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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

Hello.  My name is Paul Jenkins and I am the Chief Executive of the Tavistock and Portman NHS Foundation Trust. The topic I want to cover in today’s podcast is the issue of switching off.

We are living and working through a dramatic set of events and anxiety is rife.  Staff in the NHS and social care are working exceptionally hard to support patients and each other.  Events are moving at an amazing pace and the decisions we are taking can, literally, be matters of life and death. 

Against this background I am not surprised to hear that colleagues are finding it hard to switch off and that some are also having difficulties sleeping. It is really important that we all do our best to look after ourselves and find ways to disengage from work.

In my career, I have encountered lots of situations which have put me under a lot of personal stress, and which have tested my resilience. 

Over the years I have tried to identify strategies for coping with that level of pressure.  I don’t claim to have cracked it but here are some of the things which have worked for me.

The first is to acknowledge that to be effective I do need to set some boundaries.  Nobody can work 7 days a week flat out without some time off.  However much my job requires me, at times, to work out of hours I always try still to preserve some space where I am not on duty and where I do not look at my phone. More importantly I try to do my best to respect those boundaries with others.

The second is the value of outside interests.  I am a keen cyclist, love reading and music.  All those activities help me escape from the here and now and help me recharge my batteries. 

Getting out for exercise is particularly important.  Not just in respect of looking after my physical health, but also to refresh my psychological wellbeing. #

I have always stood by the famous line of the Welsh poet W.H.Davies:

What is this life if, full of care, we have no time to stand and stare

Even at a time when the requirements of social distancing are limiting horizons, there are, in the immediate area around where I live in South London, so many places which call me to stand and stare.

I am finding it very helpful that we are going through all of this at the start of Spring when each walk or cycle offers a new treat as different trees come into leaf and new blossoms appear.  In normal times some of these things can pass me by but, at present, they are particularly comforting.

My third tip is the importance of other people and appreciating each other. We will get through this current crisis by sticking together and supporting each other.  There are moments, in what we are dealing with, for challenge and difficult conversations but there is more need for praise, gratitude and thanks.  They are the fuel on which we all best run at times of stress.

As a Chief Executive, I am pretty used to brickbats and criticism.  You develop something of a thick skin, but constant negativity gets at me and amplifies the sense of stress I feel.  So last night, when I got a lovely positive response to an all staff email, it gave me an enormous boost and helped me disengage from the pressure of other difficult issues I am dealing with.

My final point is to try not to be a hero.  There are lots of brilliant people doing brilliant work at present but no one of us is indispensable.  The world will not fall over if we’re not there for a day and we all deserve the chance to stand back, have some time to ourselves and recharge our batteries.  After all a burnt-out hero is no good to anyone. 

Paul Jenkins is the Chief Executive of the Tavistock and Portman NHS Foundation Trust. Paul talks about the importance of switching off during this difficult time, and talks through some of his personal coping strategies during periods of stress and pressure. He offers some helpful, practical tips for everyone to consider.

Wellbeing Quiz Profile: #MoreFrantic

Podcast 1: Recognising Burnout: Helpers Stress Reactions

“The first podcast emphasises ways in which specific helpers such as keyworkers, first responders, NHS workers, NHS frontline staff, responding to the corona virus crisis, can support themselves and their colleagues by recognizing the signs of stress and burnout, and learning techniques which may help to alleviate or prevent severe emotional reactions.

If you are a Keyworker responding to this crisis you are likely to be exposed to highly stressful situations in the course of your line of duty and routine tasks. Usually the traditional heroic role of helpers includes expectations that they are selfless, tireless, and somehow superhuman. However due to the unprecedented situation created by this pandemic you might also be affected by the nature of your job in this crisis. Therefore, maintaining your ability to function efficiently and effectively it is essential for you to provide this relief work.

Specific situations that increase your vulnerability to stress might be:

  • Having no control over the volume work
  • Working long hours/shifts without many breaks and rest
  • Leaving your job with a feeling of not having done enough, because needs in this situation are so overwhelming that they by far exceed your capabilities
  • Feeling guilty about life or death decisions that you have to make and carry a sense of responsibility that you fail to prevent harm by transgressing your deeply held moral beliefs and expectations
  • Being troubled by the victim’s stories
  • Feeling guilt at the death of a patient or patients
  • Feeling despair faced with the repetitive cycle of death that the present pandemic is creating
  • Feeling anxious that you will also be infected and worry about how you will cope with your own fears of contamination, death and deterioration as you assist others.

If these reactions and experiences are left unaddressed after a prolonged period of time on the job, these stress factors are likely to affect your well-being, and the quality and efficiency of your work, which in turn might lead to Burnout and compassion fatigue.

These conditions happen when stress factors have taken over, and there is an exhaustion of normal stress coping mechanisms leaving you unable to distance yourself from the situation.

Symptoms of stress and “Burnout” Amongst frontline staff

  • Excessive tiredness
  • “Loss of spirit”
  • Inability to concentrate
  • Somatic symptoms (e.g., headaches, gastrointestinal disturbances)
  • Sleep difficulties
  • Neglecting own safety and physical needs (not needing breaks, sleep, etc.)
  • Grandiose beliefs about own importance (E.g., engaging in heroic but reckless behaviours,
  • Cynicism
  • Inefficiency
  • Mistrust of co-workers or supervisors or organisation
  • Excessive alcohol or drug use, caffeine consumption, and smoking

Please listen to my other podcast where I will be talking about detecting stress and burnout signs in yourself and peers and learn effective self-care stress management techniques that will help you increase your coping capacity to deal with the present situation.”

Podcast 2: Reducing Burnout: Helpers Stress Reactions

“In the second podcast I will be talking about how to recognise signs of stress and burnout and give you tips on how to reduce these stress factors as a frontline worker tackling the corona virus crisis.

As mentioned in my other podcast it is important that you identify your own stress reactions and have coping strategies options that you can use for own self-care. You can also identify these in peers in order to provide them peer support and also help them with their own stress management

How to identify these stresses?

  1. Pay attention to your body for signs of stress. Is your body giving you warning signs? Rapid heartbeat, stomach pains, tightness in the chest, trembling, feeling tired all the time, headaches and other aches and pain.
  2. Pay attention to your mind. Do you have difficulty concentrating and /or remembering, do you find that you are more “disorganized” than usual, do you feel overwhelmed or fearful by the present work situation?
  3. Pay attention to your personal life and your emotions. Are you arguing more than normal with others including co-workers or family and friends? Do you constantly feel angry or sad or fearful or hopeless?

Therefore, it is important that you feel supported, and that you can be supported at several key points of their provision of care in order to reduce the likelihood of developing stress-related problems. So please reach out to your peers and/or managers for support and acknowledge that it is ok not to feel ok.

Self-care stress management techniques

How can you be attentive to your own self-care?

Prepare before beginning your work shift

  • The more prepared you are before taking up your work assignment, the more likely you will be able to deal effectively with the emotional challenges of nature of the work that needs to be carried out.
  • Be aware what to expect, both practically and emotionally, in yourself and in the people you will be helping.
  • Be aware if the common responses to stress and about signs of stress and burnout in yourself and in co-workers.
  • Learn as much as you can about the particular situation in which you will be working. The closer your expectations are to the realities you will face, the greater your sense of predictability and control and the less your feelings of helplessness and uncertainty will be.
  • Talk to others who have had direct experience of the particular work you will be doing.

Take care of yourself during the duration of your shift

  • Make sure you take adequate “break time” or “down time.”
  • If at all possible, this should be taken away from your work site (e.g., in a separate room like a staff room or rest room).
  • Take care of your body – Pay attention to eating properly and getting enough rest.
  • It might seem that taking time away from your work to eat, drink, and rest may feel like is a time waster in the midst of this crisis response but it will help you work at maximum efficiency and do your job better and with fewer errors.
  • Physical activity helps dissipate stress.
  • Get some form of exercise and other forms of recreation also help dissipate stress away from you job
  • Engage in an enjoyable activity at home: like drawing, painting, writing, playing music
  • Avoid the temptation to use alcohol or drugs or to engage in risky behaviours to wind down or escape the pressures of your work.

Talk about your experiences

  • Talk to others like your co-workers and/or supervisors about your experiences and your needs. What information do you need? What support do you need?
  • Be prepared for your return home after work
  • Expect that your return home after you completed and intense working day may be more complicated than you have anticipated. You have been in a very intense, demanding situation during your work.
  • Have a plan of action in advance of how you will wind down.

Reducing stress responses

These are simple stress management techniques and coping skills that you can use to protect yourself emotionally.

You might try one of the following:

  1. Visualizing a pleasant image of a safe space – like a beach or a beautiful mountain site or visualizing yourself doing a pleasant activity – like walking the woods, being in the garden. Try to visualize the scene in some detail and as vividly and clearly as you can by engaging all of your senses. What you can hear, see, smell and feel as if you are there.
  2. Another way is to reduce your muscle tension. Take a few deep breaths. Focus your attention on the feeling of the air moving in and out of your body. Continue to breathe deeply. Now imagine that the tension in the muscles of your forehead is flowing out of your body with each exhalation. Do the same thing, breath by breath, with the muscles of your jaw, shoulders, arms, and legs.
  3. Press your thumbs and forefingers together tightly. Take a slow deep breath and hold it for two or three seconds. Then slowly release your breath while you simultaneously slowly relax the pressure of your fingers and slowly say to yourself RELAX….

But there are other relaxation and mindfulness meditation exercises that you can use to help stay in the present moment.

Your own self-care is both an essential pre-requisite for effectively helping others and a means of maintaining one’s fitness to increase your capacity in responding to demands faced in the frontline.”

Silvia Miranda is the Clinical Co-ordinator and Senior Counselling Psychologist at Islington iCope IAPT Service and a Lead Counselling Psychologist at The TILS Veteran Service in Camden & Islington NHS Foundation Trust. In her first podcast she talks directly to frontline workers about the range of complicated emotional responses they may be having and gives examples of how to recognise symptoms of stress and burnout in yourself. In the second podcast, Silvia gives a range of stress management techniques and self-care tips to help you reduce stress reactions and burnout.

Wellbeing Quiz Profile: #MoreFrantic

Hello this is Tim Kent from the Tavistock and Portman NHS Foundation Trust. I’m the Director of Adult Forensic Services here and I’m a psychotherapist and a social worker by background. It’s interesting this pandemic crisis that we are in the throes of at the moment, it mostly reminds me of parents and grandparents stories of the Blitz, wartime, rationing, pulling together, and the sense that what was at stake was people’s mental coherence as much as the fear of loss of life and loved ones and of course with that fear comes the sense that we’re not always together and a lot of our work at the moment is remote. I’ve just been on a Skype, sorry, Zoom call, with several colleagues, spending a lot of time on the phone and you know managing a huge array of new experiences and feelings sort of bombarding the mind at any one point and trying to metabolise it like a new medicine so it’s quite bizarre and I think we’re all both sort stimulated and in a way very anxious about the outcome and what’s it’s going to mean.

Of course we all know people who are currently very ill and some who we’ve lost and many thankfully who had mild versions and are either recovering or haven’t yet been unwell so there’s a very strong sense of that kind of spirit of the Blitz, for want of a better description, and I think it’s valuable.

There’s something that’s been on my mind for several years about the experience of a country or nation, that hasn’t in any recent past history been through a considerable period of real adversity and I suppose before COVID-19 we thought that 10 years of austerity and cuts to the NHS was real adversity, which of course it very much is and has been and continues to be and now we are reaping the fallout from that experience.

But more immediately and more personally, my wife’s been unwell so I’ve been advised by our doctors to isolate and it feels as busy working from home as it has been the office, although I miss being around friends and colleagues and within the institutional environment. I’m thinking ahead to whether I could and should be redeployed back into social work and with experience in child protection and adults with mental problems and working the community.

I think for lots of people at the moment there is a sense of wanting to help and wanting to be able to go above and beyond the norm is shared by so many, at the same time that that some of our colleagues are just really frightened and very much wanting to retreat, so a really complex and difficult time and am very very grateful to have so many supportive colleagues.

I know it feels like a difficult thing to come to terms with the moment but it does feel great to be part of the NHS and to see the appreciation of our public for what we do. It’s also extremely worrying to see how austerity has left us unprepared in so many ways and that that ultimately is going to impact on mortality rates.

So in psychological services, just as a final note, for some of our patients if not most of our patients, the psychotherapy that we provide at the Tavistock and Portman, alongside our other services, is a lifeline, literally, for many people. As Donna Winnicott and Albert Einstein wrote to the government during the Second World War, the thing about protecting children and adults from adversity at a time of crisis, and at that point wartime, is not just about a threat to the physical body, the psychological threat to people’s emotional development and mental capacity and ability to keep going and in some cases keep living with the huge threat and therefore the huge anxiety that it causes is paramount.

It’s not really to compare the body and the mind, perhaps better to say that they’re part of the same thing and it’s important to keep going psychologically as it is physically. I think the fact is at the moment that a lot of us are experiencing a very serious traumatic impact to our mental functioning and the bombardment of new experience and change can get through some of the time, so you know you can feel all right one minute and then completely discombobulated the next and unable to think and then them you try and re-gather.

Okay I think that’s enough and I will sign off now. Thanks for listening, take care, keep well and love to you all.

Tim Kent is Director of Adult & Forensic Services, Consultant Psychotherapist and Social Worker at the Tavistock and Portman NHS Foundation Trust. He delivers a rousing commentary for NHS and social care staff about the experience of living through, and working in, the current time of adversity and how the services we provide are a lifeline, literally, for many people.

Key workers across different sectors have some big questions about how to continue to do their work and look after their children in this time of huge upheaval and uncertainty.  

How to explain that you want and need to keep working, managing your worries about the spread of the virus, and how to reassure children that you and they are safe at work and at school.

When the news came a couple of weeks ago that schools would be closing because of COVID-19 the landscape changed for all of us. Without, it seems, even a moment to draw breath, parents and children have had to find a way to trust that continuing to go to work and school is vitally important if collectively we are going to manage this crisis.  Of course there is often huge pride for children in knowing that their parents are part of the helping professions, but at this point it may feel quite difficult to hold onto this.  

Whilst many parents will have had the task of getting used to home working, key workers will have known that this was not going to be an option for many of them. 

The news that key workers’ children would continue to have a place at school came quickly, and with the relief came a number of questions in the minds of adults and children about what being a key worker now meant.  And some of these, for parents, might feel unspeakable.  

How do I keep working in situations that might put me and my family at risk?  

How do I explain that my work commitments will mean that my children have to continue to go to school?  And will they be safe there?

And other questions about what happens for key workers and their children but not for everyone.  Lockdown surely means just that! But of course lockdown means different things for adults and their families in certain professional roles. 

As this pandemic has continued to develop there is a need to keep talking to children about this changing landscape – for some children this may have felt at first like  the beginning of an extended school holiday.  But it is now week two and children of key workers have been attending school as usual, but of course there is nothing usual about school at the moment. So   as the traditional Easter break approaches, how to explain to children that this probably will continue for some time to come and that it won’t end after the holiday – key worker parents will still be working. 

As the reality of this new normal continues, parents will probably be aware of the need to stay alert to the spoken and unspoken worries that their children may have.

How do you have a conversation following the daily briefings which bring news about testing, resources and the numbers of people who are sadly losing their lives.  For those parents who are key workers, and their children, these are uncertain times, feelings of fear, upset and possibly anger are surely somewhere in the minds of your families.  

Thankfully, the thinking and more rational parts of the brain will, with your explanations and reassurances, reason away some of these thoughts, but this may only provide temporary relief for children who because of their age, or their own psychological and emotional needs, find it hard to hold onto these explanations. You may need to explain more than once, to help them regain balance. 

So, how do you manage the emotional roller coaster that you find yourself?

One key task is to find ways to not only remind yourself of the value of your role, but to allow yourself to think about your own worries.  Some of these might take you to places that ordinarily you do not usually have to visit, but by allowing yourself to notice your own ‘not knowing’ you might be able to begin the journey back to what will help you to feel fully equipped, practically and psychologically, for what you are facing.

Speak up and seek reassurance that everything is being done to keep you safe in your job, and ask how your employers will respond when you need a helping hand to get you back to somewhere near your best.  At these times, being in a team and/or finding a colleague to talk to has never been more important – and the difficulties you are facing in relation to your children are very unlikely to be yours alone. 

​ For your children it will be important to talk about your work, perhaps in a bit more detail that you would normally, to let them know that everything possible is being thought about to keep you safe.  And importantly that you would not be sending them to school if you did not trust that they will be safe there too.

Being clear yourself about how the school is operating will help you to have confidence when talking to your child.  Check in with staff about how they are managing the children, and ask them to give you feedback if they have any worries about how your child is coping.

You may also need to give space to allow your child to talk about how upsetting it is to still be going to school when their friends are not.  Whilst they may be proud of your role, they may also resent the fact that this has an impact on them.  Talk about the breaks you plan to take (because your annual leave is still important) and how you and they can spend some different time together.

You will probably be completely worn out due to the mental and physical impact this crisis is having on your well being, so take time to find something relaxing that you can do to recharge your batteries, if only temporarily, but also find short bursts of time (ten to fifteen minutes) to sit with your child doing something that they want to do with you.  The usual rules apply; give them your full attention and that little bit of tlc that you both need.​ As far as you can, it helps if you can keep being  the mum or dad that they know, even though there is so much that is new and uncertain for everybody. 

Laverne Antrobus is a Consultant Child and Educational Psychologist at the Tavistock and Portman. Laverne talks about the challenges for key workers and family life, where children (and parents) may have all sorts of feelings about a situation where work might be felt to be an unsafe place, and where school has suddenly become  a very different place. She talks about the range of feelings that there might be for both parents and children, and has some ideas about how to help children to manage and how to look after yourself as a parent, and a key worker in this difficult and constantly changing situation.

Wellbeing Quiz Profile: #MoreFrantic

Hello, this is Jane O’Rourke. I’m a Child Adolescent and Family Psychotherapist, and yoga and meditation teacher. Today we’re going to do a relaxing, calming breathing exercise, so let’s start by taking a moment to find a comfortable resting position; could belong down or sitting in a chair – whatever feels most comfortable for you.

Let’s start with a few relaxing breaths, inhaling through the nose and out through the mouth, taking deep, relaxing in-breath and slow, relaxing out-breaths, and relaxing out and releasing any tensions of the day with each out-breath, just following your natural breathing pattern: breathing in and breathing out. Breathing out through the mouth helps relax all the tensions that might have built up through the day, almost like a releasing valve.

And now let’s begin our restful breathing pattern. To do this, we’ll be inhaling though the nose, and again, breathing out through the mouth.

So inhale through the nose for a count of 1, 2, 3, 4; holding the breath for 2, 3, 4, 5, 6, 7. Exhale through the mouth: 2, 3, 4, 5, 6, 7, 8.

Inhale through the nose: 2, 3, 4, hold for 2, 3, 4, 5, 6, 7. Exhaling for 3, 4, 5, 6, 7, 8.

Now on your own, inhaling for 4, holding the breath, and then exhaling. Now inhaling 1, 2, 3, 4, holding, now exhaling.

We’re about half way through.

Inhaling, holding, exhaling.

Inhaling, holding the breath, exhaling.

Inhaling, holding the breath, and exhaling.

The last time: inhaling, holding, and exhaling.

And now letting the breath return to its regular rhythm, not trying to change the breath in any way. Breathing in and out through the nose and allowing yourself just to completely relax here, and allowing any tensions in the body to just evaporate with each out breath, Allowing each in-breath to bring strength and courage, a new life; and every out-breath just to allow the tensions of the day that have built up to release and let go. Allow yourself to do nothing.

You can focus now on the breath, wherever it’s most prominent in the body. That may be at the tip of the nose or in the chest or in the belly, but still notice the rise and fall of each in-breath and each out-breath. And of course our minds might wander, so any time you notice your mind has wandered off, just bring it back to the focus of the breath, allowing the whole body to relax and the mind to relax as well. Allowing the mind to slow down.

You can stay here for as long as you like now, just resting, or allowing yourself to fall asleep.

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. Jane guides us through a 5 minute soothing sleep breathing exercise aimed at helping you to get some rest, or to get to sleep.

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.