Is it normal to feel like this?
Individuals

Is it normal to feel like this?


Is it normal to feel like this?

The answer to this question is almost certainly yes! Because these are unusual and stressful times and you’re a human being as well as a professional.

There are lots of different ways that we respond when we’re under pressure, in danger or witnessing the suffering or death of fellow human beings. Everyone is different and there’s no right or wrong way to feel. Some days you may feel energised and proud of the work you and colleagues are doing. Other days (and sometimes the same day) you may feel overwhelmed, guilty or heartbroken. These are all normal responses to stress and distress.

It’s important you don’t worry too much about your reactions. They are likely to be temporary and there are things you can do to manage them.

We hope the information below will help you make sense of how you’re feeling and give you some ideas on how to deal with them. Please also have a look at the tips on the Staying Well page.

Health and social care staff across the country have responded to the pandemic with dedication and energy, lots of energy. With long hours and missed weekends, we have stretched the boundaries between our work and our personal lives, often working at home whilst juggling caring responsibilities and technology glitches, on top of the challenges of delivering health and social care remotely. It’s easy to go from one virtual meeting to another, without the natural breaks that happen in our usual working days and, when we feel less productive, it can be tempting to work longer hours.

Those of you who are in work are dealing with the challenges of PPE and social distancing, on top of the emotional strain of your work and the impact on home life.

It takes a lot of energy to keep going during a crisis of this duration, so it’s normal to feel fatigue and exhaustion after a point, as our bodies try to recover and recuperate from expending such a large amount of energy. During the crisis you’ll most likely find yourself feeling tired, as your body won’t have the energy available to keep you in a state of readiness full time.

Sometimes, if your brain decides that being on high alert is not something that is going to resolve what is making you feel anxious, it can drive you to “shut down” in order to save energy. This might impact your mood, and make you feel low or numb. You might experience feeling slowed down and unmotivated.

 

Things that can help
It’s important to listen to the signals of your body and to rest when you need to.

If you’re working at home, try to have a routine and allow yourself to take breaks. Be careful not to work longer hours than you would if you were at work. If you’re in work, talk to colleagues and managers about how you can take breaks during shifts and where you can get uninterrupted rest with something to eat and drink.

You might feel reluctant to take time off work, because you know the pressure colleagues are under and the scale of the need of the people you’re looking after. But we all need a break.

If you feel you would benefit from time off from work, and this is currently possible within your professional role, consider speaking to your manager.

Holidays won’t feel the same during the lockdown (and you may have had plans cancelled), but having time off is essential for our mental and physical health and wellbeing.

Be aware that if you’ve been working full tilt for a long period, you may not realise how physically and emotionally exhausted you are until you stop.  Don’t be surprised if you find yourself feeling more emotional and make use of the resources on this site to take care of yourself.

Fight Fatigue is resource for better understanding what fatigue is and what you can do about it.

Feeling Good: A free audio programme that combines relaxation and sports coaching to reduce stress, anxiety and depression and improve sleep.

Many people have had to react and adapt quickly to the constantly changing needs during this crisis. You may have had to keep going even when you felt tired, overwhelmed or out of your depth.

Burnout is when people feel physical and psychological exhaustion related to their work over a long period of time. In some jobs, including in health and social care, this exhaustion may be combined with exposure to distress and human suffering. When this happens we are at risk of experiencing feelings that have been called compassion fatigue.

Burnout or compassion fatigue are not medical conditions, but they feel horrible.  You may question whether you can do your job and perhaps struggle to feel empathy or compassion for others. You might experience feeling detached, tired, shut-down or even angry.

Things that can help
It’s not unusual for people in caring roles to feel some of these things sometimes and especially during a prolonged crisis like this one. This doesn’t mean that you’re not a good person or a competent worker. Try to be compassionate towards yourself during these times and recognise that you are only human and capable of so much.

When you’re not in work, try to do things that give you pleasure and connect to the people who are important to you. As much as possible, try to maintain a balance between your work and home life.  If you feel that you need time off from work, consider speaking to your manager about when this would be possible. You can also get support from one of the services listed on the Getting Help page of this website.

You can click on the links below for further information on self-care and resilience. Resilience refers to your ability to navigate through and recover from stressors you are faced with on a daily basis. Whether you can bounce back depends on the stresses you face and the resources you have to help you cope. When your resilience is low, there is a higher risk of developing signs of burnout.

Individual and Team Resilience
Managing Wellbeing ICS poster
Aim for a healthy life balance
Staff Wellbeing Toolkit
Stress, Coping and Resilience Poster NES
Psychological protection in a Crisis
Silvercloud: Programs that focus on supporting your wellbeing, including managing your mental health, resilience, stress and sleep.

When we’re under acute stress the survival areas of our brain are more likely to be “online”, which means that our thinking becomes much more black and white, our attention is more narrowly focused on the immediate here and now, we start to have difficulty planning or thinking ahead, we have difficulty regulating our emotions, and we become less able to make decisions. This is a normal response to challenging times. Any other source of “threat”, such as long-term stress, worry, anger or tiredness can turn the survival parts of our brain on.

For more information on strategies for managing stress:

Extreme Stressors – NHS+Stressors

 

Jen, PRoMIS team: What stress is and how to manage it

Yes! There are lots of things that will be helping you feel OK despite the stress and sadness. People in health and social care, and across the country are working together for a common goal and many of us feel proud of this and grateful that we’re able to help our fellow citizens during a time of crisis. We may have a new appreciation for the people and things that matter to us.

It’s natural to feel worry during stressful and challenging times like these. When you are stressed the survival parts of your brain are more active and releases adrenalin into your body to  respond to these challenges. Your muscles tense ready for “fight or flight” and if your body remains in this state over time, you can start to feel aches and pains, for example in your shoulders and neck, or headaches.

Things that can help
Try to remember the things that usually help you to relax and unwind and, if you can, take time to do them. The lockdown may have disrupted some of your usual routines (like meeting friends or playing sport), so have a think about things you can still do, for example going out for a walk, cooking, gardening, listening to music or watching an entertaining programme.

Learning to relax our bodies can help reduce physical tension and make us feel less stressed. It can help us to feel calm and better able to focus. Using relaxation techniques can help to calm down the survival parts of our brain. Some people find that relaxation techniques work quickly for them, whereas others find they have to practice them over time before they start to work.

Click on the links below for different relaxation exercises:

Most of us have had nights when we can’t get a good night’s sleep, and given the current challenges it’s possible that your sleep may be affected.  When you’re worried or stressed you might struggle to get to sleep, wake up in the night, or have nightmares. This is because the survival parts of your brain are more active and reluctant to switch off. This is helpful at times when you need to stay awake to keep yourself safe, but not when you’re exhausted!

Sleep can be affected by other things as well, such as caffeine, alcohol or changes in daily routines. You might also find that you can’t stop thinking about a difficult experience you’ve had recently.  If sleep disturbance is prolonged it can affect your physical and mental wellbeing, for example it can affect concentration and make us irritable.

Things that can help
Where possible, try to have a bedtime routine and do things before bed that help you to feel calm and relaxed.

Sleepio: A free app for improving your sleep 

Feeling Good: a free, evidence-based audio programme containing a module aimed at helping you sleep better

For information on how to monitor and improve your sleep: Download an NHS sleep guidance pdf

Click here to watch a short video on how to improve your sleep:  Improve your sleep

For more information on improving your sleep, click here.

And for more information specific to improving your sleep hygiene, click here.

In the course of your professional duties you may be faced with difficult decisions that are not in keeping with your values or moral code. You may have to enforce social distancing rules during highly distressing times for families, or you may be unable to deliver the level of care that you would in normal times. This can lead to feelings of guilt or distress, which is sometimes described as moral injury.

Things that can help
Speak to your colleagues and teams if you feel able. It may be that many people are experiencing something similar. Be kind and compassionate to yourself, remembering that many things are outside of your control and that while this is difficult, it reflects what is necessary and possible in the current crisis. Remember that doing your best looks different under different circumstances.

For more information on moral injury and how to cope: Moral Injury

Dr Esther Murray talks about Moral Injury:

This audio is from a full webinar which you can access here.

 

Worrying about our own health, the health of our family and friends, as well as the future, are all understandable worries to have right now. These are uncertain times and we’re all facing an unknown future in many respects. Our brains, however, like predictability and a sense of control, and when we don’t have these things the survival parts of our brain can be activated. This can make us more likely to focus on things that seem more threatening, for example frequently checking the news or catastrophizing about the future. While many of our worries are warranted, it’s important to try to manage anxiety so that it doesn’t start to feel overwhelming or cause feelings of panic.

Things that can help
It can help to try to keep your mind focused on the present moment and on what you can currently control. Distract yourself from worries by doing something else, for example exercising, cooking, watching a film or talking with family and friends. Try not to over-check the news throughout the day and only seek information from reliable sources. It’s easy to get caught up in the wider media’s coverage of the pandemic, but this is not always accurate and can cause unnecessary alarm. Talk to your friends and colleagues about your worries, but also try to spend time talking about other things.

See below for additional resources on how to manage changes in thoughts, emotions and psychological wellbeing:

NHS Anxiety and Fear pdf

Doing what Matters in Times of Stress: Stress Management Guide. Spending a few minutes each day doing some of these techniques can help to reduce your stress. You can also listen to audio clips that go with the guide.

Living with Anxiety and Worry Amidst Global Uncertainty is  a guide for managing worry and anxiety.

Face Covid is a video clip and written guide on steps you can take to manage feelings of anxiety and worry, based on the principles of acceptance and commitment therapy.

Coronavirus-Anxiety-Workbook: A guide you can work through to help manage your anxiety, including a list of 74 ideas for healthy distraction.

Free apps and online programs:

Daylight: A smart phone-based app that helps with anxiety and worry.

Feeling Good: An evidence-based audio programme which helps with anxiety.

Silvercloud: Programs that focus on supporting your wellbeing, including managing your mental health, resilience, stress and sleep. Use code NHS2020.

At times, the pandemic and its wide-ranging impact can feel unending, but it’s understandable and OK to feel low or even hopeless in the face of such a challenge. You may have experienced, witnessed or learned about difficult and tragic events, and you may have been cut off and isolated from family and unable to do the things you normally do to boost your mood. At times you may have felt ineffective at work or at home. It’s important to remember that even if you’re not at work, you can experience this.

Things that can help
Try not to spend too much time dwelling on negative thoughts and feelings. If you can, try to remind yourself of positive things that you, colleagues, friends or others have been able to do. Avoid excessively watching media coverage. Reach out to friends and family online.  Try to stick to your normal routine as much as possible and remember to do activities you enjoy (which may have to be adapted in the context of social distancing). It can be helpful to think about things you used to enjoy doing, and try to do them again if you can.  Try to exercise where possible at least once a day, and keep a healthy and balanced diet and sleep pattern.

Aim for a healthy life balance

Stress, Coping and Resilience Poster NES

COVID-19 Staff Wellbeing tool kit

Feeling Good: A free, evidence-based audio programme which can help with depression and low mood.

Silvercloud: CBT based programs that focus on supporting your wellbeing, including managing your mental health, resilience, stress and sleep. Use code NHS2020.

Coronavirus Anxiety Workbook: A guide you can work through to help manage your anxiety, which also includes a list of 74 ideas for different activities you can try.

If you struggled with mental health issues before the pandemic, you might find that some of those difficulties are worse right now. Many of us cope with life’s challenges by going outdoors, meeting up with friends and family, or going on holiday, but these coping strategies may be compromised just now. We may also be facing additional worry, stress and loss during these times, all of which will impact on our mental health and wellbeing.

Things that can help
Right now, you may be unable to do some of the things that used to help you cope. Consider ways you can adapt any healthy coping strategies to the current situation. It might be helpful to speak to your GP for further advice. It can also be helpful to speak to friends, family or colleagues if you feel comfortable enough to do so.

For information on mental health and wellbeing supports in your local area, please click here.

 

Below you’ll find a list of resources that will help you to manage stress, worry and anxiety:

Doing what Matters in Times of Stress:  A Stress Management Guide. Spending a few minutes each day doing some of the techniques can help to reduce your stress. You can also listen to audio clips that go with the guide.

Living with Worry and Anxiety amidst Global Uncertainty: A guide for managing worry and anxiety.

Face Covid:  A video clip and written guide on steps you can take to manage feelings of anxiety and worry based on the principles of acceptance and commitment therapy. Click here for the pdf.

Coronavirus Anxiety Workbook: A guide you can work through to help manage your anxiety, including a list of 74 ideas for healthy distraction.

 

Free apps and online programs:

Feeling Good: A free audio programme that combines relaxation and sports coaching to reduce stress, anxiety and depression and improve sleep.

Sleepio: An evidence-based sleep improvement program.

Daylight: A smart-phone based app that helps with anxiety and worry

Silvercloud: CBT-based programs that focus on supporting your wellbeing, including managing your mental health, resilience, stress and sleep. Use code NHS2020

Social distancing and not having access to usual coping mechanisms or support systems can make people feel lonely and isolated. Work can also be a major source of stress at the moment, with changes to the way we work, increased workload and increased absences as colleagues self-isolate or take leave for other reasons. Drinking a bit more than usual is a common way of coping with difficult feelings or sleep problems, so if this is one of your coping mechanisms right now, you need to be aware that long term and frequent drinking can actually reduce your mental wellbeing and contribute to feelings of stress and anxiety, potentially impacting on both your performance at work and your relationships at home.

Things that can help
Drinking alcohol can impact your health in many different ways and the more alcohol you drink, the higher your risk. So keeping track of your drinking is now more important than ever. Understanding why you drink, being aware of how many units you’re drinking and the ways to reduce risks to your health and wellbeing can help us make informed choices.

The low risk drinking guidelines state that to keep health risks from alcohol low, both men and women are advised not to drink more than 14 units a week, on a regular basis. If you’re pregnant, trying for a baby or become pregnant, no alcohol is the safest option. You can find out more about alcohol and pregnancy here.

For people under 18 years of age, the Chief Medical Officer advises that an alcohol-free childhood is the healthiest and best option. If you’re taking prescription medication, or any other drugs, it’s important to be aware of how they interact with alcohol.

Choosing to cut back on how much you drink may help reduce related health risks and any associated complications linked to COVID-19.  Alcohol can reduce the immune system’s ability to fight off infectious diseases and have an impact on the health of your heart and lungs.

You can find further information and guidance about alcohol via the following links:
Information on drinking sensibly, knowing your limits and getting support
CMO low risk drinking guidelines
How does your weekly drinking add up?
Ways to keep track of your drinking
Tips on how to cut down
Information on where to get help
Healthy living and alcohol

 

When we experience challenging situations that are highly stressful, the survival parts of our brain come online. When these parts are in charge, the part of our brain that allows us to concentrate and make decisions doesn’t work as well. It becomes “sluggish” and the longer the survival parts are online, the more sluggish it can get. This can also happen when we are worried, tired or angry.

Things that can help
Where possible, give yourself the chance to unwind and relax, do something fun or something that takes your mind off your worries or stress. Try to get a good night’s sleep and keep a balanced diet. If you feel comfortable enough, speak to your colleagues or managers at work for support.

Stress can impact many different systems in our body and can throw us off our normal eating routines. Sometimes it’s difficult to tell if you’re being affected by stress or worry. Being mindful of eating habits and noticing a change can therefore be useful in helping you get a sense of this.

You might not feel hungry or you might find yourself eating more than usual. Sometimes eating more can make you feel better in the short term. We also crave high energy foods if we are low on energy.

When our bodies are in survival mode, all resources are geared towards being able to survive the here and now, for example diverting energy away from our digestive system and to our muscles instead, so we may not feel hungry. You may also experience an upset stomach or need to use the toilet more.

Things that can help
Eating as healthily as you can and drinking water throughout the day will help you physically manage the challenges you may be facing. Where possible, it may be helpful to plan out your meals in advance and stick to regular meal times. Try to be mindful of alcohol and caffeine intake too.

How to eat a healthy balanced diet

The Eat Well Guide

During times of high stress you might find yourself shut off from your emotions. This can be a good way to cope in the short term when you don’t have the psychological resources to manage at that particular time. For example, you may need to remain focused on your professional job, or aspects of your job may be distressing but unavoidable. You can also become detached if you feel emotionally overwhelmed, as this is your brain’s way of trying to survive the moment.

Things that can help
While this can be useful in certain situations, try to recognise if this is happening in other areas of your life as well. Be mindful of how you might be trying to cope with these feelings, such as use of alcohol. Speak to your colleagues for support if you feel able to.

Memories of distressing experiences may come into your head in the days and weeks after the event. When you experience something under acute levels of stress your brain works a little differently, which can affect how you remember it afterwards. Your brain then has to sort out, or process, this information to get it stored in the right place. This can result in you re-experiencing the memory in ways that are more distressing or emotional compared to how you experience other memories.

When we sleep, our brain sorts through our memories and experiences, and this means you may also have dreams or nightmares relating to what happened.  For many people, these memories will naturally be processed in the days and weeks following the event. Sometimes, when the stressful situation goes on for a long time, your brain may not start to make sense of it until it’s over, so don’t be surprised if the processing happens some time after the experience.

Kate from the PRoMIS team talks about intrusive memories:

Things that can help
If you’re having experiences like this it can be helpful to look around you, to ground yourself in the present moment. Name five things you see, four things you can hear, three things you can smell, two things you can touch and one thing you can taste.

It can help to speak to people you trust about these experiences if you feel ready to do so. It’s likely to be unhelpful if you feel forced or pressured to speak about things, so it’s ok to tell people that you don’t want to speak about things, if that’s how you feel. Some people can find it helpful to write down their experiences or speak to their peers.

If the memories don’t settle down after a few weeks or you’re continuing to find them very distressing, then please get some help. You can contact your GP or find information about the support that’s available on the Getting Help part of this site.

If you’re concerned about symptoms of post traumatic stress, one of which is recurring nightmares that are re-living in nature, more information can be found here.

When we experience something that is highly stressful or distressing, we don’t want to be reminded of it, so much so that we may avoid things that remind us of it, such as the place where it happened or the people connected with it.

You might find yourself minimising contact with patients, thinking of not reporting for work, or avoiding people who are coughing or sneezing, or public spaces.

When we’re around people who are unwell, even in normal times, our brains encourage us to avoid situations that will increase our own chances of becoming unwell. Many of these messages are being reinforced in the current pandemic to reduce transmission rates, but you may find yourself experiencing more anxiety than you’re comfortable with.  We might feel fear, disgust, or a need to “decontaminate” ourselves or the area around us.

Things that can help
Where possible, try not to avoid. For example, if you become aware that you’re working hard to avoid reminders of something unpleasant,  it’s important to know that while this might reduce feelings of anxiety in the short-term, in the long run this can maintain your anxiety and reduce your quality of life.  Remember that the event has passed. You can do this by focusing on differences between then and now, and keeping yourself grounded in the present moment.

It can be helpful to speak to others about these experiences, if you feel ready to do so. If you find these experiences persist or you find them highly distressing, speak to your GP who may be able to help.

All of us have experienced a change in how we interact with people, in terms of the impact of social distancing, PPE, and also with regard to the people we live with. You might find at times that relationships become more strained at home and within the work place as people respond and try to cope with the current situation in their own ways. You might worry about expectations placed on you by your family, colleagues, media and society as a whole.

Things that can help
It might be helpful to speak to peers within your team if you feel comfortable enough to do so. Take time out for yourself if you can, or reach out to friends virtually for support. Be compassionate to yourself and understand that stress can make you and others more irritable.

If you feel that you need professional support, click here  to find information about relationship and counselling support, as well as guidance on mediation and help for people separated from their partners. You can also find out about local counselling services, including what happens at counselling and how much it costs, by visiting the website of Relationships Scotland.

If you need help
If home doesn’t feel like a safe place for you at the moment and you need to talk to someone in confidence, you can find help here.

 

 

Jen, PRoMIS team.

What stress is and how to manage it.

Darren, Paramedic

“I wouldn’t normally make a video like this…”

Katie, PRoMIS team.

What you might experience after a distressing event and how to cope.

Leah, Care worker.

“I’ve been anxious about possibly passing it around family, friends, colleagues, service users.”

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