The Pain Exchange

Mental Health Tips

SCROLL DOWN AND LOOK FOR TIPS ON MANAGING: 

  • COMING OUT OF LOCKDOWN
  • EMOTION
  • ANXIETY 
  • STRESS 
  • GRIEF 
  • DEPRESSION
  • WORRY

Managing your mental health as we come out of lockdown -


So we are 100 plus days in, and lockdown is finally easing……. This gradual easing brings with it the  longed-for joy of seeing friends, playing sports, resuming contact with family in ‘real space’, getting back to work and attending our places of worship  (even if only at a social distance).

For many of us, even the happy, these much anticipated changes can be difficult for our mental health, and for others the prospect of coming out of lockdown (while the debate surrounding the science, is still live) will be a real worry particularly for those more vulnerable to the virus and those  with mental health concerns.

Of course for those who are shielding, the easing of lockdown has been very minimal, and they have been advised to take extra care of themselves to minimise their risk of contracting the virus. For these groups in particular it might be difficult to see their lives returning to anything like ‘normal’ in the near future.


Managing the mental health challenges we are facing 

It is quite possible that the end of lockdown might be as hard for some of us as the start was.  It took us time to find ways of coping during lockdown, so we should also expect that it will take time to find our way back, and to reconnect with life…. different now in many ways than it was before. Managing your mental health by finding routines, staying connected, eating well, and taking exercise apply just as much now as they did at the start of lockdown – arguably even more so as we remain in a period of high stress but with more demands on us. 

We are all facing uncertainty and challenge – and we have no choice but to move through it as best we can, so it is really important to try not to judge ourselves harshly based on what other people are doing. We are all having our own unique experience as well as a shared wider experience. 


Fear and anxiety

Fear and anxiety are likely to be the most common emotional responses we have felt as we approach the release from lockdown. Finding a way to pull ourselves through lockdown will have taken a lot of emotional energy, and we may just be getting comfortable in a place that lets us cope, one we might not want to leave behind just yet. 

We may still fear becoming ill with the virus or passing infection on to loved ones, as the risk increases through new interactions. This is a very normal response - risk can be reduced by following the guidelines:  

Going back to something can feel strange or even scary, and we might feel nervous or anxious. Partly due to not having done it in a while, (like going back to work or school) and we’ve forgotten how it feels, or because things are different because of the pandemic and the routines have changed (like one-way systems and queues to enter shops). It’s important to acknowledge that these feelings are perfectly reasonable and normal, and to expect them. Only by building up tolerance gently can we move through these fears. 

The behaviour of others might leave us feeling angry, with the urge to rush to judgment or make comments on social media, reflecting our inner anxiety. Unfortunately there is little we can do to control others behaviours, and commenting online can lead quite quickly to unpleasantness and more anxiety.  Try instead to express your frustration quickly and privately with someone you trust, and then let it go. Holding onto things can lead to rumination – Going over and over and over things in our heads. 

The pandemic may have increased your anxiety, or made existing mental health issues worse, so it  could take longer to adjust to necessary new changes – such as one-way systems in shops, blocking off safe exit routes or wearing face masks, which could trigger trauma flashbacks, or panic attacks in some people because of the sensation of not being able to breathe.  

Take things at your own pace where you can, and try to challenge yourself to try something different each day or every couple of days. Don’t allow the seclusion that was necessary during lockdown to become deliberate isolation as lockdown ends.

For many people lockdown has been relatively quiet and isolated.  Coming back into shops, traffic, transport, and work might lead to sensory overload – feeling overwhelmed by sights, sounds or smells. Headphones may be a good way to reduce some of this by helping you to focus and creating a distraction with calls, music, podcasts or audiobooks. 


Coping strategies for fear and anxiety

  • Control what can be controlled – loss of control is often what leads to fear and anxiety. Therefore, creating an action plan to manage the things you find difficult can help reduce your anxiety as you take back some control.  
  • Pace yourself – we have a tendency to compare ourselves to others but it’s important to acknowledge that you need to go at the right pace for you! Don’t feel pressured by others into doing things you don’t want to – but also try not to let that be an excuse. It can be hard to let others move forward without you – maybe your child wants to see friends or needs to return to work, but you can’t. Discuss these concerns with those close to you, but also to allow other people space to move at their own pace.   
  • Build up tolerance – try doing something that challenges you every day, or every few days. Give yourself a break if it doesn’t go well but keep on trying. Keep a note of things you’ve achieved, enjoyed or surprised yourself doing so you can look back on your progress.  
  • Vary your routines – to see different people and encounter different situations try varying your routines. If one supermarket makes you nervous, try another. If a walk at one time of the day is very busy, try mixing walks at busy times with walks at quieter times. 
  • Talk to work – Many workplaces are allowing more flexible working even if people need to return. Speak to your manager if you are finding it hard to get to work, or do particular shifts or activities because of anxiety or fear. If you have had, or are currently struggling with your mental health, you could be entitled to reasonable adjustments as a disabled person under the Equality Act. Even if you haven’t disclosed before, if it feels safe to do so now you might be able to benefit from doing so.              


Coping with anxiety 

The ‘new normal’ – what does it actually mean? Our ‘normal’ is constantly changing, and uncertainty and managing risk is our new reality for the foreseeable future. This is uncomfortable and difficult for many of us.  With no clear answers yet, it’s impossible to predict what the course of the rest of the year will look like. ‘New normal’ for most of us will mean ‘what we need to get through today, or this week’. It might help to focus on the things we have learned and achieved in the last few months.  

Most of us have been tested in ways we never imagined, we may have found new ways to manage – or even flourish. Lockdown may have challenged your values and what is important to you. The life, values, and attitudes you had in early March might not be the ones you necessarily want to return to in July, and there may be opportunities for you to make positive changes in your life as well. 

  • Focus on today – you can only do your best with what you have today. There is still so much change around us as we all try to figure things out, so try to stay in the moment. Mindfulness exercises are one way of bringing your mind back to the present moment. 
  • Bring things that are certain back into focus – many things are still uncertain, but there are also things to be hopeful about and look forward to. Take notice of and appreciate good things as they happen, holding them in your awareness and make opportunities to reset and relax.                                                                                                        
  • Talk to people you trust – talking about how you feel is always important. Don’t dismiss your concerns or judge yourself too harshly and reality check your thoughts with somebody you trust.

 

Picking up social lives

Woohoo… we can start socializing again! – albeit with changes for the foreseeable future. Some of us may me desperate to do so – but others might be quite nervous about doing so, or even unable to do so because of their situations. 

If you are part of a social group doing an activity together, try and plan ways for people who aren’t ready for face to face meetings to still take part. 

We may have become very comfortable in our own space and with our own company over the few months, and it’s been intense in all sorts of ways. We might really have to push ourselves to reconnect with people and overcome initial awkwardness. It could be knowing how to insist on social distancing with friends or relatives, knowing where/when you have to wear your mask, or feeling strange not stopping to chat in the street. Many of us just want to get it right and are worried about slipping up and offending. It’s all new – and doing your best to follow the rules is good enough for most situations. 

The same applies to our children’s friendships – many children have been desperate to see friends, but all families are making sense of the changes as they happen and it’s important to make an extra effort to pick up friendships especially if schools aren’t back. 

People in a vulnerable group, who have been shielding are likely to feel more isolated as others start to emerge from lockdown and do the things we miss, and may feel less able to resist pressure to reduce lockdown measures. There may be a risk that employers, schools businesses and friends and family will be less able to relate to and support the lockdown releases for people in these groups. It takes considerable emotional energy to keep reminding people why you can’t participate or follow the same rules as a shielded person. Don’t forget that rules and guidelines vary depending on who you are and where you live. You can find more detailed tips on what you can do and what the current limitations here. 

Whether we have stayed working as a key worker, worked from home, been placed on furlough or lost our jobs during lockdown, our working lives have changed considerably in response to this pandemic. And as lockdown eases, things will continue to change, and many people will be looking for new work. 

Across the country people are being called back to work, even though the official advice is still to work from home wherever possible, so for many, coming out of lockdown is not a choice. Therefore  the prospect of returning carries with it a need to weigh up the potential safety risks to ourselves and family, alongside the need to earn money, restart the economy and/or provide service to others.  


Looking after children and family

For those of us who have had caring responsibilities, supporting our families through lockdown, returning to work may provide a much welcomed distance, but could also prove challenging emotionally when family closeness has become such a support during lockdown. 

Whilst schools have been closed, or only open part time for some pupils, parents have faced considerable pressure keeping up with school work up –  now many are under pressure from work to either return to the office, or to resume a level of productivity and engagement which doesn’t fit with their childcare responsibilities across the working week. Find information about returning to school here. 


Grief

Grief is something most of us will have experienced during the lockdown - whether it’s the loss of your independence, a job, or relationship. Many will also have faced the loss of someone close during these past months. This will have been especially difficult with attendance at funerals restricted.

Moving out of lockdown will allow us to see people again, and to provide support to those close to us who have been bereaved. At the moment however, this must be socially distanced and cannot involve a hug – unless you are a single parent with children aged under 18, or a person living alone, who has formed a ‘bubble’ with one other household. Here is some information on dealing with loss and bereavement.

 

Take care x


Practicing Emotional First Aid during Covid19 -



Emotional injuries can be just as debilitating as physical ones, yet they are not weighted nearly as seriously. While we may take the time to treat and attend to our physical wounds, we are often expected to just “get over” psychological wounds. All of us have at some point ruminated over a painful rejection or agonized over a failure.

With less distraction and more time on our hands, some of the psychological wounds that have not been attended to in our past may be resurfacing unexpectedly. How could we attend to them now? Is it time we learnt how to practice emotional first aid? In a recent Ted Talk, Psychologist Guy Winch talks about the ways in which we might do this:

Pay attention to emotional pain — recognize it when it happens and treat it before it becomes overwhelming.

Our bodies evolved the sensation of physical pain to alert us that something is wrong and we need to address it. The same is also true for emotional pain. If a rejection, failure or bad mood is not getting better, it means we’ve sustained a psychological wound which needs attention. Loneliness can be very damaging to both our psychological and physical health, and should be addressed when someone is feeling socially or emotionally isolated.


Redirect your gut reaction when you fail.

The nature of psychological wounds makes it easy for one thing to lead to another. Failure often drives us to focus on what we can’t do rather than focusing on what we can, making us less likely to perform at our best, which in turn makes us even more focused on our shortcomings, and before we know it we are in a negative spiral. To avoid getting sucked into this spiral, learn to ignore the post-failure “gut” reaction of feeling helpless and demoralized, and instead make a list of factors that you can control were you to try again. For instance, think about preparation and planning, and how you might improve each of them. This kind of exercise will reduce feelings of helplessness and improve your chances of future success.


Monitor and protect your self-esteem. When you feel like putting yourself down, take a moment to be compassionate to yourself.

Self-esteem is like an emotional immune system that buffers you from emotional pain and strengthens your emotional resilience. Therefore, it is important to monitor it and avoid putting yourself down, particularly when you are already hurting. Practicing self-compassion will “heal” a damaged self-esteem. Instead of being critical of yourself, imagine what you might say to a friend in the same position as you. How would you show them compassion and support?


When negative thoughts are taking over, disrupt them with positive distraction.

Ruminating over distressing events in your mind without seeking new insight or trying to solve a problem, especially when it becomes habitual, can lead to deeper psychological pain. Try instead to distract yourself by engaging in a task that requires concentration (do a Sudoku or complete a crossword). Studies show that even two minutes of distraction will reduce the urge to focus unhealthily on the negative.


Find meaning in loss.

Loss is an unavoidable part of life, which can scar us and keep us from moving forward if we don’t attend to the emotional wounds it creates. In order to move on from a loss it is important to find meaning in the loss and derive some sort of purpose from it. This might feel difficult to imagine at the time, but think of what you might have gained from the loss (for instance, “I lost my job, but I’ve found an even better one”). Consider how you might gain or help others gain a new appreciation for life, or imagine the changes you could make that will help you live a life more aligned with your values and purpose.


Don’t let excessive guilt linger.

Guilt can be useful in small doses, as it alerts you to amend your actions in your relationship with another person. Excessive guilt is toxic though, and wastes emotional and intellectual energies, distracting you from other tasks, and preventing you from moving forward. To resolve lingering guilt you need to offer an effective apology — which includes an “empathy statement.” It’s important for your apology to focus more on how your actions (or inactions) impacted the other person, than explaining why you did what you did. It is much easier to forgive someone when you feel they truly understand.


Learn what treatments for emotional wounds work for you.

Notice how you, personally, deal with common emotional wounds. Do you shrug them off, get really upset but recover quickly, get upset and recover slowly, or supress your feelings? Now consider how best to attend to yourself in these various situations. The same goes for building emotional resilience. Try out various techniques and figure out which are easiest for you to implement and which tend to be most effective for you. But mostly, get into the habit of taking note of your psychological health on a regular basis — and especially after a stressful, difficult, or emotionally painful situation.

Some of these concepts may feel quite strange to begin with, and integrating them might take a while before they become a habit, but in the long run practicing emotional first aid will seriously elevate your entire quality of life. 


Stay well,

Chantelle x


Anxiety during Covid-19


It is a time of uncertainty, confusion and frustration. No matter who you are, you’ll have been affected by our current climate. In recent weeks we have been plunged into uncertainty with constant news about the Coronavirus pandemic. The world we have always known ceases to exist as we are forced into isolation to prevent the spread of the disease. Already this is starting to take its toll on people's mental health, especially those already living with conditions like anxiety. The fear of being out of control and the inability to tolerate uncertainty are common characteristics of many anxiety disorders.


Understandably, we are all concerned about the news, but for many people it can make existing mental health problems worse. In a document published recently by the World Health Organization on protecting your mental health during the outbreak, the following recommendations were made: 

  

  • Avoid watching, reading or listening to news that could cause you to feel anxious or distressed.
  • Seek information mainly to take practical steps to prepare your plans and protect yourself and loved ones
  • Seek information updates at specific times during the day – only once or twice. The constant stream of news reports can cause anyone to feel worried.

 

Reading lots of news about the Coronavirus outbreak could  lead more severe sufferers of anxiety to have panic attacks. Having long periods away from news websites and social media can help with anxiety. Support helplines such as Anxiety UK can also be very helpful. 

So how can we protect our mental health?

 

Have breaks from social media 

  • Limit the amount of time you spend reading or watching things which aren't making you feel better. Perhaps decide on a specific time to check in with the news
  • There is a lot of misinformation swirling around - stay informed by sticking to trusted sources of information such as government and NHS websites

  •  Mute key words which might be triggering on Twitter and unfollow or mute accounts

  • Mute WhatsApp groups and hide Facebook posts and feeds if you find them too overwhelming

  • Watch TV (not the news!) or read books instead.


Stay connected with people

Despite the difficulties facing us currently, we have never been more well-equipped with ways to stay in touch while in quarantine. You can meet face to face with individuals or a group via Zoom, Skype, video calling/face-time and fun new platforms like Houseparty. Strike a balance between having a routine and making sure each day has some variety by agreeing regular check-in times, so you feel connected to the people around you.

Avoid burnout

With weeks and months of the coronavirus pandemic ahead, it is essential to make sure you take some down time. Mental health charity Mind recommends continuing to access nature and sunlight wherever possible. Take a holistic approach by doing exercise, eating well and getting enough sleep. Anxiety UK suggests practising the "Apple" technique to deal with anxiety and worries:

  •  Acknowledge: Notice and acknowledge the uncertainty as it comes to mind.

  • Pause: Don't react as you normally do. Don't react at all. Pause and breathe.

  • Pull back: Tell yourself this is just the worry talking, and this apparent need for certainty is not helpful and not necessary. It is only a thought or feeling. Don't believe everything you think. Thoughts are not statements or facts.

  • Let go: Let go of the thought or feeling. It will pass. You don't have to respond to them. You might imagine them floating away in a bubble or cloud.

  • Explore: Explore the present moment, because right now, in this moment, all is well. Notice your breathing and the sensations of your breathing. Notice the ground beneath you. Look around and notice what you see, what you hear, what you can touch, what you can smell. Right now. Then shift your focus of attention to something else - on what you need to do, on what you were doing before you noticed the worry, or do something else - mindfully with your full attention


     Adopt a growth mind set

    During times of fear and panic, when we are facing the unknown we can tend to get caught up in a fixed mind set, filling the void (unknown) with all the scenarios of things that could go wrong. And it’s easy to get stuck in this space too. Here are some ideas to help us gain momentum and move into a growth mind set:

    • Look for opportunities
    • Think about others and how you could be of help

    • Live NOW – create a clear picture of what you would like next
    • Ask yourself how you want this moment to be, your response is the one thing you can choose right now

    • Be appreciative

    • Be grateful

    And remember to breathe. One of the most effective ways of managing overwhelming feelings is to breathe. This might sound too simple to be true, but by slowing our breathing down, we activate another system in our body which acts as a brake, letting our body know the 'danger' has passed. 

    The summary of strategies outlined in the diagram below will help you manage your anxiety and the cycle of thoughts, behaviours, feelings and physical symptoms which arise as a by product.

                             Anxiety

    If you are still struggling you could consider online support - many counsellors and therapists have now adapted their practice for online work, so if you see a therapist that you think would be a good match for you, contact them to discuss your options. While it might feel different establishing a connection over the telephone or via online platforms, it remains an effective way of accessing support and getting the help you need right now.

    Remember this time will pass. Before too long we will be in a different space, having learned much about ourselves and the world around us. 

    Take care. Stay safe.

    Chantelle x


    Managing chronic stress during Covid-19 - a Polyvagal approach


    When the brain senses threat, it triggers the 'flight-or-fight' response. In recent weeks you may have experienced a racing heartbeat or tightness in your chest/stomach when you read/hear news about the coronavirus pandemic. This occurs as a function of our sympathetic nervous system. Conversely, our parasympathetic nervous system plays a role in calming our bodies. For example, running away from a snake and returning to safety will signal to our brain that the threat is gone, causing the stress response to come to an end. Once the threat is resolved, we can return to a state of calm.

    At the moment however, we are being exposed to a chronic stressor with no definitive ending — the coronavirus pandemic may go on for months? Without managing our nervous systems, we could suffer some health consequences in the longer run. Chronic stress results in raised levels of Adrenaline and Cortisol. Prolonged excess levels of these hormones can have a negative impact in the following ways:

    Adrenaline increases your heart rate, elevates your blood pressure and boosts energy supplies. Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain's use of glucose and increases the availability of substances that repair tissues.

    Cortisol also curbs functions that would be nonessential or detrimental in a fight-or-flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system and growth processes. This complex natural alarm system also communicates with the brain regions that control mood, motivation and fear.

    The long-term activation of this stress-response system and the overexposure to these stress hormones can disrupt your body's processes putting you at increased risk of many health problems, including:

    • Anxiety
    • Depression
    • Digestive problems
    •  Headaches
    • Heart disease
    • Sleep problems
    • Weight gain  
    • Memory and concentration impairment


    The vagus nerve

    The vagus nerve is a major nerve in the parasympathetic nervous system. Recent research suggests that we can tune into our nervous systems and find ways back to a “rest and digest” state amidst chronic stress. Psychiatrist Stephen Porges, author of The Polyvagal Theory, describes the parasympathetic nervous system as having two parts which result in two different responses: the dorsal vagal nerve network and the ventral vagal nerve network.

    Since we can’t resolve the current threat through fight-or-flight or establish to more or lesser degree, the connection to help calm us (also known as regulation), we may instead have ‘checked out’ physically and mentally. Our bodies have opted for a freeze response, also known as dissociation, and it’s the work of the dorsal vagal nerve network. When we’re dissociated, we may often feel powerless and hopeless, or even depressed. It’s as if our body has begun to decide it’s trapped!

    The ventral vagal nerve network becomes activated when we connect with another person, or when we respond to our body’s signs of stress, which triggers calmness - regulation. This is the part of our nervous system we need to stimulate when we’re stressed.

    For this reason, the ventral vagal network is also known as the social engagement system. It runs upward from the diaphragm area to the brain stem, crossing over nerves in the lungs, neck, throat, and eyes. Therefore, actions involving these parts of the body, such as deep breaths, gargling, humming, and even social cues like smiling or making eye contact with someone, will send messages to the brain that it’s okay to relax. Activating the ventral vagus nerve also activates the prefrontal cortex, the part of the brain that deals with logic. So calming yourself down allows you to think more clearly and process your difficult circumstances — which will further resolve your stress.

    Using this four-step plan can help you activate your ventral vagal network to limit the effects of stress and prevent dissociation. It should help you regain a sense of calm while the threat of our current circumstances are overwhelming you….. and hopefully beyond!

    Step 1: Tune into how your body feels

    The first step back to “rest and digest,” is paying attention to our body’s sensations. If we’re not aware of how our body feels when we’re stressed, we are likely to find it hard to know when we need to give our nervous system some rest and relaxation.

    Start by noticing your body’s baseline physical state when you’re calm so you can notice how stress changes your body. Maybe go for a walk, stretch your legs, or bend over and touch your toes, paying attention to what feels good and what doesn’t. Once you’ve worked out your body’s baseline, start noticing the small ways stress impacts you physically. For example, you may notice your shoulders tense slightly when you hear of the daily rates in deaths on the news. Take a moment to consciously relax them — this act of compassionate self-care will signal to your ventral vagus nerve that you are in a safe place.

    Step 2: Use your breath

    Mindful breathing — or paying focused attention to your breath, can be a powerful way to self-regulate, as deep breathing directly stimulates the ventral vagal system, since the vagus nerve passes through the vocal cords.

    Research shows that mindful, deep breathing from the diaphragm reduces cortisol, the stress hormone mentioned above. A recent 2017 study recorded people who participated in a guided breathing program as having lower cortisol levels in their saliva immediately after the exercise. The exhale is one of the most important aspects of mindful breathing. Exhaling longer than you inhale puts the ventral vagal network into action and promotes the ‘rest and digest’ response.

    Step 3: Connect with people

    Social connection with other people or ‘compassionate attention’ to ourselves, is one of the most important ways to activate the ventral vagal network. With current social distancing restrictions in place, we are unable to connect physically with friends and wider family, therefore it is especially important to FaceTime a loved one or have a meaningful conversation with someone you’re isolating with. Establishing a sense of safety and connection with someone, making eye contact even online, can cue your body to relax.

    If you become frustrated with blurry and broken online interactions, you could try visualizing someone you trust and imagine feelings of safety and connection. Or make yourself comfortable in a relaxing room in your house and hunker down for a bit.

    Step 4: Harness anxious thoughts

    The story we tell ourselves about our situation and its danger can dictate how our body responds, and the level of our chronic stress. Knowledge that our situation is not likely to change anytime soon, makes it that much more important that we change our perception of the threat by changing how we perceive it – reframing our situation.

    For instance, rather than thinking about social distancing as being stuck in your house indefinitely, think about being home as a way to contribute to public health, and an opportunity to slow down. Steering your thoughts in a more hopeful direction could cause the brain to send messages through the vagus nerve, triggering calm in all the organs and systems along the way.

    A way to do this is by using our five senses. For example: go outside, listen to the birds, smell a flower etc: - these are all simple “grounding” techniques which help activate the ventral vagus nerve.  If you are actually in a dangerous situation, like being abused, then you should try to get away. But if you’re safe in the present moment but your body feels like it’s threatened, grounding can calm perceived threats.

     Essentially all these strategies bring your body back to the present moment, which may feel safer to your nervous system than the potential scenarios of the future.

    When you’re paying attention to both your mind and body under stress, you should feel more relaxed and ultimately, more yourself. Perceiving everything as a threat will drain you of your resources. But paying attention to your emotional response will give you more energy and clarity to problem-solve effectively.

     

    Take care. Stay safe x


    Grief during Covid-19

    ‘’Grief happens upon you. It’s bigger than you…. In the moments of my life when                       I have fallen in love, I have just as little power over it as I do in grief. There are                  certain things that happen to you as a human being that you cannot control or                     command, that will come to you at really inconvenient time, and where you have 

    to bow in human humility to the fact that there’s something running through you                 that’s bigger than you.’’                                               

                                                                                                     -         Elizabeth Gilbert

     

    How are we feeling? If we can name it, perhaps we can manage it….

    A recent interview with David Kessler in the Harvard Business Review raised some                 interesting points about our current situation. Kessler along with Elizabeth Kubler-                Ross is the world’s foremost expert on grief. Recently he shared his thoughts on                       why it is so important to acknowledge the grief you may be feeling, how to manage it,                and how he believes we will find meaning in it. 

    Could this feeling be grief?

    Kessler suggests it is possible that we may in fact be feeling a number of different griefs. We might have lost a loved one, or not. But the world has changed, and though we might know this is temporary, it may not feel that way right now, and deep down we may also realize things will be different. Things will change and this is the point at which they changed. The loss of normalcy; choice; connection and the inevitable fear of economic toll is hitting us all at once like a tsunami, and we are grieving. Collectively. And we are not used to this kind of collective grief in the air.

    More than one kind of grief?

    In addition, we may also be feeling anticipatory grief. Anticipatory grief is that feeling we get about what the future holds when we’re uncertain. Most often it focusses on death or dying. It could present itself as a feeling when someone gets a dire diagnosis or when we have the normal thought that we’ll lose a parent someday, or could be more broadly imagined futures. This kind of grief is so confusing for people in the case of a virus, because our primitive mind knows something bad is happening, but we can’t actually see it, which erodes our sense of safety. So we’re feeling a loss of safety too. Feeling this loss of safety collectively is also new for us so we are grieving not only on a micro, but a macro level too – individually and as a group. We may even be stunned to find that during this time other losses or grief from the past is triggered again. 

    How can I manage this grief?

    First we need to understand the stages of grief, but it’s very important to remember that these stages are not linear and may not happen in this exact order but shift backwards and forwards between them. They provide some scaffolding rather than an exact map of how we grieve.

    • Denial:  which we say a lot of early on: This virus won’t affect us. 
    • Anger: You’re making me stay home and taking away my activities. 
    • Bargaining: Okay, if I social distance for two weeks everything will be better, right? 
    • Sadness: I don’t know when this will end. And finally there’s acceptance. 
    • Acceptance: This is happening; I have to figure out how to proceed.

    Acceptance is where the power lies, and it is in this acceptance we finally find control -  I can wash my hands. I can keep a safe distance. I can learn how to work virtually.

    How can we manage the physical pain and  a racing mind?

    Let us consider anticipatory grief again for a moment. Anxiety is the by-product of unhealthy anticipatory grief that is left unchecked. Our mind does not like not knowing so will begin filling in the gaps or voids and showing us possible, often the worst scenarios. We are likely to see the worst scenarios because our minds want to prepare and protect us. Our mind won’t let us ignore the scenarios or try to make them go away — they will keep returning to us. Therefore we need to acknowledge them and try to find balance in the things we’re thinking. When you start to feel the worst thoughts taking shape, try to replace them with better thoughts such as; We all get a little sick and the world continues; Not everyone I love dies; Maybe no one does because we’re all taking the right steps. Neither scenario should be ignored but neither should dominate either.

    Anticipatory grief is the mind propelling into the future and imagining the worst, often without us even realising it. To ground yourself, you need to come back into the present – a key principle followed in meditated or practiced mindfulness and a strategy for coping with a panic attacks. Try this technique: Name five things in the room, for example: a television, a sofa, the dog, a plant, an old lamp. Now pay attention to your breath. Realize that in the present moment, nothing you’ve anticipated has happened. In this moment, you’re okay. You have food. You are not sick. Use your senses and think about what they feel. The sofa is firm. Your dog is warm. Feel the breath coming into your nose. This really will work to dampen some of that pain and anxiety you may be feeling in the moment.

    Next, think about how to let go of what you can’t control. What a local shopper might be doing is out of your control, but you can control staying 2 metres away from them and washing your hands. Focus on what you can control.

    Now is the time for compassion…… a helping for everyone else and then a second generous helping for yourself! Everyone will have different levels of fear and grief which are likely to manifest in different ways, so try to be patient. 


    But it’s so open-ended….!

    This is the most troubling aspect of this pandemic, but it is a temporary state. And it helps to keep repeating it. The precautions we’re taking are the right ones. This is survivable. We will survive. This is a time to overprotect but not overreact.

    We can find meaning in all this, no matter how disastrous it may feel. Kessler has recently added a sixth stage to grief: Meaning. We often seek meaning in our darkest hours and it’s during these times we can also find the light. Perhaps it’s the new joy of going for a walk, a warm smile from someone  two metres ahead of you in the queue at Boots – a reminder that somehow we are all in this together. Maybe it is reconnecting with an old friend or family member we have fallen-out with, or getting to really know each other and ourselves for the first time, as a result of being ‘locked-in’.


    So what is left when you are still overwhelmed with grief?

    Just feel sad. It’s OK. Let yourself go for a bit to feel sad. Your work is to feel your sadness and fear and anger regardless of what those around you may be feeling (which is probably the same, even if they don’t show it). There is something powerful about naming this as grief. When you name it, you feel it and it moves through you. Emotions need motion. It’s important we acknowledge what we go through but you don’t need to go through it alone. If you feel you’d like help with this process you could also consider online support - many counsellors and therapists have adapted their practice for online work and reduced their rates, so are more accessible than ever before to support you in getting the help you need right now.

     

    Afraid to feel?

    It’s not unusual to hold the fear that if we let one feeling in we might soon become overrun by a deluge of feelings we can not control. The truth is that no feeling is permanent when we feel it and allow it to move through us. We will feel it and it may then go away for a while, or we may move to the next feeling. Grief often comes in waves, sometimes out of the blue. It is a process which gets easier and less intense as we allow it to pass through. 

    Remember this time will pass. Before too long we will be in a different space, having learned much about ourselves and the world around us. 

    Take care. Stay safe.


    Managing your depression during Covid19 - A sensorimotor approach


    So, we're six weeks in...  In a very short space of time the world we have always known has suddenly ceased to exist and life is very different. In the wake of all this we are facing isolation, joblessness, fear, and anxiety—a lot of us may already be exhibiting signs of depression, especially those with a history of depressive disorders. A lot of us will also be feeling sadness brought on by a grief from the various losses we may be experiencing.

     

    So what is the difference between sadness and depression? It is important to make this distinction as they are two separate states that are often confused. Sadness is a normal healthy emotion brought on by loss – it is transient and will come and go. Many of us may well be feeling this under the circumstances. Depression is a mental health condition, much more enduring, debilitating and oppressive. Dr Janina Fisher, clinical psychologist at the Trauma Center in Boston, and senior faculty member of the Sensorimotor Psychotherapy Institute suggests some simple Sensorimotor techniques below that can help if you are feeling depressed and alone.

     

    Lengthen your Spine

    This technique is deceptively simple — just lengthen your spine from the lower back up. With depression the heaviness of even just saying the words ‘I'm depressed’, tends to collapse the spine. Because depression is such a physical experience this technique can be very helpful. It is not difficult to do and can be effective in the moment as it doesn't require much effort if you are depressed and have no energy.

     

    Orienting                                                                                                                         
    This is a technique used to ground yourself during panic attacks. It’s done by visually noticing/naming things in your environment, or using your auditory sense if you are visually impaired. It’s helpful because when you look around and notice where you are, it usually regulates autonomic arousal and brings your nervous system up into window of tolerance.

    Dr Fisher suggests this useful tip:  “Just look very, very carefully around the whole room and one thing you like the least in the room. Then look around again very carefully and find the two things that you dislike the most?” 


    Verbal Techniques

    Orienting and lengthening the spine represent somatic (bodily) techniques. Using words is important too because they have such a strong impact on body experience. The impact of negative words, such as “I'm hopeless” may leave you feeling worse. It’s much more helpful to repeat the words, “I’m doing the best I can”, which is likely to make you to feel a little bit better.

     

    Movement

    If you are feeling very depressed - numb and passive with no energy or interest, try your best to get your body moving. Movement might seem harder in these days of isolation, but we can still do it, with more access to online exercise resources than ever before! Talking about COVID-19 generally increases anxiety. If you are feeling very anxious right now, try standing up and rocking from foot to foot. This can be very soothing and regulating.

     

    Dropping the Content

    Another very simple Sensorimotor technique for depressed or anxious people who tend to ruminate on negative thoughts or fears, which can exacerbate self-loathing and a sense of unworthiness is to notice it out loud, “There is that thought again, that __________,” ask yourself, “When I have that thought, do I feel better or worse?” If the answer is worse, then you could try this exercise:

     

    Hold out your hand, palm up, then imagine someone putting a burning hot potato onto the palm of your hand. . . . What is your hand going to do? Every time you have one of those toxic thoughts, drop it immediately—just like a hot potato.

    NOTE: During this time of isolation and crisis, we will have frequent negative thoughts and predictions. That is fairly normal in this situation but can also add to the stress involved in dealing with the crisis. I’m not suggesting that it’s abnormal to feel anxiety and depression in a state of emergency, but as normal as it is to have such thoughts, they are toxic for you, so work on putting them aside because that will support your mental health and your immune system.


    Playfulness

    It might seem counterintuitive during these serious times, but try to have some fun. It can be the best medicine in the world!!

     

    When is it time to seek help for depression?

    If you have been struggling with severe depression which you cannot shift, it is really important to get some professional help. Contact your GP as soon as possible, particularly if you are having suicidal thoughts. If you are not at immediate risk you could consider online support. The Health Hub is an online resource for people in isolation, so you are able to access the support and get the help you need right now.

    Take care. Stay safe 

    Chantelle x


    Managing your worrying during Covid-19

    We have no control over many of the things that happen in our life. Never before has this been more true……

    A resistance to this fact may induce in us controlling behaviours such as micromanaging -  a refusal to delegate tasks, and trying to force other people to change. We might be holding the idea that if we gain enough control over other people or situations, then we might just be able to prevent bad things from happening. In certain cases this might actually be true although it probably has more to do with being prepared than holding control per se.

    Or, it might be that we are indeed accepting of this fact, but worry incessantly anyway, fretting about everything from natural disasters to deadly diseases. Being tied up in theses worries is ultimately a waste of our time and energy since worrying can’t change the outcome in any way.

    Consider these six points instead, as they might help you to re-frame your problems and reduce your worrying:

    1. What is within your control?

    Examine what you do have control over next time you find yourself worrying. You can't prevent a pandemic, but you can prepare for it in certain ways. You can't control the impact of the pandemic, but you can control how you react to it.

    Recognize that, often, all you can control is your effort and your attitude. Diverting your energy into the things you can control will give you some agency (personal power) and make you far more effective.


    2. Focus on your influence

    Having influence requires us to change our own behaviour by being good role models and setting healthy boundaries for ourselves. Thus, we may be able to influence people and circumstances, but can't force things to go our way. You might be observing social distancing rules, but that does not necessarily mean everybody else will.


    3. Identify your fears

    What are you afraid might happen? What catastrophic outcome are you predicting? Do you doubt you will be able to cope? Sometimes we are so busy thinking things like "I can't allow my business to fail" that we don't take the time to consider, "What would I do if my business did fail?" It can be very helpful drilling right down to the worst-case scenario and acknowledging that you will be ok, despite it being very difficult. It can help you put your energy into more productive exercises like getting yourself prepared.

    More often than not, the worst-case scenario isn't as catastrophic as you might envision and there's a good chance you're stronger than you think!!

     

    4. Differentiate between ruminating and problem-solving

    Replaying conversations in our head, or imagining catastrophic outcomes over and over again isn't helpful. But solving a problem is. Consider whether your thinking is productive - are you actively solving a problem, trying to find ways to increase your chances of success? Keep working on solutions. However, if you're ruminating, try to switch channels in your brain. Acknowledge that your thoughts aren't being helpful at the moment, and get up to go and do something else for a bit, focussing your brain on something more productive.


    5. Make a plan to manage stress

    Managing our stress is super important as it allows us to operate more efficiently. Exercising, eating well, and getting plenty of sleep are essential to managing our stress. Some other healthy stress relievers may include meditation/prayer, an engaging hobby, or time with friends. 

    Be mindful of stress levels in your body, and notice how you cope with distress. Try to avoid unhealthy coping strategies like complaining to others or drinking too much – these will only cause you more stress in the long run!

     

    6. Develop healthy affirmations

    You might be thinking: what an old cliché!...... but the words we use have an enormous impact on us unconsciously, so pay attention to what you tell yourself and use positive words that instil a sense of capability, such as: ‘I am enough’, ‘I am OK’, ‘I will cope’. A few healthy mantras will keep you mentally strong, combatting self-doubt, catastrophic predictions, and endless rumination. Do what you can to make it happen or deal with the things you have no control over.

     

    So you’ve tried these techniques and find you’ve been able to manage your worrying during the day…. Bravo! You lie yourself down in bed and as you sink your weary head into your soft pillow, and there it is! Sound familiar? Worrying has a way of sneaking up on us just as we are trying to go to sleep. If you find yourself in this position you could try some breathing exercises to help relax you, diverting your thoughts to your breathing and away from your problems. Alternatively there are some great apps like Headspace and Calm to help you practice some mindfulness.


    And finally, talking (not complaining) to someone can help reduce your worrying. Getting another perspective, whether it’s over a cup of coffee with a friend you trust, or some counselling if your problem is more serious, can be very helpful and grounding, allowing you to find solutions instead of just worrying.


    Stay safe,

    Chantelle x