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This week I am talking about caring for a loved one or friend during a crisis, in this instance the triggering event is COVID, however, the practical activities I will outline below will support you in any crisis.
As I was thinking about this post, it seemed to break down into three natural phases for me. The first phase was when the pandemic was identified, and we went into lockdown. Obviously, it was disappointing initially to see people’s reactions, such as panic buying and the impact on people who were at the time, and still are, at the forefront of protecting us, keyworkers, particularly healthcare professionals. It was horrible watching the video of the nurse who was finishing a shift and couldn’t buy the basic items she needed and sat in her car crying. This was such a visual example of how, as humans, we need to have our ‘basic needs’ met before we fully function on other levels and is reflected in Maslow’s ‘Hierarchy of Needs’. The first level, which relates to our physiological needs, such as food, drink, shelter, warmth, clothing, sleep. The second level which covers our safety needs, such as the need for security and safety and for things to be in order.
So, particularly in relation to Maslow’s second need, as humans we need to experience things that are predictable and controlled in our lives, such as going to school or work, knowing that healthcare provision is available and certainly, in those initial weeks and months, these things were suddenly gone and that created a lot of fear for people. However, as unpaid carers, not only did this dismantling of our societies as we knew them create fear for us, it also created fear for the wellbeing and safety for those we care for. I will share a personal example of how this unprecedented situation completely changed how I would normally react to challenging situations. So, firstly I am not an overly emotional person and I have spent most of my career dealing with difficult and highly stressful situations, so would consider myself as someone who doesn’t easily become upset or distressed in challenging situations. However, at the beginning of crisis, before lockdown, Iike a lot of people, I couldn’t get toilet roll for a couple of days and this one particular day, I visited five different supermarkets, one after the other and eventually I managed to get a pack of four toilet rolls. At the time our local pharmacy was having problems getting the medication for my loved one, but after going to all these different shops, on the off chance they had had come in, I decided to try the pharmacist again on the way home. Fortunately, they had her medication, which was such a relief, so I collected those and returned to my car…then just burst into tears. It really took me by surprise, crying or expressing such overt emotions is not something I ‘do’. However, in hindsight, I think it was just such an intense couple of days, that the relief of getting the basic essentials I needed to keep us both safe, was just a complete emotional overload. Without noticing the anger, frustration, relief, guilt, which are often present as a carer anyway, build up so quickly and to such a level, that when I managed essential items we needed, the relief was overwhelming.
However, what I did next surprised me even more! When I got back home, without even thinking about what I was doing, I shared this event on social media, and was overwhelmed, for the second time in a day, by the response and support from people, some whom I have known for many years, but others I’ve only met more recently. Some people who commented on the LinkedIn post, I am not even connected with, but they really understood that sense of overwhelm and were really supportive, which was really touching and I’m very grateful for their kindness and support. Since that day, the kindness of others has continued, with friends checking in with us, making sure that we were okay. But by now, with the initial sense of overwhelm has subsided, actually, to begin with, I reverted back to how I would ‘normally’ deal with highly charged situations and I didn’t feel comfortable with people attention and kindness. I am not somebody who accepts help very easily; I am very independent; trying to do everything myself and to be perfect, so the thoughts racing around my head were; do I deserve this? can we accept it? So, that was an interesting time for me and something I thought about a lot quite about since.
Hopefully we are now emerging from the worst of it, with most parts of the UK coming out of heavy lockdown and our lives returning to some level of stability. But what about those feelings from the initial phase?
Are they still there?
Have you dealt with them or even thought about them, put them into context perhaps, being able to move on?
Is there a new normal for you?
For me, there hasn’t really been such a shift from the life I had prior to lockdown. Due to my loved one’s care needs, I really wasn’t able to go out that much, so the tight restrictions had a limited emotional and psychological impact on me. However, it did make me think about my priorities and although very few personal things changed, I did reflect and alter the plans I had previously made for my business and the social enterprise I wanted to start, which is this, ‘A Carer’s Heart’. Originally, the intention was to concentrate on starting and developing my online membership, to start generating an income and then start ‘A Carer’s Heart’ later in the year. However, when I thought about all the feelings I had experienced on that strange day before lockdown, when the overwhelming emotions seemed just too much, even if only for a few moments, it felt right to start to try and help other carers, who might also be experiencing new and perhaps overpowering emotions now. So, without really knowing what I was doing, I launched ‘A Carer’s Heart’ podcast at the beginning of June 2020 and have rescheduled launching my business membership until early 2021.
We are living in a changed world, because COVID or at least the risk of it, isn’t going to go away anytime soon and we are not likely to wake up one morning and COVID will just be a horrible, distant memory. However, history can provide some hope for the future, albeit, in the longer term. Globally, although not the same as COVID, humanity has survived many other highly dangerous diseases over the centuries, such as, Cholera, TB, Polio, etc. Where they haven’t been completely eradicated, the risk they pose is managed by vaccines and continuing research and development. So, the world moving forward is going to be one where COVID may always exist, but hopefully, scientists who are working on a vaccine to allow us to return to some level of ‘normality’, will soon be successful, however, realistically life is probably never going to be quite the same again.
So, as an individual and a carer, how are you negotiating a safe way forward for yourself?
Have you thought about what it is that has changed for you?
Or indeed, has anything changed?
Do you have new goals or dreams?
Do you now want a different future now?
Or are you now more resolved than ever to grow in the life you have?
In terms of looking to the future as a carers, in the 2020 Carers Week Research Report, it was found that 6% of new carers are also students, that’s 270,000 people, which includes me! That is a lot of people, juggling caring while learning a new skill or refreshing an old one, is that perhaps something that you’re considering doing now? During lockdown there has been a significant increase in the number of people providing unpaid care for a loved one. The Carers Week Research Report also found that 9% of the general public said they’re providing unpaid care, where they weren’t before COVID, that’s about 1 in 10 adults and equates to approximately 4.5 million people in the UK alone.
So, how can you reduce or mitigate the additional emotional and psychological stress, events such as the pandemic, have on your physical and mental wellbeing?
To try and support you, I have out outlined five practical actions and activities which work best when facing new or overwhelming events. The topics are:
1.Introduction to recognising and managing emotions, particularly relating to what you can and can’t control, which will help you to develop psychological flexibility;
2. Discussing the healthy consumption of facts and managing emotional responses to fake and alarmist news;
3.Understanding the differences between the self-care and self-compassion and why they are both important;
4. Quickly being able to be present, to better respond to overwhelming or emerging situations;
5. How regularly practising gratitude can help to balance negative environmental bias.
So, let’s get started!
1. Developing psychological flexibility: When starting to think and understand how you manage situations that you can control and those you can’t, having a good source of information such as Stephen Covey’s “The 7 Habits of effective people: Powerful lessons in personal change” is a good place to start. He talks about the things that make us uniquely human, self-awareness, imagination, a conscience or values and independent will. In terms of what we’re going through at the moment, one of the interesting thing he speaks about is how we react to events or situations. We can either respond to things ‘reactively’ and this is often affected by social and external environments; building emotional lives around other people; allowing other people to control us; blaming others when things go wrong; feeling like being a victim and having no control over things, like over the weather or even the Government’s response to COVID. Covey states that the other side of reactive thinking, is when we think ‘proactively’, when the choices that we make are driven by values; our actions are thought-out, and we take responsibility for those actions. We have differing amounts of control over any given situation, but we have total control over how we respond to it. We will be discussing values in more detail in a future episode, however for now, I want to concentrate on how thinking differently and how changing how you view situations and your responses, can really change the outcomes that you achieve.
One of the most important parts of this is proactive process is ‘personal responsibility’. You might say, “well it wasn’t my fault, it was somebody else’s action, they did it, not me” for example, you parked your car, someone crashed into it, didn’t leave a note and there’s quite a lot of damage. This actually happened to me at a family member’s wake, so you can probably imagine how distressing that was and, yes, my initial reaction was anger, blaming who had ever done it. Then I took a deep breath, put the situation into context, where I was and what was happening right now and realised that carrying around that anger wasn’t going to change anything and would just upset my family, on an already sad day.
A useful exercise to help demonstrate the difference between the two styles of responses, is to think about something that’s happened to you in the past, perhaps something you owned was damaged or something had gone wrong and you didn’t have had any control over any part of it? Then recall and recognise the choices that you made in how you respond to that situation: was it negatively, reactively, blaming other people, not taking responsibility for how you dealt with it? Or did you respond proactively, acknowledging your emotions and feelings in that moment and then thinking about how you dealt with it. The power is in recognising the emotions and feelings for what they are; letting them sit there; not assigning any meaning to them; letting them drift away and then taking positive action to move forward. By acknowledging those emotions and thoughts and identifying and labelling them as they are, takes away some of the impacts that they can have. They are NOT who you are, they do not define you, they are simply a psychological response to an event. When you have thought about a couple of situations and how you responded to them, either reactively or proactively, think about the different ways you can respond to future incidents, with positive steps and releasing the baggage of the negative emotions, thoughts and feeling. Practice responding proactively the next time something negative event happens, then keep practicing until it becomes a learned response and gradually you will build your psychological flexibility.
The second activity is ‘No news is good news’; the healthy consumption of facts and managing emotional responses to fake and alarmist news. When the Spanish flu struck 1918, information and particularly misinformation, wasn’t as quickly and easily conveyed as it is now. In the 21st century we consume information through a variety of mediums, not just news channels and social media. So, the quantity of the information that we consume can be overwhelming, as can the negative emotional and psychological effects, as well as the quality of the information potentially having devastating effects. A recent academic research study concluded that the initial underplaying of the seriousness of the pandemic on a widely viewed US cable news channel, might have influenced people’s reactions to the pandemic early on and it could potentially have led to an increase in the number of cases. It is worth remembering that all research is just that, research, and has to be taken into context. However, it is a powerful reminder about the influence of what we read, and watch can have on our actions, including our emotional and psychological responses and the consequences of the actions we take, or do not take. A considerable amount of the news we have been exposed to over the last couple of months has focused on things like dangers to health care professionals, the number of people who have lost their lives to COVID and the intense pressure on everyone’s daily lives. This can have an adverse effect, particularly if you are someone who is suffering yourself or you know somebody who has been directly affected by these events. Another study reflected that it takes just 14 minutes of consuming negatively biased news to increase anxiety and sadness and can also increase the tendency to catastrophise if a person is already worrying or concerned about something.
So, what can you do?
Perhaps not to watch the news! However, that is just not practical, as it is important to stay informed about what is going on in the world, particularly at the moment. However, one practical step is to choose a reliable source and control the amount of information that you consume. Generally speaking, social media is not a reliable source of information, as tantalizing and interesting is it might seem sometimes and it may seem real, however, before you take something that you see or you read as being the truth, fact check it with an alternative, reliable source of information first. It is also recommended not to consume news after 5 or 6 o’clock in the evening. Quite often the evening news is just repeating what has been broadcast during the day anyway and watching it later in the evening, will mean it will potentially stay on your mind, particularly, if you’re very tired or if it’s a distressing story and you might dwell on it as you’re going to sleep. Also, if you’re alone most of the time or you don’t have anyone to discuss the things that you see or hear with, reach out to friends, a trusted source, family member or support group and talk through the concerns and worries that you have. If, however, you feel highly distressed about something that you have seen or heard, there are a wide variety of mental health support organisations available online or through mobile apps. Alternatively consider reaching out to a professional, perhaps your doctor or somebody that you know is in that profession that may be able to refer you to professional support. In the blog notes, I have provided links for mental health lines in the US, the UK and Australia.
The third topic is understanding the difference between self-care and self-compassion and being able to utilise them both when you need them. So, what is self-care? ‘It is an activity that we do deliberately in order to take care of our mental emotion and physical health’. Activities such as eating a balanced, healthy diet; getting enough sleep; getting enough exercise; maintaining physical and psychological health; making space for relaxing; sharing time with friends and family and being kind to yourself and, of course, others. Start by exploring what works best for you and then try and build a routine and stick to it as much as you can. If you try something because somebody says “… you really should be doing this” but it just doesn’t work for you or feel right, don’t do it. But don’t just give up. Think about an activity you have enjoyed in the past or would like to learn; something that you know will fit in with your life as a carer and what is affordable.
So, next what is self-compassion then? This is often confused with self-care, however, self-compassion is quite different and is “showing the same warmth care and compassion to yourself as you would to someone else” (Neff), such as to those who you love and care for. Self-compassion helps us to get through a situation, such as the pandemic, which is important, because there is no way of getting around it! It’s a way to relate to our own struggles in a way that helps us. These can be very small actions that we think about and make small changes; it is important not to judge yourself; not to fall into the drama of something and catastrophise it and it is about having awareness of yourself in the moment. Acknowledging that something is hard and perhaps at times, overwhelming but it’s not just you. Recognising it is a shared experience will help you to draw strength from what is a very difficult event.
There are three main elements to self-compassion and all three need to be present for it to be a useful and stable mindset.
Mindfulness: Firstly, to start to develop a self-compassion routine, you need to be aware that you are struggling but in a balanced way, not getting wrapped up in the emotions. The second element is to cultivate a sense of common humanity. Events such as the pandemic happen and will continue to happen, different ways, throughout most of your lifetime. The power comes from accepting that life can be cruel and unfair sometimes and empowering each other to work through the difficult times. So, the last element of self-compassion is kindness, which is a motivation. Scholars define compassion as ‘the kindnesses and motivation to alleviate suffering’. Self-compassion is a desire to alleviate your own suffering, paradoxically to be able to do that you have to acknowledge that you are actually suffering and be motivated to want to help yourself; accepting that the event happening and how you can look to the future to heal and to grow.
A great question to ask yourself is: What can I do differently to make this situation better for me, so I can also help others? Kristine Neff is the lead researcher into self-compassion and in her mindful self-compassion programme, she has developed three short exercises to help you to develop a self-compassion mindset. I have placed all three of them in the notes at the end of this post, both verbal and written exercises versions, with links to Kristine’s website as well. However, it is useful to explore one of them now. This exercise is called ‘How would you treat a friend exercise’. It is a simple exercise to follow and it is a great starting point for identifying how you would treat others versus how you would treat yourself in a challenging situation. You will need a pen and paper, or you can record in your phone or device, just have an open and honest mind. Firstly, think back to a time when a friend or a loved one has been struggling in some way, then ask yourself:
How would you respond to that?
What would you say to them?
How would you say it?
What questions would you ask them?”
Then write out (record) what the best version of you would do in that situation in supporting your friend. Now think about a time when you have struggled with a similar situation or think of yourself in that situation; write down (record) what your immediate thoughts and feelings are about yourself in that situation:
How do you talk to yourself?
What words, language and tone do you use to describe yourself in that situation?
Lastly, compare the two parts of the exercise and consider any differences between how you would react if it was a friend and how if you react if it was you:
Do you notice any differences? if so, what are they?
What fears are being played out in how you treat yourself compared to how you would treat your friend?
Why do you think that is?
On a fresh piece of paper or recording, write down HOW you would like to be treated.
What words, gestures and behaviours do you feel a more accepting and supportive of their self when you were feeling difficulties?
Use the information you have gathered from the above exercise, to think about how you can treat yourself more like you would or friend in a difficult situation and the next time something challenging arises, put into practice what you have learned. The other two of Kristine’s exercises are called ‘Identifying what you want to exercise’ and the ‘The Criticiser, The Criticised, and the Compassionate Observer exercise’.
The fourth activity area is to learn to quickly be present in your life and to better respond to overwhelm in a difficult, emerging situation. Jon Kabat-Zinn is the lead in developing the mindfulness-based stress reduction programme and his definition of mindfulness is “paying attention in a particular way, on purpose, in the present moment and non-judgmentally”. Although I am not discussing mindfulness-based stress reduction today, the last part of that definition is really important in exploring how mindfulness can help in difficult situations and how it can help you to move forward. But why is that important? Personally, there have been months, even years when I haven’t been present in my own life and there are big chunks of it that I can’t even remember and I don’t think I am alone in experiencing this!
As powerful as being mindful or present in your life is, you can’t be present all the time, your brain would fill up with way too much information and cease to function efficiently. So, it is helpful to understand the difference between modes of thinking. Professor Daniel Kahnemann, developed what he calls, ‘System 1 and System 2’ thinking. The best way to describe System 1 is like when you are driving your car; you drive to work, to school or the shops every single day…you know the route, you know the problem area and you do it seamlessly, get to your destination without any recollection of the journey itself; that is not being mindful or present. However, System 2 is when you are taking the same journey, day in, day out, and then one day someone suddenly pulled out in front of you, NOW you are suddenly aware that they are there, you have butterflies in your stomach, your heart’s pounding, and you are shouting at the driving as loudly as you can! That is System 2, because now you are very present in THAT moment; you are aware of everything around you, noises, smells etc. and this is what I am referring to when I talk about being present in your life.
So, how does that help? Being deliberately conscious or present, being aware of your environment and what is going on is very important when you need to make critical decision, very quickly. By having the ability to be present in your life ‘on demand’, means you can take those decisions in a considered way and make better-informed choices. Combining that with a mindful breath, which I will cover in the next section, provides even more benefits. Deep breathing triggers the Parasympathetic Nervous System (PNS), which is the opposite of the freeze, flight or fight system. Being able to ‘tap’ into the PNS response system, can reduce stress and anxiety and give you that extra time to be focused, think more clearly and make an informed decision, rather than having a ‘knee-jerk’ reaction.
I will be covering the broader benefits of mindful breathing in a future episode, however, a quick technique is to use ‘one mindful breath’ when you are facing a distressing or overwhelming situation. I use it regularly and it helps me to take back control when I can feel my mind starting to get fuzzy and I can’t think straight. There are various different ways of performing the ‘one-mindful breath’ technique, but the one I particularly like is called ‘7-11 breathing’. For this technique you are breathing in through your nose for the count of 7, holding that breath for 1 second and then breathing out through your mouth for 11 seconds, really pushing deep when you get to those last few seconds and then just breathing in normally. Breathing out for 11 seconds might seem like quite a long time but what you are doing is getting rid of all the stale air that sits around in your lungs and doesn’t really get changed or used. As you are going to be taking in quite a lot of extra air into your lungs, particularly the first couple of time you practice this technique, it can make you slightly lightheaded. So, do not ever do this while you are driving or carrying out any activity that requires your absolute attention and ability to responded. If an event suddenly occurs, then as soon as you can do so safely, stop, sit in a safe environment and complete the one-mindful breath technique above. If you feel like you need to do another one, that is fine but usually one is enough to ground you, and give you precious time to think about what you need to do next.
The last activity is how regularly practising gratitude can provide a balance to negative environmental bias, such as events mentioned earlier; negative or fake news. It might seem like a strange thing to add to this list, and you might well be thinking, “what have I got to be grateful for at the moment?” However, there are numerous studies that have found that feelings of gratitude can actually change the state of your brain. It can also be a tool for overcoming depression and anxiety and there are also research studies that found that gratitude can send signals to your heart in a positive way. There are several studies about the benefits of gratitude writing, these often involve letter writing exercises, which you may have come across before and I will put links to a couple of gratitude exercises, including one for gratitude writing. The gratitude exercise I am going to explore with you today is ‘Three Good Things’ or ‘Three Grateful Things’. I have added a link to a short video from ‘Action for Happiness’, where Martin Seligman, who is one of the founders of positive psychology, explains the exercise well and I will also write it out and post it below.
Personally, I have carried out this exercise, each night, for several years now, and it often helps me to relax and get to sleep more quickly. However, it is important to remember that you don’t have to thankful for the things that you are showing gratitude for. They might be events or interactions that, although might feel negative, they might be things that you can really learn from and will be benefit you in the future. By showing gratitude for them, you are assimilating the learning from them and making a positive connection with that learning for the future. This exercise, or anything similar, doesn’t have to be done at night, this is just the best time for me, you can practice it at any time that feels right for you. The most important thing is to try it for long enough and on a regular basis to really give it a go, so it becomes a habit and is a meaningful part of your day. Even better, if you can practice your gratitude exercise while you are being mindfulness as well, it can help you to explore what is happening right now or what has happened during your day and can help to put things into perspective.
So, that is the conclusion of the five practical activities and exercise to help you when faced with a crisis or overwhelming situation. All the exercises I have mentioned will be in the ‘resources’ section below and if you would like any more information please email at firstname.lastname@example.org Also, I will be expanding on these activities and developing a short course in the future, with lots more information and exercises to help us get it through which is a difficult time at the moment. If you would like to be notified when that is available, again please drop me an email at the above address.
So, next week’s post is “a goal without a plan is just a wish”. Having a personal or professional goal as a carer can seem disloyal to your loved one or just plain unrealistic with the time constraints that you have. However, having a clear focus on achieving things, anything personal or professional, either now or in the future, can be empowering and can make the transition between the different phases of the caring journey, feel less stressful and emotional.
Well thank you again so much for reading this first blog post, I hope you found it interesting and useful and remember what a special thing it is that you do.
References and resources
Maslow’s Hierarchy of Needs
Carers Week 2020 Research Report
Stephen Covey – 7 Habits of Highly Effective People – (Affiliate Link)
Franklin Covey – The 7 Habits
Bursztyn, Leonardo and Rao, Aakaash and Roth, Christopher and Yanagizawa-Drott, David, Misinformation During a Pandemic (April 19, 2020). The University of Chicago, Becker Friedman Institute for Economics Working Paper No. 2020-44. Available at SSRN: https://ssrn.com/abstract=3580487 or http://dx.doi.org/10.2139/ssrn.3580487
Johnston, W. M., & Davey, G. C. L. (revised 2011). The psychological impact of negative TV news bulletins: The catastrophizing of personal worries. British Journal of Psychology (1997), 88, 85-91
How to be intentional about consuming Coronavirus news
Coronavirus and a fake news pandemic
How much news is too much news these days?
Mental Health America
UK NHS Mental Health Helplines
Health Direct – Australian Mental Health Helplines
What is self-care?
Self-compassion – Positive Psychology Today blog and Kristin Neff’s exercises
Kristin Neff – Definition of self-compassion
Kristin Neff – YouTube video explaining self-compassion
Jon Kabat-Zinn: Definition of mindfulness video
System 1 and System 2– Danial Kahnemann explaining in this video (it is an hour-long, but worth watching for a deeper explanation).
The 7-11 Breathing Technique
Wood AM, Froh JJ, Geraghty AW. Gratitude and well-being: a review and theoretical integration. Clin Psychol Rev. 2010;30(7):890-905. doi:10.1016/j.cpr.2010.03.005
Action for Happiness – The Three Good (Grateful) Things Exercise and other gratitude resources