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PPE for the Mind

PPE for the Mind (Psychological Perspectives on Experiences)



'PPE for the Mind' is a collaboration between Organisational Development, Occupational Health and Trust Psychologists.

 

 

Guilt

How often have you felt guilty since the latest lockdown started? Perhaps it was because you were off sick while others worked, or you snapped at your colleagues because you were exhausted, or maybe you felt relieved at not having to visit friends and family due to restrictions…?

The pandemic and lockdown has left us struggling with a lot of “shoulds” and not being able to do them or feeling happy that you can’t do them can trigger feelings of guilt. While guilt is a healthy emotion and shows we have a conscience, sometimes it can be unnecessary and even toxic.

Rather than trying to avoid these emotions or punish ourselves for having them, notice the feelings and acknowledge them. Think about your behaviour and ask yourself whether the guilt serves a sensible purpose of reminding us of when we have done true wrong or whether the guilt is more about putting others needs ahead of our own valid ones. If it is the latter, then practise some self compassion; these are extraordinary times and everybody deserves to cut themselves some slack. This link talks more about guilt and how to handle it.

 

What can I control or let go of?

In facing any kind of crisis fear and anxiety are normal and natural responses. For some of us, these feelings may have started to subside after the first lockdown, but many are noticing their resurgence with the second wave of coronavirus and again facing more restrictions on our lives. As the uncertainty continues, we can be left feeling powerless and unable to control what is happening for our patients, colleagues, families and ourselves.

Acknowledging the things that we have no power to change and letting them go can open up space to focus on the things we are able to do something about. For example, you might not be able to control the fact that a family can’t visit a loved one on the ward, but you probably can do something to support a patient in making a video call or connect in another way. You can’t control how tough this separation might be for everyone involved, but you can acknowledge and validate the difficult emotions that might be coming up for the patient, their family, and for you.

This short video is a reminder of the FACE COVID technique which can help in dealing with those feelings of powerlessness and uncertainty during the pandemic.

 

World Kindness Day
Kindness is defined as the ability to overcome self-interest and take on the interests of others. The source of the word ‘kind’ comes from the Celtic word ‘cynd’ (kin) meaning family or lineage. Michael West of the King’s Fund has a great way of describing what kindness looks like in our workplace; it is: Paying Attention, Listening with Fascination, Empathising (understanding without judging) and Being Helpful. It can sometimes be difficult to be kind, when under pressure or unaware of the whole situation, when working with people outside of our own team, professional group or a patient who has very different beliefs or background to our own; we might react negatively driven by our own needs in that moment. So remember, when it is a struggle try to Attend, Listen, Empathise and be Helpful.

 

Feeling Defensive?

We come to work with our own personal histories, shaped by our family, culture and context. These histories shape how we as individuals respond to all sorts of things, both in our personal and professional lives; how we relate to others, and particularly shape how we respond and react at times of increased stress. Patients on wards will often show signs of ‘regression’ - behaving in a more childlike way than they might otherwise do in less stressful times. Understanding this is crucial for our work with them, and their ability to feel understood at a time of significant anxiety. And so it is for us.

Maybe one colleague is pretending all is fine when it clearly isn’t, another is working so many hours that you are concerned, and another is calling others out for aggression that really is their own. These are all examples of what we might call ‘defence mechanisms’. Whilst difficult to manage, and likely a source of tension in our teams and organisation right now, understanding that the root of the behaviour may be anxiety is helpful. What coping mechanisms do you use, and what about your colleagues? Compassionate care always starts with an attempt to understand, ourselves, and then others. : https://psychcentral.com/lib/how-to-talk-to-someone-who-always-gets-defensive/

 

Coping with a ‘new normal’ that definitely isn’t normal

Change is always difficult, but the constant change associated with the coronavirus pandemic is impacting on our capacity to tolerate change. It was hard to get used to the initial lockdown measures when they came in. Then lockdown eased and we were required to get used to “the new normal” where services were expected to return to full capacity whilst at the same time working within a very rigid set of restrictions. Now amidst the developing second wave we are having to adapt again both with the knowledge that we survived the last round and the memories of quite how difficult it was to do so. Now more than ever it is important to look after ourselves and start to recognise the signs that we may not be coping as well as we might normally be. Signs include:

  • changes in sleeping patterns
  • changes in eating habits
  • changes in activity level or motivation
  • increase reliance on substances
  • negative thoughts
  • feelings of “survival mode”

So how do we continue within the “new normal” when things definitely are not normal, and what counts as normal keeps changing?

  • prioritize taking care of yourself
  • check in on your thoughts and try to recognise when we are becoming focused on what isn’t going well
  • recognise you are not alone
  • seek help from friends, family, colleagues, managers and occupational health

To read stories about coping (or not) with the ‘new normal’ on the BBC website, click here.

 

Fatigue & Exhaustion

The colder months inevitably bring the anticipation of an overworked hospital. On top of this we may also be feeling “covid fatigue”. Are you managing your energy levels or just slipping into “survival mode”? Be careful of avoiding fun/energetic events for fear of greater fatigue. Things like being out with friends and walking/exercise actually help to replenish our energy. Make sure you take your breaks at work (even if you still have work to do) and try a short ritual to separate the working and non-working day – take three deep breaths, list three things which were tough and then three things which went well. Finally, your sleep may be affected by current stresses, so remind yourself of good sleep hygiene. This link will take you to further information about managing fatigue and sleep more generally.

 

Heroism in the NHS

Many people have a view on the heightened profile of the NHS and the associated hand clapping that quickly became a social movement. The positive intent and sense of common purpose uniting the nation may have been felt in different ways by all of us. 

As we are discovering now through recent events, heroism has a shadow side. A hero can prove to be a disappointment when they don’t live up to expectation. For the hero it creates enormous pressure to live up to. Heroes don’t complain about the long hours, difficult working conditions or the discomfort of PPE. Putting someone on a pedestal can (also) be a way of abdicating responsibility ourselves. You may be feeling that pressure yourself, likewise have your own heroes you look up to. What we are actually? Compassionate professionals who show up to do our best. We must look after ourselves and each other, recognise we are not heroes but human, with all the complexity that brings at a time of heightened anxiety. In the words of Brené Brown, “You are enough”.

 

Resilience 

With winter coming and our general workload increasing it is very important to consider our own resilience, particularly due to the impact of COVID on our personal and work lives. Being emotionally resilient helps us to manage change and stressful situations, something which we experienced almost constantly during lockdown and so our resilience may have become depleted as a result of that. 

Resilience is not just our ability to bounce back, but also our capacity to adapt to challenging circumstances, our ability to shape our environment better and to perceive change in terms of challenge rather than threat, all whilst maintaining good mental wellbeing. So, when have you needed to be resilient over the last 6 months? When is your resilience good and when does it need extra help? Take a moment to consider if you have recharged your “resilience battery” ahead of the coming winter work pressures? 

Luckily for us all, resilience is something that we can improve for ourselves, so visit this link and take the first step towards that: https://www.mind.org.uk/information-support/types-of-mental-health-problems/stress/developing-resilience/ 

 

 

Team Dynamics

Over the last 6 months there are likely to have been changes not only in the physical make up, but also the emotional experience of teams. This is likely to be so whether you are thinking about the small team you are part of, your wider team/care group, or the Trust as a whole.  The covid outbreak mobilised some teams in ways that helped individuals to come together, be very task focussed and fight a ‘common enemy’.  This can be a powerful experience, helping us to forget previous team dynamics and tensions, at least for a moment in time. As the threat diminishes, there is likely a re-emergence of competition, rivalry, previous tensions, differences and avoidance.  Whether in your smaller team, or the wider Trust, this is a ‘normal’ part of group life. Who has become your ‘enemy’ now, are they located within or outside of your immediate team? Our challenge is to understand some of this phenomena in our own team or organisation in ways that can help us with our primary task.

 

Isolation and loneliness

Many of us over the last six months will have experienced periods of isolation in order to protect either ourselves or others through the pandemic. But what is isolation and how does that differ from loneliness? Isolation is defined as “removed from society”. It can be a physical isolation – stranded on an uninhabited island, or emotional isolation - an inability to connect with others.  In both cases how we respond to that experience of isolation may be positive or negative. We may appreciate being able to shut the rest of the world out for a while, or we may crave human contact especially when it is denied us.

Loneliness is when we feel disconnected from people immediately around us. It is the subjective gap between our desired level of social contact and the actual level. It is the perceived quality of our relationships with others.  There is huge variation culturally and in our character that determines how many intimate friends we have, or have capacity for.  According to Snapchat, Britons on average have 2.6 close friends in comparison to Saudi Arabia where the number is 6.6. Other research sets five as being the maximum number of close friends you can sustain.  Regardless of the research, loneliness is a problem in our society and impacts on our physical and mental wellbeing.

Whether you are the one feeling lonely, or you notice that others might be, please reach out and connect. Try not to assume that when someone disengages they are not interested.  It can take time to build trust and develop confidence to create connection and develop friendships,  but a genuine smile and inquiry, followed by your full attention and listening will go a long way to welcoming someone into your NHS family.

 

Adaptation
Adaptation - the process or state of adjusting or changing to become suited to an environment.

The reality is that we have adapted so well to this pandemic in such a short amount of time. We all pulled together for a common purpose. And as it moves from an acute stage into a chronic one we are still adapting. Despite times when you were frustrated or upset or even cried (all understandable and acceptable emotions), you have got used to changing your routines, learned to focus and concentrate while in a new environment, and modified your way of existing.

It is truly amazing, but also worth highlighting that adaptation is not always easy and this period continues to be very tough. Since the start of the pandemic there has been an in increase in the number of people reporting sleep disturbances, in the amount of alcohol consumed and in the number of people calling mental health helplines. So, in what areas have you unconsciously adapted to your new situation with ease and where have you struggled, or continue to struggle to adapt? Whilst we are resilient, we are also human and it is okay to not always get it right and to sometimes need some support and help.

 

Anger and COVID
There seems to be a lot more anger in the media since the easing of lockdown and perhaps you are feeling frustrated or irritated yourself.

The initial wave of fear that we felt in March seems to have been replaced with anger as a result of social isolation and great loss of life. However, anger can mask a lot of other emotions such as fear, grief and anxiety as it is a more powerful, and therefore, a "less helpless" emotion than those others.

In addition, our anger will be fuelled by stress - life has become just that little bit more challenging with changes to working practices and routines, endless queuing, loss of holidays and some recreational activities. It may also feel like there is "no end in sight”. For simple management of your irritability click here. 

 

Supporting parents supporting children returning to school

With children due to return to school, increased tension and anxiety not just for children but for parents and carers is to be expected. The following tips are for those who are providing support to children and young people returning to school:

  1. Remember that everyone is different. Try to focus on the specific needs of your child and what works for your family and not to compare your approach or progress to others.
  2. Don’t put pressure on yourself. The transition back into school is likely to take some time. Try not to put pressure on yourself to make sure homework is done or your child settles into a routine straightaway.
  3. Seek support if you need it. Reach out to your child’s school so that you can make them aware of the specific challenges and work together to support your child.
  4. Where possible model calmness. It is ok to be anxious! Try and model calm responses to anxiety and promote conversations about experiences of anxiety. 
  5. It is ok not to have all the answers. Tolerating uncertainty is likely to be uncomfortable but where possible be transparent about what you do and don’t know and try to focus on the things that you can control.

 

Burnout

Burnout has been identified as a significant problem for healthcare professionals. According to the World Health Organisation, Burnout is classified as occupational phenomenon resulting from chronic workplace stress that has not been successfully managed characterised by energy depletion and exhaustion, increased mental distance from or feelings of cynicism about one’s job and reduced professional efficacy, (World Health Organisation, 2019).

Athough Burnout refers to the occupation context, it is important to note that at the present time given the coronavirus outbreak, there are new daily challenges not only in the workplace but within our personal and social lives that are likely to impact on our ability to do our job, how we feel about our job and how we feel we are performing. Therefore, it is helpful to be mindful about the expectations we have of ourselves and our colleagues and try to be realistic about what we can achieve both individually and as a service.

For more information about the impact of burnout on healthcare workers please go to:

https://blogs.bmj.com/bmj/2020/05/04/covid-fatigue-is-taking-an-enormous-toll-on-healthcare-workers/

For more information about ways to combat burnout please go to:

https://vitals.lifehacker.com/how-to-avoid-burnout-in-the-middle-of-a-pandemic-1843322169

Burnout Leaflet

 

Circle of Concern and Circle of Influence

 

During the COVID pandemic how often have you caught yourself saying: “They should be more careful! People are so stupid! Look at them all at the beach – unbelievable!”.

Right now you may be worried and feel that it is all hopeless. This is when we are caught in our ‘Circle of Concern’, which creates anxiety and a sense of futility and we might just give up trying.  However, what if we focus on things we can control such as our own behaviours in maintaining a safe distance, or picking up the phone and asking for a catch up? We can then feel more energised and take others with us. Suddenly, we have a social movement. Think about the last time you made an important decision and acted on it. How did that feel? More information about Circle of Concern versus Circle of Influence.

You don’t have to be in crisis to benefit from psychologically informed support, and it may help you better understand yourself and others in the workplace. For more information, click visit the UHP support hub.


Change


Did you know that even change which is desired, such as getting your dream job, scores high on assessment scales for stress?

That’s because all change, even positive, reawakens fears about survival – even when our lives are not in any actual danger. From the birth of a new sibling to the death of a parent, change also triggers feelings and memories from our past that we may not even be conscious of. Some of these unconscious feelings are playing out now in our teams, as each of us responds to COVID in our unique way, related to our unique personal histories. This may be altering team dynamics in ways that can be hard to understand, for everyone and particularly for managers.

You don’t have to be in crisis to benefit from psychologically informed support, and it may help you better understand yourself and others in the workplace.

 

Imposter Syndrome


In the current climate there is lots of focus on key workers as heroes but that may not be our lived experience. As we adapt to new challenges, we may end up thinking ‘I can’t do this’ or ‘I’m not good enough’ as we cherry pick perceived role models and find ourselves wanting. It’s endemic in the NHS.

Imposter Syndrome summarises all of these emotions. The main issue is the fear of being “found out”; the impact is that it can drive long working hours, risk avoidance, defensive responses to feedback or complete avoidance of work that may stretch us. We cope by adopting positive strategies such as self-development and attention to detail, but unchecked can lead to “Burn Out”.

Respond by looking for the positives, be open to others opinions and perspectives and accept that is all they are. Read more about imposter syndrome.


Tiredness


While most of us are less active at present than in our usual daily lives, many have reported feeling strangely fatigued. Reasons you may be aware of include: Boredom and monotony, having children at home, juggling home schooling and working from home, or going to work in new and unfamiliar environments to name just a few.

Other reasons you may not be aware of include:

Being in an almost constant state of high alert - At present our brains are constantly alert to the danger of the virus and our bodies in a continual state of readiness to deal with the threat.

Poor quality sleep- Many people have reported being plagued by nightmares or intense dreams which are the brains way of processing what’s happening.

Having to adapt to new routines also impact on the level of fatigue we experience-which may be further exacerbated by the ever-changing government guidelines.

 

Responding to Disappointment

 

As we have been living through the pandemic, having hope about a more positive future is really important to us.  When we are disappointed it can take hold and be a distraction.  It can lead to long term cynicism and negativity i.e. “Perpetual Disappointment”  just think Eeyore from Winnie the Pooh.  Disappointment is a feeling “of sadness or displeasure caused by the nonfulfillment of one’s hopes or expectations,” says Google.  But according to Brenee Brown; “Joy comes to us in moments – ordinary moments.  We risk missing out on joy when we get too busy chasing down the extraordinary” . 

The following 4 steps describe how to manage disappointment: 

 

  1. Accept  and Acknowledge the situation – talk about your disappointment, it is real, and you have the right to feel the way you do. 
  2. Make a conscious choice about how you are going to respond to that disappointment – remember to be compassionate and kind both to yourself and others. 
  3. Review  and reframe your expectations to a realistic level, that’s not to dumb down your ambition but think what could be possible in this context?  E.g. recreating your version of holidaying abroad as a staycation.
  4.  Finally take a breath, think positively and let it go.   

 

Gambling Awareness

 

There has been much in the news about how the coronavirus pandemic has been "absolutely disastrous" for people suffering from gambling addiction. Boredom, sport cancellations and money freed-up from mortgage holidays could also be increasing the risk, including for recovering gamblers. If this is a situation you or a family member/friend or colleague are experiencing, you can find some helpful advice and sources of available here:

GambleAware: Support for Family and Friends (Aug20) 

GambleAware: Tools to help you stop gambling (Aug20) 

GambleAware: Help with Gambling Problems (2019) 

GambleAware: Dealing with Gambling Debt (2019) 

For further information please follw this link: https://www.thingscouldbeworse.org/dealing-with-disappointment/

 

A Psychological Perspective on Experiences (PPE for the Mind)
While most of us are less active at present than in our usual daily lives, many have reported feeling strangely fatigued. Reasons you may be aware of include: Boredom and monotony, having children at home, juggling home schooling and working from home, or going to work in new and unfamiliar environments to name just a few.

Other reasons you may not be aware of include:

Being in an almost constant state of high alert - At present our brains are constantly alert to the danger of the virus and our bodies in a continual state of readiness to deal with the threat.

Poor quality sleep- Many people have reported being plagued by nightmares or intense dreams which are the brains way of processing what’s happening.

Having to adapt to new routines also impact on the level of fatigue we experience-which may be further exacerbated by the ever-changing government guidelines.

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