Taking care of yourself during difficult times

Stress responses are common and everyone experiences them. When stress is experienced more frequently or more intensely it can impact on our physical and emotional health. Common response to stress that people may notice include;

• Sleep disruption
• Feeling overwhelmed or irritable
• Making mistakes or forgetting things
• Sadness, low mood, irritability, guilt, anxiety, worry
• Tiredness and lack of motivation to do things
• Not wanting to see or speak to people
• Taking less care of yourself
• A decrease in helpful coping strategies and an increase in less helpful strategies
• Physical symptoms – e.g. headaches, stomach difficulties, muscle tension
• Difficulty concentrating, restlessness and being unable to settle
• Finding it difficult to cope with things you would usually be able to manage

Anxiety is another common reaction to a threatening or potentially harmful situation. Our brains are designed to notice danger and take action before we even have a chance to notice we might be in danger.

By flooding our bodies with activating hormones and neurochemicals our brains create the 'flight, fight, freeze' response, which means we respond to the best of our ability to keep ourselves safe in a situation.

The trouble with human brains is they can think too much and can use imagery to replay scenarios over and over again; as well as creating scenarios that haven’t happened. This can keep anxiety going long after the threat has gone and can create a sense of ‘threat’ when it’s not even there.

This is when anxiety can start to feel overwhelming and exhausting and life can start to feel much more difficult to navigate. We can begin to feel unsafe in places that used to bring comfort and we become focused on the safety of ourselves and others.

It is also common that people become anxious about their own symptoms of anxiety; wondering if they are sick or going mad.

All of this fuels the brain’s threat response and the anxiety keeps coming, but there are steps (see page 5 onwards) that can help to break this cycle and allow you to feel more in control.

Some common responses that people describe when anxious include;

• Increased heart rate
• Increased breathing
• Feeling dizzy
• Trembling or tingling in extremities
• Feeling like you need to get away
• Feeling under threat or like you need to be alert
• Only being able to concentrate on the threat and not on other things
• Worrying about bad things happening
• Feeling unlike yourself or like you are disconnected from the world
• Physical side effects such as dry mouth, lump in throat, tight chest, nausea and need to use the toilet

At times distressing situations may become traumatic. A traumatic situation is one that is often unexpected, outside of daily experience and where you fear for the safety of yourself or others.

Traumatic situations can be a one-off (road traffic collision) or can be ongoing (such as paramedics attending multiple medical traumas or managing end of life care).

As a professional you may be used to dealing with traumatic situations, however, this does not make you immune to the impact they can have; especially if they are particularly challenging or if there are other stressors in your life.

Please remember hearing about other people’s traumatic and distress stories can significantly impact your mood and wellbeing.

Some common responses people notice are:

• Feeling shaken, shocked and frightened
• Feeling a range of emotions – sad, distressed, worried, anxious
• Feelings of shame and guilt
• Experiencing intrusive and upsetting thoughts, images and memories
• Difficulties sleeping, nightmares and anxiety during the night
• Loss of enjoyment and a sense of hopelessness about the future
• Feeling disconnected, lonely and becoming withdrawn
• Feeling out of control, unlike your ‘normal’ self
• Being short-tempered, irritable, on edge or jumpy
• Being more aware of potential risks and dangers
• Avoiding anxiety-provoking situations

These feelings may lead to a change in energy levels, motivation, sleep and appetite. They can also affect your ability to concentrate and remember information; and can stay around for days or weeks at a time, or may change from moment to moment. Exposure to traumatic situations can sometimes have longer-term impacts on your mood and wellbeing.

Dealing with challenging situations for a prolonged period may mean that people start to feel low in mood, or hopeless.

You might notice that you don’t enjoy things as much as you used to, or you find it harder to look forward to the future. Over time this may lead to a reduction in activities, which can therefore stop activities lifting your mood.

If your mood deteriorates significantly, seek support from your GP.

Working on the frontline with those who are ill and dying, and families who are grieving, can have a huge psychological burden on you.

It’s normal to experience feelings of sadness when around other people’s grief; this is especially likely if you have experienced your own loss either recently or in the past.

Sometimes other feelings associated with past deaths can resurface, such as anger or guilt. It is important to notice your reactions and consider your own support and wellbeing.

You will find some ideas that could support you further down this page.

It is important that you apply the same care that you provide to others to yourself;

• Try and understand and accept what is happening, rather than judge
• Be realistic about what you can and should take responsibility for
• Remind yourself of factors that may be outside of your control that are influencing your current situation
• Speak kindly to yourself and don’t be hard on yourself if you are finding things difficult
• Give yourself permission to have time to look after yourself
• Build-in time for self-care – you may need to plan this if you are busy

Humans are like mobile phones; the more we use up our energy - both emotional and physical - the more depleted our batteries become. Sometimes it is useful to stop and plug in for a full recharge.

However, when time is short a quick five-minute recharge may be enough to get through. Be realistic about how much time you have to recharge – even taking a few deep breaths outside during your break will be more helpful than working through it.

Whilst it is common for people to notice they struggle in some way during challenging times, for most people, difficult thoughts and feelings will settle with time. Some people may even find themselves relatively unaffected; there are many different responses to difficult experiences.

When things are particularly difficult, sometimes all you can do is keep going. It might be that all you can do to help your situation is keeping put one foot in front of the other and try not to make things worse for yourself.

Below are several strategies that might be helpful. It’s enough to try one of them – don’t overwhelm yourself with them all at once. Useful strategies will also differ from person to person, here are some general ideas that may help;

• Focus on what you can influence and change – not what you can’t.
• Looking after your body: Try to eat well, stay hydrated, keep to a regular sleep routine and engage in daily exercise or activity. Try to avoid less helpful strategies, such as alcohol.
• Treat yourself to the little things: Make sure that you treat yourself to small things that can make the days easier; this could be a small smile, having a nice coffee once a day, watching your favourite film or series, going for a walk somewhere you enjoy, or even using your favourite pen.
• Have realistic expectations of yourself: There’s a limit to how much any of us can take on, and when we take too much on we risk not doing any of our tasks properly. Having realistic expectations of ourselves and our limits is an important part of making sure that we don’t become overwhelmed.
• Monitoring media consumption: Staying informed is important, but if you find that you are becoming overwhelmed or too focused on the news or social media consider limiting it in some way: for example, turning off notifications and reducing the number of times you look at it.
• Rebuild or develop a new routine: Find ways to get back to doing things you would usually have done, or consider a new structure that may work better for you at this time. Try to do one thing that you enjoy every day, however small. You can tackle bigger things you would like to do step by step.
• Managing worries: For those worries that can be resolved – plan a response and action it. For those that are unhelpful or not resolvable practice acknowledging they are there and then let them go.
• Connect with the world around you: Ground yourself in the world around you rather than getting lost in your thoughts and emotions. Hold a cold can, eat a sour sweet, have a hot shower, make dough and knead it…
• Be compassionate to yourself: People are doing the best they can. This doesn’t mean they will always get it right. Be compassionate to yourself and speak kindly to yourself.
• Take time to reflect: It can be helpful to take time to make sense of what you have been through at a pace that suits you. You could try writing it down, recording it on your phone or talking to someone you trust.
• Use your senses to soothe: use comforting sounds, images, tastes, smells and textures to soothe yourself. Find things you can take to work with you so you can easily access them.
• Think about your environment: Have things around you that make you feel safe or remind you of special times. Do you have a place where you can feel safe and comforted? Is your bedroom relaxing?
• Find ways to stay connected: Stay linked in with those who matter most. Be creative about how you reach out, do it in a way that makes you feel comfortable and choose how much you want to share with others.
• It’s okay to not be okay: Remind yourself that having strong feelings and thoughts about the situation is okay and that there is no right way to react.
• Coping with upsetting thoughts and images: Distressing thoughts and images often settle down over time without any intervention. However, while they persist it can be helpful to accept they will be there without engaging too much with them. If you find that you are overwhelmed, try letting them go and intentionally refocus your attention onto something absorbing. You can also try engaging your mind (such as counting backwards in sevens or naming all the blue things in the room) or reconnect with the world around you (notice one thing you can see, hear, touch, taste and smell).

Our mood is influenced by the balance of neurotransmitters. There are four key neurotransmitters that you can activate or boost that will give you a natural lift in mood.

Dopamine: The reward and pleasure system, motivates us to achieve goals:

• Planning short and long term goals
• Celebrating small wins (yours and others)
• Encouraging others

Oxytocin: the ‘hug drug’, creates trust and connectedness:

• Holding hands
• Hugging
• Giving compliments or gifts
• Stroking a pet

Serotonin: creates a sense of belonging and importance:

• Reflecting on past achievements or victories
• Sunlight exposure
• Connecting with others

Endorphins: ‘happy hormone’:

• Laughter, humour
• Exercising
• Eating dark chocolate or spicy food
• Smelling lavender or vanilla

It can take time to feel more like yourself. The feelings and responses described above might be around for days, weeks or months after a difficult situation. We also know that some people may feel fine to begin with, but then experience difficulties further down the line, especially at times of increased stress. If you are experiencing ongoing distress then there are people that can help.

• Greater Manchester Resilience Hub - specialist psychological support for Greater Manchester health and care staff affected by critical incidents or traumatic events in work.

• Employee assistance: Speak to your line manager or employer about if they have any staff wellbeing or psychological support schemes.
• Psychological support: If you are over 16 then your local NHS talking therapy service (psychological therapies) will be able to help. You can self-refer to some services or ask your GP to refer you. Counselling is often helpful for relationship difficulties and ongoing stressors. CBT may be more helpful for anxiety and low mood. Trauma-focused CBT or EMDR are the evidence-based therapies for trauma.
• Greater Manchester Bereavement Service - support for anyone in Greater Manchester that has been bereaved or affected by a death.
• Mental health helplines - a number of helplines are available to call any time you need support.
• Urgent or crisis support: If you feel that you cannot keep yourself safe or have concerns for the safety of someone else, reach out to someone. Your GP can support you or help you to access mental health services. In an emergency, attend your accident and emergency department or call emergency services on 999.