialise, how to work, how to communicate with one another and even what to do about our pets. There’s no area of our lives that hasn’t been thought about by someone out there and deemed worthy of a COVID makeover.

For professionals in particular, there is even more ‘help’, our professional bodies and colleagues have swung into action and I don’t think I’ve ever seen such proliferation and sharing of helpful information, all of which feels compelling but also, if I’m honest, exhausting.

All this information is becoming overwhelming. There is a limit to what we can take in and there is a danger that in protecting ourselves from overload we can become indifferent to all new information, including stuff we really need to know …

I have colleagues whose views I respect and value … they send me reams of ‘helpful’ links they’ve found. I can see that a lot of it is the same content, sometimes repackaged in a more user friendly way, and it has stopped feeling quite so helpful or even friendly to me, and now I am starting to feel a bit hounded by all this stuff.

But it’s difficult to just turn off the information flow. It feels important somehow to keep up and who knows, there might a golden nugget out there that is going to make all the difference. And even though most of us know there isn’t, the pressure is there to keep looking for something more, something new, to stem the anxiety we feel and to help us feel less powerless.

One of the more unhelpful sides of this information overload is that the skills we thought we had somehow don’t feel good enough anymore. We can begin to feel inadequate to the task in hand and to lose our grip on the competencies we took for granted before the pandemic. In my organisation, for example, as in many others, a huge source of anxiety has been the lack of adequate protective equipment. There has also been a lot of confusion about how to use it. Our leadership responded positively by managing to get the equipment that was needed and by issuing guidance about usage. But staff continued to feel confused about how to use it despite our organisation’s clear guidance. Here I think anxiety was fuelled by exposure to an unhelpful slew of confusing external information and this led to staff feeling deskilled and less competent. This got in the way of their being able to understand and follow local instructions which they would normally have had little difficulty with. The problem here was not the information we were giving staff, rather it was about containing anxiety stimulated by multiple inconsistent information feeds, and that needs a different kind of response.

The point I’m making here is that while information is vital, so is context, and what is helpful in one situation may not be in the next. In my organisation, the guidance about protective equipment was not the problem, it was how it was communicated. After a couple of goes at reissuing the guidance, our leadership took a different tack and decided to write personally to each staff member about how to use the equipment. This personal level of communication helped to contain staff anxiety and it made it easier for staff to recover their usual level of competence and take in the provided guidance.

In amidst this information snowstorm it’s important to remember that most of us already have within ourselves much of what we need to deal with the challenges of this pandemic through our trainings or in our personal tool kits. And what we actually mostly need is the support of our friends and colleagues, space to talk and share our experiences, learn from and lean on each other. This camaraderie is what will help up tolerate and manage the huge uncertainties facing us and allow us all to mobilise our resources effectively … remember … it is good to talk!

Ravi Rana is a Clinical Psychologist and Director of Therapies at East London NHS Foundation Trust. In this podcast she talks about the wealth of information created in response to COVID-19 for the general public and health and social care professionals, and that while helpful, there is a danger of becoming overwhelmed and indifferent to new information and feel deskilled and incompetent. Many already have the skills needed to deal with the challenges of the pandemic, with communication and comradery with friends and colleagues helping the effective mobilisation of resources.

Wellbeing Quiz Profile: #MoreFrantic #LessInterested 

Hello everyone, my name is Chris Atherton and I am the Adult Principal Social Worker in Haringey. I wanted spend a few minutes in this podcast talking to you about my experience of working with my social care staff over the last few weeks. Specifically, I wanted to talk about the emotions that some staff have been, and are currently feeling, around the situation brought about by COVID-19.

So, there are 3 emotions specifically that I wanted to focus on for today’s podcast. Now I am only focusing on 3 because I only have a few minutes to talk with you but I did want to recognise that we have all probably felt, or are feeling, a kaleidoscope of emotions. What we are facing at the moment is unprecedented and the demand that staff are facing in health and social care is huge, and with that comes the spectrum of emotions. If any of you are having a particularly difficult time I just wanted you to know that we are with you and please do seek support through your employer.

The 3 emotions I wanted to focus on for this discussion are Fear, Helplessness and Hope.

Firstly, Fear. Given the worldwide impact that COVID-19 has had, the lives it has taken, and the effect it has had on our day to day lives, fear is a completely rationale emotion to have. Fear helps keep us and the ones that we love safe. Fear will be particularly prominent for those of us who are working directly with individuals in our community. It is something that staff have expressed to me regarding the lack of PPE (personal protective equipment) and the differing guidance being given to those working in the NHS and social care. But, even though people are afraid, they still continue to do their roles. They still continue to go out in to the community and work with those who are most vulnerable. To be fearful of something and yet to confront it shows courage, the one cannot exist without the other.

Secondly is Helplessness. For a number of practitioners, like myself, home working has come into play and face-to-face contact with those we support now being done via telephone, text, Zoom, Skype, to mention a few. This feels very alien for many of us. Social Care is about being there. It’s about showing up, supporting, empathising and enabling. So, to be told to retreat to the safe space of home and wait for further instructions has led to a lot of practitioners feeling helpless especially when other social care colleagues and those in the NHS are battling from the frontlines. The role that we all play will be invaluable and those who feel they are sitting on the bench will get their chance to join the fight, but this challenge is a marathon not a sprint.

Lastly, Hope. Even in the most challenging of circumstances we can always find hope. COVID-19 has presented devastation and despair but there is still hope to be found. So, there’s the big things we all might be feeling. Firstly, hope for the approach we have to tackling adversity as a system, a nation, a species, Hope for the environment given the pause to our normal routines and given those pauses hope to what we prioritise most in our lives.

For my practitioners, hope for better recognition of those heroes in health and social care and perhaps even hope of a decent pay rise, hope of communities, partners and systems working better together in the future as we are showing what we can do now and hope of changing our working processes – reducing red tape and reducing paperwork – getting away from our desks and into our communities more.

Thank you so much for listening keep safe everyone, goodbye.

 

Chris Atherton is the Adult Principal Social Worker in Haringey Council. In this podcast Chris draws on his experience and that of his adult social care colleagues to talk about three emotions, among others, felt in response to working during the pandemic; Fear, Helplessness and Hope.

Wellbeing Quiz Profile: #FeelingHopeless

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.