Resources for managing stress and anxiety
Managing worry and anxiety
You may be feeling more worried or anxious than usual for yourself, your family, friends and colleagues as well as for your patients. Living with anxiety and coping with the increased pressure due to coronavirus can be hard. However, there are things you can do to help manage these emotions.
- Try and manage the things you can control. This could include how much you use social media and when and how you watch the news.
- Talk about how you are feeling with friends, family, colleagues or whoever you feel comfortable talking with.
- If you are feeling overwhelmed, focus on your breathing by slowing down the ‘out’ breath and taking a few slow, deep breaths in. You may find the breathing exercises on the NHS in Mind website helpful.
- Try activities such as yoga or meditation to help you relax.
Useful resources for managing anxiety
There are resources available to help manage worry and anxiety.
- Anxiety UK has DVDs, CDs, online apps and podcasts.
- Mind, the mental health charity has advice to help with staying at home and coping with feelings of anxiety.
- Living with worry and anxiety amidst global uncertainty is a practical guide put together by psychologists. It contains a selection of practical exercises that anyone can use to manage worry.
You may find it helpful to keep an anxiety diary where you note down things that made you feel stressed each day. You also write down:
- where you were
- who you were with
- what you were thinking about
- what triggered your response.
You may find it useful to look back at the diary and think about any patterns. This can help prepare you for situations that you know may trigger anxiety and need a problem-solving approach. There is more information about problem-solving approaches for stress and anxiety in the section below.
Managing and recognising stress
It is sometimes difficult to know if you are experiencing the effects of prolonged stress. But there are important ways that your body lets you know that you are struggling. Watch out for the following warning signs:
- inability to concentrate or complete tasks
- body aches
- irritability and anxiety
- trouble falling sleeping or staying awake
- digestive problems such as bloating, indigestion and IBS.
Stress is an inevitable part of life. But you can improve the way you respond to stress even when you can’t avoid or change the situations that cause it.
Our past experiences affect the way we react to stress. Often when we are faced with a stressful situation, the emotional impact of stress can flood our brain. This prevents us from making logical decisions on how to react. If we can recognise the first signs of stress in our body and have awareness of things that can ‘trigger’ a stress response, we can learn to:
- initiate our coping mechanisms sooner
- think calmly and logically
- take control of the situation.
In order to do this, it helps to write down the things that ‘trigger’ a stress response.
Useful resources for managing stress
There are resources available to help manage stress including:
- The NHS Traumatic Stress Clinic in London, the UCL Institute of Mental Health and the COVID Trauma Response Working Group have produced this video, Coping with stress associated with COVID19: advice to hospital staff.
- The Sage and Thyme website has a useful short video, Tips for health workers on coping with anxiety during the COVID-19 pandemic.
- The NHS website has some useful stress busting tips.
- Mind, the mental health charity, have developed some helpful information on stress and how to manage it. This is also available to download as a PDF document.
Problem-solving approach for anxiety and stress
You may find it helpful to use a problem-solving approach. You could try the following steps to help you.
- Write down the main issue that is making you anxious.
- When do you feel this? What are the things that trigger this response in you?
- Use the table below to write 3 solutions to help you deal with the problem.
- Choose 1 solution from the table above.
- Write down the steps it would take to achieve this.
After you have done this, you could:
- Reflect on what worked well and what did not work so well in that situation.
- Think about how you feel after managing to control the situation.
You are likely to have been successful at this in the past and already have strategies that work. Reflecting on this will help build your confidence.
Supporting people living with cancer and their families, particularly during the current coronavirus pandemic, may cause Vicarious Traumatisation (VT). If you have repeated empathic connection with someone who is in pain or distress, the ‘mirror’ neurons in your brain can interpret this distress and reflect similar sensations.
Some of the signs of VT are:
- feeling useless at your job or powerless to help others
- feeling a lack of hope or meaning in what you are doing
- feeling obsessed by the person you are helping or desperately wanting to avoid them
- having intrusive thoughts or dreams
- feeling overly anxious about your own loved ones
- feeling increasingly disconnected and isolating yourself from others
- feeling a lack of motivation for everyday life and self-care.
This information can help you to understand more about VT, the signs and what you can do about it.
Download some information to help you to understand more about VT, the signs and what you can do about it.
Here are 4 short videos on vicarious traumatisation, the aim of which are to:
- raise your awareness of VT so you can spot any signs of VT in yourself or others
- highlight the self-care strategies which actively build resilience to VT.
If you find the topic of interest, you can download a full list of references and further resources.
Finding balance in your life
With the current restrictions in place, you may find it difficult to keep to your normal routines and daily activities both at home and at work. This can be unsettling, so it’s important to find a way to create a routine for yourself that provides a sense of balance. It may help to focus on activities that:
- create a sense of achievement. This might be doing an online exercise programme or taking a break at work or at home to practise brief mindfulness activities, such as a 3-minute breathing space (see section on Mindfulness).
- help you to feel close and connected with others. You may want to stay connected with friends and family. There is more information about this below.
- allow you to treat yourself after a long shift at work. This might be doing something like having a bath, watching your favourite film, listening to some music or reading a book.
If we don’t have a healthy balance in our lives, our moods are affected. For example, if you spend most of your time working with no time for pleasure or connecting with others, then you may start to feel low and isolated. If you spend most of your time relaxing for pleasure and not doing other things that provide meaning for you, this can also impact your mood.
The Every Mind Matters website has advice about looking after your mental well-being while staying at home.
Creating a routine
When at work, your routine may be more fixed than on your days off or if you are at home self-isolating. While working, it can be helpful to find ways that you can:
- switch off from work at the end of a shift
- reflect on the day
- share with others what went well and what was difficult.
If you are at home, creating and sticking to a daily routine can help you feel more in control and make your day feel more normal. You should try to:
- wake up at your normal time
- get ready for the day like you would normally
- go to bed at your usual time.
Eating regularly and healthily helps our mood, energy levels and overall well-being. Here are some tips to help:
- The Eatwell Guide on the NHS website has advice to help you have a healthy, balanced diet.
- It can be tempting to snack at home or at work and you may find yourself eating unhealthy snacks. Try to choose healthier options, when you can, to maintain a healthy weight. The NHS website has information about keeping a healthy weight.
- It’s important to stay hydrated, so make sure you’re drinking plenty of fluids (6-8 glasses daily). The NHS website has information about staying hydrated.
- Stick to sensible drinking guidelines. There is more information about alcohol and drinking guidelines at Drink Aware.
Staying physically active is very important for your well-being. For many of you, working is likely to keep you active but it’s also important to consider how you could keep active for your general fitness and well-being on your days off.
If you are at home, and particularly if you are self-isolating, it can be difficult to keep active. There are lots of great resources online to help you:
- The NHS website has lots of exercise advice. They also have some home workout videos, including a cardio workout, and a strengthening workout.
- Yoga can help with strength and flexibility as well as keeping you active. It can also be relaxing. The NHS website has a 45-minute home yoga video for beginners at any fitness level.
There is lots more practical advice online to help you stay active while self-isolating. Doing small amounts of physical activity is better than doing nothing. You might find that now is a good time to try something new, so take time to search online and find what works for you.
Sleep is important for your well-being. Getting enough sleep can help with:
- clarity of thought
- overall mood
- decision making.
The following links have some useful information about sleeping well.
There are apps available to help you sleep better, such as Sleepio. This is an online sleep improvement programme that has been clinically proven to help you:
- fall asleep faster
- stay asleep through the night
- give you more energy during the day.
This is currently free for all NHS staff via the NHS Apps library. You can also download it from your app store.
Taking time to relax
Taking time to relax can help you to find balance in your life both physically and emotionally. Everyone has their own way of relaxing.
Choose what works best for you. You might find that now is a good time to try some different ways of relaxing. These can then become part of your daily routine.
There is lots of evidence to suggest that mindfulness can help build resilience and support your mental health and well-being. It can help increase your awareness of your thoughts and feelings. It can also help you feel calmer and more able to manage stress. Taking a few moments out of your day, whether at work or at home, to practice mindfulness, can make a real difference to your well-being over time.
- Watch this 3-minute breathing space video from Mark Williams and Danny Penman’s ‘Finding Peace in a Frantic World’ Mindfulness Programme.
Macmillan has an online, 4-week course called Be Mindful on mindfulness-based cognitive therapy. It is free for Macmillan professionals.
Here are some mindfulness apps that you might find helpful:
There are also other apps you could use. If you have one that you are familiar with, you may want to use that one.
Connecting with others
It is difficult not seeing your loved ones. There are lots of ways you can still stay in touch with the people who are important to you.
If you have a smartphone, computer or tablet, you may want to use some of these different video call apps to keep in touch:
- House Party
Using video calls to see someone’s face can help you feel connected. Sharing everyday moments with someone can help make your day feel more normal.
Being kind to yourself
Self-kindness and practising gratitude can help to positively impact your well-being. Developing gratitude can help you connect with moments of joy, kindness and pleasure in difficult times. Some people find it helpful to keep a daily gratitude journal or to put notes into a gratitude jar. Other people in your home might also like to join you in practising gratitude. To start, you could:
Building your resilience
Resilience is the mental reservoir of strength that people can call on in times of need to carry them through difficulties. Resilience is something everyone can develop, not just to help us bounce back but also to be able to adapt in the face of challenges, while maintaining balance and well-being. Find out more about resilience.
‘FACE COVID’ is a set of practical steps for responding effectively to the coronavirus crisis, put together by Dr Russ Harris, author of ‘The Happiness Trap’. The steps use the principles of acceptance and commitment therapy (ACT) and are as follows:
F = Focus on what’s in your control
A = Acknowledge your thoughts and feelings
C = Come back into your body
E = Engage in what you’re doing
O = Opening up
V = Values
I = Identify resources
D = Disinfect and distance
Macmillan has developed a guide specifically for health professionals who are caring for people with cancer during the coronavirus pandemic. The guide is based on the steps of ‘FACE COVID’ and is adapted here for you to record your experience of putting the steps into practice. You can use it to record your thoughts and feelings, as well as the actions you take to care for yourself and others during this time.
You can get more detailed information about each of the steps in this PDF.
You can also watch a 5-minute animated video explaining 'FACE COVID'.
'Your Moment Out' during COVID-19
'Your Moment Out' is a booklet that aims to remind us how important it is to look after our mental health and well-being, especially at this time. It can be used by individuals or by line managers. It is in an easy format for managers to email to staff as an overview of resources to support well-being.
As health and social care professionals you may be responsible for a team or other professionals. You may want to offer psychological support and advice to them, as well as to the public. We recognise that during this difficult time, managers and team leaders may need additional support and guidance for their staff.
Here are useful links to psychological resources which might assist your clinical practice during the current crisis:
The British Psychological Society (BPS) has published recommendations for services to protect the mental health of frontline staff during the coronavirus crisis. The full report can be found below, but the key set of principles included in the guidance are:
- Provide visible leadership.
- Have a communications strategy.
- Ensure consistent access to physical safety needs (eg Personal Protection Equipment).
- Ensure human connection and methods of pre-existing peer support.
- Providing psychological care to patients and families is key to staff well-being.
- Normalise psychological responses.
- Deliver formal, psychological care in stepped ways.
- Innovate to implement psychological care.
- Come back to your core NHS, organisational and professional values in making decisions.
- Take care of yourself and pace yourself.
- There is a dedicated NHS website to help you manage your own health and well-being while looking after others.
- If you would like to run a staff support session for health workers during the COVID-19 outbreak you could use this Sage and Thyme video to help you.
- A COVID Trauma Response Working Group has formed to help co-ordinate trauma-informed responses to the COVID outbreak. It is made up of psychological trauma specialists and well-being leads from NHS trusts. Access the resources.
- The Kings Fund has produced some helpful tips and quick read practical guides to support health and care leaders through the COVID-19 crisis.
- NHS Employers has produced a helpful infographic as part of their toolkit, to encourage staff to take time out to tune in to how they are feeling and provide them with some practical tips to support them.
- The NHS has produced a helpful checklist to support the well-being of healthcare workers at the end of their working day, including steps to take before going home.
- There is also a useful guidance document on the psychosocial response to stress experienced by hospital staff associated with COVID-19. It has a list of recommendations of things likely to be helpful or unhelpful, in supporting staff.
The following resources may also be helpful to you during this time: