In Mindcast

Jane O’Rourke – Breathing Exercise for Calming Mind and Body

Jane O’Rourke is a Yoga and Meditation Teacher, and a Psychodynamic Psychotherapist with Children, Young People and Families. She teaches Yoga4Trauma within the Trauma Service at the Tavistock and Portman NHS Foundation Trust. How we breathe has a big impact on our mental and physical health. Jane guides us through a breathing exercise called the ‘box technique’ to calm the body and mind.

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Hello, my name is Jane O’Rourke, I’m a yoga and mindfulness teacher as well as a child, adolescent and family psychotherapist and today I am going to show you how to do a simple breathing exercise to calm your mind and body.

How we breathe has a big effect on our physical and mental health. Whatever we happen to be doing, our breath is automatically responding all the time. For example, if we are feeling quite rushed the breath quickens, and if we are feeling in a panic the breath shortens, and if we are feeling relaxed the breath lengthens. So whatever we do or feel, our breath is responding to it. I like to think of the breath as our constant companion on our life’s journey, and we can use this constant companion to help us change how we feel emotionally and physically by watching the breath as well as using techniques that have been developed over thousands of years in ancient wisdom traditions. So breathing well helps the body regenerate itself by receiving good amounts of oxygen, and it enables our mind to be calm and present. It also reduces the bodies stress chemical, cortisol.

So this breathing exercise I’m going to show you helps slow down the heartrate, which allows the body to begin to relax and release tension.

You can sit on the floor and perhaps use a cushion so you can sit nice and comfortably, or you can use a straight backed chair. Having a good posture is important to breathing well and this will allow the breath the flow really well, so sit tall and imagine a golden thread at the top of your head being gently tugged so your spine grows a little and the chest expands, or you can lie down on the floor and keep your knees bent and your feet flat on the floor so you can feel your back is nice and relaxed.

Now bring your attention to your shoulders and allow them to soften and relax, soften the jaw, soften the root of your tongue and allow your gaze to soften, or you can close your eyes. This technique is called Four Square Breathing or Box Breathing, it helps balance your nervous system and so helps us calm by breathing in and out in equal proportion. You breathe in fully for a count of four, you hold it for a count of four, then you breathe out fully for four seconds and also hold for four seconds again. I’ll show you now.

So on your next in breath, breath in for a count of 4… 4, 3, 2, 1, hold the breath: 4, 3, 2, 1, breathing out: 4, 3, 2, 1, pausing: 4, 3, 2, 1, breathing in: 4, 3, 2, 1, holding: 4, 3, 2, 1, breathing out: 4, 3, 2, 1, pausing: 4, 3, 2, 1, breathing in: 4, 3, 2, 1, holding: 4, 3, 2, 1, breathing out: 4, 3, 2, 1, pausing: 4, 3, 2, 1.

We are about half way through.

Breathing in: 4, 3, 2, 1, holding: 4, 3, 2, 1, breathing out: 4, 3, 2, 1, pausing: 4, 3, 2, 1, breathing in: 4, 3, 2, 1, pausing: 4, 3, 2, 1, breathing out: 4, 3, 2, 1, pausing: 4, 3, 2, 1.

Last time.

Breathing in: 4, 3, 2, 1, holding: 4, 3, 2, 1, breathing out: 4, 3, 2, 1, holding: 4, 3, 2, 1.

Now just allow the breath to just flow as it likes, not trying to change anything, and just noticing how you are feeling… and give yourself a few moments here if you like just to be able to relax, and give yourself some time just to be alongside yourself. Allowing the breath to just flow in and out. And then whenever you are ready coming back into the room in your own time.

In Mindcast

Nell Nicholson – Adapting Practice

Nell Nicholson is the Head Teacher of Gloucester House, the Tavistock Children’s Day Unit and Outreach Service.  She talks about the challenge of leading a school during coronavirus, the pros and the cons for teachers, children and parents and the moment of re-opening the school.

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Hello, my name is Nell Nicholson, I’m the Head Teacher of Gloucester House, the Tavistock Children’s Day Unit and Outreach Service.  We are a specialist provision, a therapeutic school operating across education and mental health to meet the social, emotional and mental health needs of children and their families and networks around children.  I’m just going to talk a little bit about the journey that we’ve been on during the time of coronavirus.  Like all other schools and services we’ve had to adapt our practice and work.  At the end of March as the numbers of coronavirus cases climbed we had to think on our feet, think fast and listen carefully to lots of people’s very strong views and feelings and find a balanced response taking into account the needs of families, children and our staff.  Protocols for off-site contact needed to be written and a whole online way of working implemented and adapted to.  It was a time to keep our heads and a time in which the role of leader has felt extraordinarily important, easy to be swayed but essential to stay balanced and thoughtful with all the competing demands on time and emotions.  Self-caring and kindness must be applied at this time, compassion, starting with oneself. 

Staff and families did really well rising to the challenge.  We closed the on-site school two weeks before the Easter holidays and started our online service with immediate effect.  This continued through the holidays.  After Easter, as the peak in London declined, we opened our doors again for face to face work, we held a zoom meeting with parents and found many of them preferring to continue with the online provision.  We are now operating a hybrid service with some children in school and some children at home and the staff on a rotation across the two aspects of the service. We’ve given parents, children and staff opportunities to let us know how they doing.   It has been a singularly challenging time but, interestingly, some benefits too.  Here are some comments from staff about the pros and the cons;

  • it feels never-ending
  •  it can be difficult to find a quiet room at home
  • I’m proud and impressed with how we have adapted
  • I’ve found that that we are working more as a team with the parents and carers
  • it can be hard to connect online
  • time can feel disjointed
  • It’s hard to observe social distancing when I’m in school
  • I’ve learnt to be more of a leader and have greater confidence in my ability

Last week on television I found it difficult seeing children walking apprehensively into school playgrounds to be greeted by staff in full PPE, ready to take their temperature.  This was the official reopening of schools.  I wonder what memories these sorts of experiences will tattoo on the minds of the next generation.  I think of the moment when we reopened our doors after the Easter holidays, some children coming in baulking against the  bright light because they been shut in a dark room with their computers and others putting measuring tape to ensure we kept two metres away and a poignant moment with the teacher sitting on a bench in the playground with a child on the other side, she’d asked him to move up the bench to try to maintain physical distance and he had taken himself to the other side of the space unable to manage or understand not being able to sit close to his teacher. 

For those just opening their doors it is worth remembering that the thought of it is much more daunting than the actuality.  Most of our staff were apprehensive to come back to the face-to-face, but now are all saying it’s the part of the work they’re preferring.  For Heads trying to manage the anxiety of the staff, parents and children and make balanced decisions about how to work in everyone’s best interest is a major career challenge.  Listening to the demands, expectations and guidance from government and stakeholders and evaluating before acting, exhausting. 

It can sometimes feel as if our work and dedication goes unrecognised but the rewards can come not always from external validation but from the work itself.  Little moments and comments from appreciative parents and carers, joyful interactions with children and young people and seeing staff adapting in innovative and creative ways, dedicated to the cause of education and care for the nation’s children.  I’ve really enjoyed going to Heads’ briefing and other meetings with other staff and seeing how we are all adapting I think we should as a profession be really proud of ourselves.

In Mindcast

Martin Pratt – Welcome to Education in Mind

Martin Pratt is the Director of Children’s Services for the London Borough of Camden and a Director of Camden Learning.  His podcast is an introduction to the Education in Mind website.  He talks about the unique challenges our children are facing at this time and how Camden are working in partnership with the Tavistock and Portman NHS Foundation Trust to provide psychological support for the education workforce.

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Hello, I’m Martin Pratt.   I’m the Director of Children’s Services for the London Borough of Camden and a Director of Camden Learning.  I was delighted to be able to do this initial podcast to welcome a new initiative which is a joint piece of work between Camden schools through Camden Learning and the Tavistock and Portman NHS Foundation Trust.   The Tavistock have a remarkable and well-earned international reputation both for the quality of practice but also for innovation.   We have a long history of close working relationships, of developing systemic approaches together and of thinking about how different disciplines can work together to improve the lives of and outcomes for Camden’s children.  During this most difficult of times when we are all struggling to work out how to undertake our usual roles, but also how to respond both to the needs of each other as colleagues, to the families that we are working with, and most of all to the borough’s children.  We have had to think long and hard about how we might mobilise the best we have in terms of both academic knowledge, clinical wisdom and practice experience.  

I was very pleased when the Chief Executive of the Tavistock, Paul Jenkins, approached me to see if Camden schools would be interested in collaborating in Education in Mind, a completely new approach to thinking about how we create a professional response, both to the stresses and demands that are placed on the education workforce, to teachers and leaders and other staff and disciplines working in Camden schools, and how we respond to the challenges of children in this unprecedented time.  Children who for the most part have been asked not come to school and are facing the challenges and difficulties that are associated with that level of disruption.   Children who, I feel, are in a sense paying the price for the common good, for reducing the transmission and the risk to older generations but, those whose education is being disrupted, who’s social networks and supports are being are removed and who have many challenges and, in a borough like Camden, challenges which include many living in cramped and overcrowded accommodation and with little chance for respite.  

I’m concerned that and we may find ourselves in a situation where the ordinary response of our children to the extraordinary circumstances they find themselves in may lead to a surge in mental health difficulties and emotional challenges and we as professionals have a response to think about that and see how we can do fast learning and transmit information and share best practice look at dilemmas in the way that we respond together to ensure that those ordinary responses from our children receive an appropriate level of support and that as new challenges emerge we think about those things together.   I’m concerned that we may find her generation children where the principal response to the challenges that they face is to seek a kind of clinical response rather than to use their supportive network in order to deliver and the sort of support that is likely to improve matters.

The most trusted relationships that our many young people have are actually in school and we want to be able to support the workforce who are supporting our young people.  So I’m really looking forward to seeing how, as a community of practice educators, clinicians, social workers and others, we come together to respond to the Education in Mind project.  We will be hearing information back from  weekly check-ins which is a kind of rolling survey from staff where specific questions are asked and where we can share need and we can understand the impact  that we think the current crisis has been having on our children and then developing themes and as we hear those themes coming back thinking about where and how as different organisations and different professions we mobilise the best knowledge and experience in order to support these young people.

This is a huge challenge but I think it’s one that we can rise to and I’m absolutely certain that, if this can be done anywhere, it can be done in Camden, it can be done where the model of education support is one based on collaboration and high standards, one where the clinical support available through the Tavistock is world-class and one where the council and other children services have a long tradition of working collectively and collaboratively as part of a network. 

So, I’m looking forward to seeing what happens, I’m very much looking forward to hearing your views and once again thank you for taking the time to listen to this first podcast.  Please take care and we will make sure that together we can really resolve the many issues that our young people are facing.

Thank you

In Mindcast

Ravi Rana – Managing COVID-19 Information Overload

Ravi Rana is a Clinical Psychologist and Director of Therapies at East London NHS Foundation Trust. In this podcast she talks about the wealth of information created in response to COVID-19 for the general public and health and social care professionals, and that while helpful, there is a danger of becoming overwhelmed and indifferent to new information and feel deskilled and incompetent. Many already have the skills needed to deal with the challenges of the pandemic, with communication and comradery with friends and colleagues helping the effective mobilisation of resources. 

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Nowadays we have access to information and the ability to share that information on a scale that is truly amazing. We have fantastic opportunities for learning, and sharing what we are learning during this pandemic and many of us have already felt the benefits of this.

But this epidemic is beyond the experience of most of us, and I think it’s not unfair to say that anxiety, if not the virus itself, has infected most of us. Many of us feel out of our depth and in unknown territory, very quickly we can begin to feel unconfident and as if we have no skills to deal with what’s in front of us.

So we look for more information to steady ourselves, regain our balance and get some understanding of this new situation and challenges. This is a normal and adaptive response to discover everything we possibly can to give us an advantage, to get ahead of the threat at our backs.

We look for direction and to what we should we do under these new conditions.

And there can be an immediate sense of relief when new information comes in. It feels reassuring that someone out there knows what’s going on, like someone is in charge, and that someone has an answer that will relieve us of all this uncertainty.

But while there is reassurance in knowing that people are thinking about this, and even better, thinking about this collectively, there is another side to this burgeoning wealth of information. And I want to talk a little about that, and the potential indigestion and indifference that many of us are beginning to experience in the wake of the information explosion in response to the COVID-19 pandemic.

As this crisis unfolds more and more information floods in, there are helpful fact sheets about just about every aspect of our lives – how to eat and sleep, what sort of exercise to do in our confined spaces, how to socialise, how to work, how to communicate with one another and even what to do about our pets. There’s no area of our lives that hasn’t been thought about by someone out there and deemed worthy of a COVID makeover.

For professionals in particular, there is even more ‘help’, our professional bodies and colleagues have swung into action and I don’t think I’ve ever seen such proliferation and sharing of helpful information, all of which feels compelling but also, if I’m honest, exhausting.

All this information is becoming overwhelming. There is a limit to what we can take in and there is a danger that in protecting ourselves from overload we can become indifferent to all new information, including stuff we really need to know …

I have colleagues whose views I respect and value … they send me reams of ‘helpful’ links they’ve found. I can see that a lot of it is the same content, sometimes repackaged in a more user friendly way, and it has stopped feeling quite so helpful or even friendly to me, and now I am starting to feel a bit hounded by all this stuff.

But it’s difficult to just turn off the information flow. It feels important somehow to keep up and who knows, there might a golden nugget out there that is going to make all the difference. And even though most of us know there isn’t, the pressure is there to keep looking for something more, something new, to stem the anxiety we feel and to help us feel less powerless.

One of the more unhelpful sides of this information overload is that the skills we thought we had somehow don’t feel good enough anymore. We can begin to feel inadequate to the task in hand and to lose our grip on the competencies we took for granted before the pandemic. In my organisation, for example, as in many others, a huge source of anxiety has been the lack of adequate protective equipment. There has also been a lot of confusion about how to use it. Our leadership responded positively by managing to get the equipment that was needed and by issuing guidance about usage. But staff continued to feel confused about how to use it despite our organisation’s clear guidance. Here I think anxiety was fuelled by exposure to an unhelpful slew of confusing external information and this led to staff feeling deskilled and less competent. This got in the way of their being able to understand and follow local instructions which they would normally have had little difficulty with. The problem here was not the information we were giving staff, rather it was about containing anxiety stimulated by multiple inconsistent information feeds, and that needs a different kind of response.

The point I’m making here is that while information is vital, so is context, and what is helpful in one situation may not be in the next. In my organisation, the guidance about protective equipment was not the problem, it was how it was communicated. After a couple of goes at reissuing the guidance, our leadership took a different tack and decided to write personally to each staff member about how to use the equipment. This personal level of communication helped to contain staff anxiety and it made it easier for staff to recover their usual level of competence and take in the provided guidance.

In amidst this information snowstorm it’s important to remember that most of us already have within ourselves much of what we need to deal with the challenges of this pandemic through our trainings or in our personal tool kits. And what we actually mostly need is the support of our friends and colleagues, space to talk and share our experiences, learn from and lean on each other. This camaraderie is what will help up tolerate and manage the huge uncertainties facing us and allow us all to mobilise our resources effectively … remember … it is good to talk!

In Mindcast

Sarah Appleton – COVID-19: How to regulate distress and identify helpful sources of support

Dr Sarah Appleton is a Clinical Psychologist working in Employee Health for Central London Community Healthcare NHS Foundation Trust. Sarah shares strategies about how to best regulate difficult emotions to allow you to effectively identify and connect with sources of help. Two blogs accompany this podcast, one entitled ‘Why we’re all grieving’ written by Sarah and the other ‘Suffering during a time of crisis’ written by her colleague Neal Gething.

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Hi there, my name is Dr Sarah Appleton and I am a Clinical Psychologist working in Employee Health for Central London Community Healthcare NHS Foundation Trust. I am currently helping to shape the psychological support for trust staff in light of COVID-19. Throughout my conversations with staff members, and mirroring my own personal experience, I have become increasingly aware of how difficult feelings such as stress and anxiety can overwhelm an individual and make it difficult to identify a way to move forward. I therefore wanted to share with you some strategies to help you regulate difficult emotions, allowing you to engage the “wise mind” and move forward with what is most effective.

So, with that in mind, I wanted to start by reiterating that these are unprecedented times. As clinicians, we are likely to experience intense professional consequences of COVID-19 that may include a change to our job roles which bring new feelings of uncertainty or inadequacy, managing larger caseloads or holding greater risk, navigating difficult ethical decisions, or witnessing greater loss of life. 

Moreover, in addition to the professional impact of COVID-19, we are not experiencing these changes in isolation. We cannot simply “step into” our professional role and “step back out” to “normal” life; our normal has changed. Returning home may no longer be a safe place. We may find that our personal lives are now invaded with new anxieties for our own safety or the safety of those around us, with COVID-19 news offering a relentless reminder of the challenges we face, with financial uncertainty, or with personal bereavements.

Listening to Ravi Rana’s most recent podcast on “COVID-19 Information Overload” I found myself reflecting on how difficult it can be, during a time of high threat, to actually be able to see the wood through the trees and identify a helpful way forward. We may feel so overwhelmed, or so on autopilot trying to cope, that it can be difficult to even recognise our own distress let alone navigate the wealth of “support” that is made available to us.

I therefore wanted to create a podcast with this in mind. To offer an understanding as to why feeling overwhelmed is a “normal” response, and to offer some support on how to best regulate these difficult emotions to allow you to effectively identify and connect with sources of help.

Understanding our “Threat Response” System

Drawing upon emotional regulation literature, we know that when we encounter times of high threat our innate “fight, flight, freeze” response is activated.  This is our evolutionary response to threat that was designed to keep us safe. If you think of our ancestors encountering a lion, they would either need to get ready to fight it, flight (run away) or freeze (and hope the lion didn’t see them).

When this “threat system” is activated we experience a downturn in emotional processing. That is, our higher level executive functions (responsible for planning, reasoning and complex problem solving) go offline. This is not our fault. If you think back to the lion, it was not helpful for our ancestors to plan their escape or to consider the impact that their response would have on the lion – they just needed to get out of there.

However, whilst the activation of our “threat system” is not our fault, we can see that recurrent activation of the “fight, flight, freeze” response in our current circumstances can cause some problems. In our current circumstances, this might look like us snapping at those around us (fight), avoiding work or distracting ourselves with less pressing tasks (flight), or feeling so overwhelmed that we find it difficult to make decisions (freeze). This can also look like us “freezing” with knowing what, or how, to access sources of support.

Creating a Moment of Pause

So what do we do? Whilst this response is not our fault we have a responsibility to notice and work against this, actively slowing down and allowing our logical “wise mind” to come back online. In creating a moment of pause between a stimulus and our response, we can help to effectively regulate our emotions and identify/pursue what is most helpful to us.

Dr Russ Harris outlines a helpful tool for slowing down that can be described using the acronym “ACE”:

  • A: Acknowledge your thoughts and feelings. Try to do this without judgement or fear, recognising that we need to experience the full range of emotional experiences – good and bad. Try to make room for this, fostering a sense of compassion for the distress you may be experiencing.
  • C: Come back into your body. Bring attention back into your body by taking a few deep breaths, pushing your feet into the floor or pressing your fingertips together
  • E: Engage in what you are doing. Bring your attention back into the room by focusing on your five senses, or five different things that you can see. Now bring this full attention to whatever are you doing.

Committed Action: Focusing on What You Can Control

Slowing down and naming your emotional experience allows you time to acknowledge and validate the distress that you are feeling. Once you have acknowledged your emotional experience, and allowed a moment of pause to regulate the “threat” system, you are better able to recognise what support might be most helpful.

I have split the potentially helpful committed actions that I have noted from personal and professional observation into three steps.

  1. Focus on what you can control: The more we focus on what we cannot control, the more overwhelmed we feel. We can’t control COVID-19, and we can’t eliminate our normal emotional reactions to it. What we can do is focus, moment to moment, on the choices we do have.
  2. Remember your strengths: COVID-19 means that you are likely to be experiencing increased distress without access to your full range of previous coping strategies (e.g. going to the gym, distracting yourself with work, or meeting up with friends or family). It’s therefore not surprising that you might feel somewhat ill-equipped to deal with the current pandemic. Whilst COVID-19 brings new challenges, remember that you have effectively navigated times of difficulty in the past. Take a moment to remember how you coped historically. Write a list of what helped and then try to adapt these strategies to your current circumstances.
  3. Seek support where helpful: These are unprecedented times and we may all need to access additional support at one time or another. Once you have got used to naming your emotional experience, see what themes come up regularly (e.g. anxiety). You can then visit the “Resources” tab for helpful links to appropriate psychological support, clicking on whatever psychological presentation is most present for you.
In Mindcast

Lucy Swift – Managing Screen Time

Lucy Swift is an Occupational Therapist at the Royal National Orthopaedic Hospital NHS Trust working with patients who have chronic musculoskeletal pain. Lucy provides advice about how to manage screen time while working from home and shares information about some helpful apps that can support you with this.

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Hi Everyone,

My name is Lucy Swift, and I am an occupational therapist working with patients who have chronic musculoskeletal pain. Like many people, I am currently required to work from home, and I am finding that I’m spending a lot more time in front of the laptop, or looking at my phone for WhatsApp messages, and not moving as much as I’m used to.

After 3 weeks of working from home, I have noticed that I am feeling more lethargic, my eyes are sore and my joints are getting stiff.

So I’ve given myself a talking to, and decided I should probably take some of my own advice.

Firstly, I have set up a comfortable workstation. We don’t have the luxury of a separate office in our flat, so each evening the workstation has to be dismantled and return to being a dining table. This is a good thing, because it means I pack away the laptop at clocking off time, and I’m not tempted to work into the evening.

Now, I know what a comfortable workstation should look like.

But at home I thought a table and dining chair would be just fine. However, after a few hours I found that the chair I was using was too low, which meant my shoulders were elevated, creating tension. I put a firm cushion on the chair and that has made a big difference. My shoulders are now more relaxed.

I made sure there was plenty of legroom under the table. Sometimes I use a footrest (aka encyclopaedia – who even has encyclopaedias these days?!)

I have a separate mouse so my right arm and shoulder gets a bit of movement.

What I don’t have is a laptop stand. Ideally the top of the screen would be level with my eye height.  Then my neck wouldn’t have to work so hard to hold my head up! Maybe I’ll use a box file or some books to raise my laptop, and see if I can source a separate keyboard. I would use a separate monitor if I had one. Or maybe the TV.

I have popped a small cushion behind my back as a lumbar support. It’s not perfect but it’ll do.

But probably more important than all of the above, is how often I move. I wish I had a height adjustable desk, but I don’t. I don’t even have a desk raiser. Then I remembered that thing I talk to patients about ALL THE TIME.

Pacing. Changing position or demand on your body BEFORE your body tells you to.

Pacing is hard. I’m not gonna lie to you. Even when your back, neck and shoulders are on fire, you’re still thinking “I’ll just finish this sentence….” before you stand up and stretch.

Luckily there are loads of things to help with this. Before we get into the technological assistance…

I have found that if I plan my day carefully, it can prompt me to pace it better. I stretch before I sit down. (I may do “5 minute Yoga with Adrienne” on YouTube if I’m really good).  I try and stick to my usual work hours, which means I take a lunch break at 12.30. I schedule video or phone meetings mid-morning or mid-afternoon if possible, and I walk around while talking. That’s easier to do than in a meeting at work (I just need to remember to do it!). After I finish a call with a patient (which may have been intense. And tense), I stand up and stretch before writing the notes. If it’s been a particularly challenging call I might throw in a downward dog. I also drink A LOT of tea. Loose leaf green tea is my current preference. I also have a pea sized bladder (hurray!) which is conducive to pacing.

While sitting, neck stretches and shoulder rolls are essential. When I’m at work I’m frequently turning to chat to colleagues. And I wouldn’t constantly be at the computer. So I go and do some laundry or unload the dishwasher, or just dance around the kitchen. I find wrist rotations are also good, and I have a vertical mouse which I sometimes use for better positioning.

I’m also a huge fan of meditation, for many reasons. I could say a lot about mindfulness, but for the purposes of this podcast I will just say – take a short break mid-morning to meditate for 5 or 10 mins, and you won’t regret it. That email can wait!

So on to technology… of the several mindfulness meditation apps I have tried….

I keep coming back to my absolute favourite, Headspace. It has some free stuff, but it’s worth subscribing to. Calm is also very good (but you have to subscribe if you want Matthew McConaughey reading you a bedtime story). Oak is totally free, and includes sound effects.

Now on to the apps for pacing:

Firstly, the Stand Up app (for IPhone). This is so simple – you choose the sound you want it to make, to remind you to get up frequently. Mine is currently set to the “duck typing” noise every 20 minutes.

Then you have Break Time (the same thing for android phones).

Now for the computer:

Work Rave (for Windows) – this app is the absolute dog’s whatsits. A free reminder to take micro breaks, tea breaks and set your daily limit (includes stretches and eye exercises).

If you have a Mac, try Time Out or Stretchly.

There is also an app called “Stretching Exercises at Home – Flexibility training”

I like to have a soothing screensaver (I had to cancel the trip of a lifetime to Japan, so I’ve tried to bring Japan to me on my screen).

What else have I found helpful?

I go into the garden for lunch/breaks. I have that all important one walk a day as soon as I log off. I have also tried to bring the outside in by having several plants in the room.

Plants absorb carbon dioxide and release oxygen. They also soak up toxic chemicals. According to NASA, the top 10 air-purifying plants are:

  • Peace Lily
  • Golden Pothos
  • English Ivy (use with caution!)
  • Chrysanthemum
  • Gerbera Daisy
  • Mother-in-law’s tongue
  • Bamboo Palm
  • Azalea
  • Red-edge Dracaena
  • Spider Plant

I’m a real novice gardener, but if these can help, I’ll get them all!

And finally…. I try and snack every couple of hours and drink plenty of water. (Sounds obvious but it’s so easy to shut off from these basic needs when you’re in work mode).

So hopefully all of the above will make working from home a bit more pleasant. Stay safe everyone and look after yourselves.

In Mindcast

Jane O’Rourke – 5 minute soothing sleep breathing exercise

Jane O’Rourke is a Yoga and Meditation Teacher, and a Psychodynamic Psychotherapist with Children, Young People and Families. She teaches Yoga4Trauma within the Trauma Service at the Tavistock and Portman NHS Foundation Trust. Jane guides us through a 5 minute soothing sleep breathing exercise aimed at helping you to get some rest, or to get to sleep.

View transcript

Hello, this is Jane O’Rourke. I’m a Child Adolescent and Family Psychotherapist, and yoga and meditation teacher. Today we’re going to do a relaxing, calming breathing exercise, so let’s start by taking a moment to find a comfortable resting position; could belong down or sitting in a chair – whatever feels most comfortable for you.

Let’s start with a few relaxing breaths, inhaling through the nose and out through the mouth, taking deep, relaxing in-breath and slow, relaxing out-breaths, and relaxing out and releasing any tensions of the day with each out-breath, just following your natural breathing pattern: breathing in and breathing out. Breathing out through the mouth helps relax all the tensions that might have built up through the day, almost like a releasing valve.

And now let’s begin our restful breathing pattern. To do this, we’ll be inhaling though the nose, and again, breathing out through the mouth.

So inhale through the nose for a count of 1, 2, 3, 4; holding the breath for 2, 3, 4, 5, 6, 7. Exhale through the mouth: 2, 3, 4, 5, 6, 7, 8.

Inhale through the nose: 2, 3, 4, hold for 2, 3, 4, 5, 6, 7. Exhaling for 3, 4, 5, 6, 7, 8.

Now on your own, inhaling for 4, holding the breath, and then exhaling. Now inhaling 1, 2, 3, 4, holding, now exhaling.

We’re about half way through.

Inhaling, holding, exhaling.

Inhaling, holding the breath, exhaling.

Inhaling, holding the breath, and exhaling.

The last time: inhaling, holding, and exhaling.

And now letting the breath return to its regular rhythm, not trying to change the breath in any way. Breathing in and out through the nose and allowing yourself just to completely relax here, and allowing any tensions in the body to just evaporate with each out breath, Allowing each in-breath to bring strength and courage, a new life; and every out-breath just to allow the tensions of the day that have built up to release and let go. Allow yourself to do nothing.

You can focus now on the breath, wherever it’s most prominent in the body. That may be at the tip of the nose or in the chest or in the belly, but still notice the rise and fall of each in-breath and each out-breath. And of course our minds might wander, so any time you notice your mind has wandered off, just bring it back to the focus of the breath, allowing the whole body to relax and the mind to relax as well. Allowing the mind to slow down.

You can stay here for as long as you like now, just resting, or allowing yourself to fall asleep.

In Mindcast

Sheena Webb – Being OK With Not Being OK

Sheena Webb is a Consultant Clinical Psychologist, Service Manager and Joint Clinical Lead for the Family Drug and Alcohol Court Team, at the Tavistock and Portman NHS Foundation Trust. She speaks about what happens when we are pushed out of our comfort zone in response to distressing situations and pressures at work, and how to manage our inner critic.

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I have been hearing a lot about professionals in the public sector who are being redeployed and having to work in areas they do not normally deal with. With many people being exposed to things they had never been exposed to in their career before, like deprivation, death and like children at risk of harm. Even those who have not been redeployed are finding they are having to work in very different conditions, working outside of our normally tight guidance and governance rules. The phrase ‘We’re making it up as we go along’, comes up a lot, I’ve used it myself. 

Many of us are working outside of our comfort zone. Delivering services without the right equipment, without the benefit of face to face contact, with fewer resources and less contact with the colleagues who usually brighten our day. Some of us perhaps do not have much choice about being on the frontline, about being exposed to risks that make us anxious. Many are doing this whilst worrying about colleagues, friends or family who may be at risk or unwell and bearing the financial pressures and other losses that lockdown has brought. Some are doing this without the benefit of someone to meet up with at the end of the day, without that reassuring hug, that offer of a cup of tea. 

I wanted to talk a bit about what happens when we are pushed out of our comfort zone. In particular about what happens when we are exposed to distressing situations and pressures at work. I work in the Family Courts, and people often ask me how I cope with all of the upsetting things I see. To be honest how I respond usually depends on the day I’ve had. And this got me to thinking that the danger of giving messages to people about how to cope with difficult issues, is that it might give the idea that there is a right way to cope, that if you’re doing it right you should be coping, that coping means feeling fine and that somehow not feeling fine is not OK. What do we really mean by ‘coping’ anyway?  How do I know if I am ‘coping well’ with something?     

When I was thinking about this issue, I was reminded of a job interview, for my first job in safeguarding.  I remembering being the waiting room, and the interviewer handed me a case study and left me to prepare.  It was about an infant who had been severely injured.  There was detailed description. I felt like someone had punched me in the stomach, my heart rate shot out of control, I thought I was going to be sick.  Panic set in, the words on the page started to swim and I had the overwhelming impulse to leave. The over-riding thought in my mind was ‘I can’t do this’. In retrospect I think the only reason I stayed was that I couldn’t face that embarrassment of backing out at that point.

Ten years, and many, many sad and horrific stories later, whilst the stomach-punch panic response is not as strong, I have to be honest that the work still gets to me. In fact, I truly believe that to become immune to hearing about children being harmed, would be to lose my humanity. If I got to the point where I had no emotional response to such things, surely that would be a sign that I needed to leave. So how do I stay emotionally connected enough to stay compassionate without becoming overwhelmed by my emotions? As I say this, I notice, I’m back to this idea of a ‘right’ way of doing things. 

I still think that we collectively carry a notion that we somehow can become ‘OK’ with pain, abuse, death and loss. And we do as human beings have a tremendous natural ability to heal from both physical and psychological wounds. But often part of that healing process is about recognising the wounds, and feeling the pain. Often our natural healing processes are disrupted by being in too big a hurry to ‘be OK’, or at least, look ‘OK’. I think it’s also important to remember that healing doesn’t necessarily equate to feeling no pain. Rather it often means learning to carry on living, alongside the pain. 

The pressure to be ‘stronger’, to ‘cope better’ often triggers us into feeling even worse. I often hear people in therapy talking about how they feel others ‘cope better’, mistaking people’s outward calm as ‘better coping’.  Very often these are the very same people who are hiding their emotions from others for fear they will be seen as being weak. Enter our old friends, the inner critic and, it’s close cousin, the guilt monster. 

Many people have an inner critic, for some it’s just a nagging voice pointing out that the tablecloth isn’t straight enough, or that you really should have eaten that extra biscuit. For others, it is a relentless slave driver, beating the drum, constantly propelling you to work longer and harder, whilst always moving the finish line further and further away. 

The inner critic generally feasts on our fear that we not good enough, and our guilt monster believes that our entitlement on this earth is really only measured in what we do for others. Doing things for others is a great thing, but feeding the endlessly hungry guilt monster is a one-way road to exhaustion. And, here’s the snag, because the inner critic and the guilt monster are driven by fundamental fears about our self-worth, the more we feed them, the hungrier they get.    

When our self-critical inner voices take over, they often over-ride what your body is screaming out at you. These unforgiving voice will often tell you to carry on, be strong, don’t make excuses and never, never call in sick.  And then you find that, despite feeling exhausted, when someone asks you to do that one more thing, you mouth is saying ‘yes’, even if your body is screaming ‘no’.  In these moments we over-ride hunger, tiredness, pain and distress to our detriment. And that’s when we risk doing the real harm to ourselves.  The paradox is that our belief that it’s better to be ‘strong’, is actually what risks making us sick.     

However, the inner critic and the guilt monsters are wily creatures. Sometimes, I have actually found myself criticising myself for criticising myself. The issue is that when we try and battle with, or push these voices away, a bit like a wasp at a picnic, they kind of get more insistent. In reality, what we really need to do is let them be, but not take too much notice of them. Like a slightly irritating and judgemental relative at the dinner table.  Hear what they have to say, perhaps even give a polite response, but then let it go.   

Often, in the context of managing work stress, we hear a lot about self-care.  Taking breaks, talking to colleagues, engaging in mindfulness, eating well and sleeping well.  All of these things are immensely helpful in refuelling our tank. We know that working under stressful conditions has a cumulative impact on our bodies and we know these things are proven to be helpful.  We are literally bombarded with advice on social media about being mindful, eating well and focusing on ourselves.  

However, many people, me included, often find themselves ignoring that advice. Again, the self-critical and self-sacrificial parts of our minds tell us that that advice is for other people. That we are made of steel and we can, and therefore should, just keep going. Or, we really feel that we should follow the advice, but somehow don’t manage it, giving us another reason to beat ourselves with the criticism stick for not ‘taking care of ourselves better’. 

I’m not knocking good advice. It’s really helpful. But at the same time, it’s important to recognise why we don’t always follow that advice, and how that then makes us feel. 

An example of this is when people tell you ‘don’t take it home with you’.  Now I absolutely believe we should try and keep good boundaries between work and home. But this instruction suggests that we have some kind of water tight airlock in our minds that we can activate at the end of the working day. Now some people are great at that, but not everyone, not always. And sometimes, no matter how hard you try to detach from work, an image, a feeling, a painful detail, will follow you home. This is another moment to go easy on yourself and recognise that this happens sometimes.  That we shouldn’t feel bad about it. We should just feel human. 

Often the feeling that follows us home, is a feeling that we didn’t do enough, a worry that the person we tried to help, is still in pain or at risk.  It is really important to recognise that, however brilliant you are, there is a limit to what you can control. There is also a limit to how much you can do with the resources you have. The outcome of any situation is the result of many factors, not just how good a job we did. 

When we work in high risk or high need situations, we can feel terribly responsible for things that simply aren’t our doing. And this can be more acute when we are faced with vulnerable and distressed people. I always to say to my teams, imagine you are in A&E responding to a train crash, absolutely try your best to help people, but always remember, you didn’t cause the crash and you cannot save everybody.

Strong emotion, particularly anxiety, triggers powerful impulses to act.  When we see something terrible happen to someone else, a part of us says ‘that could you be you’, ‘that could be your child’, and activates our threat system. Our mind, detects the alarm and screams ‘do something’! The more frightening and shocking the situation, the more the force of our emotions can pull us into feeling we must act. But action is not always what is needed. Sometimes our compassion, our calm presence is more important than anything.   

So when we get home, whether the stresses of the day have followed us home or not, it’s helpful to allow ourselves the space to feel what we feel.  To let our inner critic chatter on like a radio in the background, without getting too involved. Whether we find ourselves using mindfulness, or crying, or binge watching box sets, or reorganising the fridge. To be aware that we all cope in our own ways, and the most unhelpful thing we can do is beat ourselves up for how we are coping.   

Some days are awful, and leave us feeling terrible. But if we can accept that and be kind to ourselves about it, more often than not the feelings pass. Like a plane bumping through turbulence, it can be uncomfortable and scary, but rarely dangerous. You can’t control the turbulence, all you can do is keep flying through it. And know that it’s not necessarily about flying the plane better.  You are already doing the best you can. And that is good enough.   

And if the turbulence doesn’t pass.  If you find that the awful feelings are still there the next morning, and the next and the next, if they are keeping you awake night after night, if your inner critic won’t leave you alone, if you feel numb and cannot connect with people and you feel like you are losing sight of the good in the world. Then yes, that is that time to seek more help.  And again, another time to be kind to yourself, because if you feel this way it is not your fault or failing, what you’re dealing with is just too much. As professionals we are not immune to depression and anxiety but we can often expect ourselves to be. Again, accepting how you feel without judgement, frees you up to seek the help you need. Berating yourself for not coping better, will make things much, much harder.

I hope you find some of these thoughts helpful, but if you didn’t, or if you find you can’t sit with your feelings, or you can’t ignore your inner critic, or you do agree to that extra shift, please remember, that’s OK too. 

In Mindcast

Jo Stubley – Introduction to Trauma and the Current Pandemic

Dr Jo Stubley, Consultant Medical Psychotherapist, Psychoanalyst and Lead Clinician for the Tavistock Trauma Service. Here Jo presents a brief introduction to trauma in relation to the current pandemic.

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Hello my name is Jo Stubley, I am a Psychiatrist and Psychoanalyst and I run the Tavistock Trauma Service. I am aware in these difficult times that many staff may well be experiencing a number of traumatic events, and I thought it might be helpful to say a little bit about that today.

So what do I mean when I’m talking about this idea of trauma? Well I think at the heart of this is an experience of helplessness, and that can be really difficult for staff who are used to doing the things, not to feeling helpless. I think the other aspect of trauma is that it is often something that is overwhelming, so that our usual ways of coping no longer work. Now that might be a single episode of something terrible happening, either that you witness or that you are involved in, or sometimes it can even just be something that you hear about. Trauma though can also be cumulative, so it may be something that small but significant episodes build up over time. What is traumatic for one person may not be so traumatic for the other, it is often a combination of that particular moment for that person, with their history and if we have a lot of trauma or difficult losses in our background, that may make us somewhat more likely to develop some symptoms after a traumatic event. It might also be that trauma occurring now can link up with these earlier experiences and one might find that earlier losses or traumas get brought to the forefront of one’s mind again.

So, in relation to thinking about the kinds of symptoms that you might have having had something traumatic happen. First of all I want to say that it is very normal after something traumatic occurs to have a number of symptoms that are not part of a mental health issue, they are a normal response to an abnormal event and for the majority of people will settle over time, particularly if one is able to use self-care and the supports that are around. The sorts of things that we find might get activated after a traumatic event come under three main headings:

  1. The first we might call anxiety or hyper-arousal. This is like the fight-flight response; a threat is perceived and one has something activated inside in terms of our body’s response to threat that keeps happening, so you can feel agitated, distressed, find it difficult to sleep, might have moments of real panic. These are the kind of symptoms of anxiety and hyper-arousal.
  2. The second type is those of re-experiencing symptoms, the reliving of the traumatic experience which might be intrusive images that come to mind, it might be intrusive thoughts, it could be nightmares or even flashbacks, where one relives over again what is happening and these things are often triggered by something in the environment that reminds us of the event, quite often it is smells that are particularly powerful for that.
  3. The third type is avoidance and numbing, and it is a way that we kind of shut down a bit, we don’t feel as much, we may not wish to talk to people, we may wish to avoid having interactions or even going back to work, and that is often a way of trying to shut down these symptoms, not get triggered, not feel so over aroused but can be problematic if one feels too much like we want to avoid.

Now all of these symptoms are normal, they are the kinds of things that over time will settle, but it is important to think about what can be done in the meantime. The first thing to say is that all of the evidence suggests that people recover from this much more easily if they feel they have a good social network around them. Now I am aware that that means at the moment we have to work particularly hard to hold on to that because it mainly has to be virtual, but it does stress the importance of keeping our connections in this difficult time. The other thing that is really important is to think about basic areas of self-care; diet, exercise, as much sleep as possible, not using alcohol, prescription or illicit drugs to try and manage these things, the kinds of basics that are really important to come back to.

We will be talking more about how to think about trauma but I hope that this brief start is something that can be helpful for you, thank you.