Ein Leitfaden von Prof. Nimisha Patel & Prof. David Becker
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COVID-19 – Psychohygiene statt Panik. Die COVID-19 Pandemie ist zugleich bedrohlich für unsere körperliche Gesundheit als auch eine massive psychische Belastung. Wie können wir in Zeiten des Krisenmanagements psychisch vernünftig bleiben und andere dabei unterstützen? Prof. Dr. Nimisha Patel hat zusammen mit Prof. Dr. David Becker im Auftrag der GIZ (Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH) und für die UNRWA (United Nations Relief and Works Agency for Palestine Refugees in the Near East) den englischsprachigen Leitfaden “Guidance: Looking after ourselves and others in times of Covid 19” erarbeitet.
Guidance: Looking after ourselves and others in times of Covid 19
Prof. Nimisha Patel and Prof. David Becker
29th March 2020
We are all living and working in unprecedented times and under extreme pressure. The current circumstances may have led to sudden and perhaps dramatic changes in our external and work environment, and significant changes in our private lives and our working practices. This is inevitably very stressful for all, at both the professional and personal levels. For some staff there is the added strain of being away from loved ones, and worries about their safety and wellbeing as well as your own; and for some the strain of juggling family life and work demands, in confined spaces.
The Covid 19 pandemic is both a real physical danger and creates a significant psychological threat. Our normal, automatic ‘fight or flight’ response to help protect us from perceived threats and dangers may no longer be useful – the threats we perceive are ever-present, invisible, unpredictable but persistent. One normal fear response may be ‘flight’ – to escape the threats we perceive, except in the present circumstances, this is not an option. The second fear response may be ‘fight’ – to try to fight the threat or danger we perceive, except again, the threat is invisible and latent. The third fear response may be a ‘non-reaction’, or freeze – we may feel like we do not know what to do, where to turn, how to handle this persistent, unpredictable and frightening threat that we cannot see. We may feel like we have no control over this threat and feel trapped, or frozen.
These feelings can overwhelm us and they can create new and additional anxieties and lead to frustrations, irritations, anger and aggression, blame and finger-pointing or withdrawing from others. We may engage in various behaviours to manage our feelings of fear, insecurity, chronic uncertainty and sense of having no control and no idea how to protect ourselves and loved ones. We may engage in reckless behaviours, minimise or deny the enormity of the threat as a way of coping with feelings of being overwhelmed. We may become hypervigilant, engage in obsessive behaviours or escalate our messaging, emailing, posting and without realising that we are escalating everyone else’s and our own fear. Relationships and our connection to each other are also often under enormous strain when we are all struggling with anxiety and various stresses. In other words, fear can compromise our ability to draw on our human connections and supportive relationships, though sometimes, where the threats are experienced by all, our shared anxieties also can mobilise us into showing support, kindness, compassion and solidarity with others.
There is no right or wrong way to cope with fear, and we will all respond in our own ways. However, there are basic steps we can all take to manage our anxieties and fears, to stay as safe and as well as possible, and to stay connected in our relationships with each other, in the current situation.
This guidance is to help you look after yourself, loved ones and each other as colleagues.
Looking after yourself
- Safety steps: Take note of reliable information from medical experts and take the key precautions and vigilance advised by the World Health Organisation (handwashing, social distance etc.) and guard against believing or spreading information from unreliable sources.
- Notice and acknowledge: What is making you feel particularly anxious or irritable in this chronic uncertainty? Acknowledge it – it is important to accept the reality that you feel afraid, and it is healthier to name it and talk with colleagues/families/friends than react with anger, irritation, blame, panic.
- Pause before you react: We can react to perceived threats often with anxiety and fear and less reflection – this can escalate rapidly into panic for some people. It can also become ‘contagious’ – you can escalate other people’s anxieties and panic behaviours. Pause, take a few deep breaths and count to 10 – before reacting. Be open to hearing what others or close ones have to say about what you plan to do.
- Reflect: The anxiety may be due to many worrying thoughts, realties facing you and loved ones – what is it that is making you feel particularly anxious right now, and why? Are you speeding ahead in your mind? Remember, not all thoughts are facts. Not everything we hear or read is true. Not everything we see is as we perceive it. Ask yourself: do I need to find out more, sift through what is reliable information and what is maybe not…?
- Focus on the present and connect with yourself: What is going on for you right now? Close your eyes or lower your gaze and focus on your breath, making it slower (e.g. breathe in to the count of 3, pause, breathe out to the count of 6, or whatever breathing exercise works for you). Keeping your eyes closed or lowered, scan your whole body and ask yourself: What are my physical reactions/sensations? What can I touch, and feel? What can I hear, what can I smell?
- Stay calm: Do not obsessively Google your symptoms – which may be anxiety-related not Covid 19. Instead, take steps first to do what helps you to stay calm and what can help build or maintain your immune system. For example, build into your day:
- Breathing exercises
- Relaxation and meditation exercises
- Exercise and regular movement
- Spending time with loved ones, where possible
- Drawing, colouring, doodling, music, dance… whatever works for you!
- Control exposure to social media and news: Limit the constant monitoring of social media and news feeds, turn off notifications and updates and check at specific times only, scrutinise sources – or limit to only trusted sources. Social media updates can inflame or spread unhelpful/incorrect information, and news items may reassure us momentarily, but can lead to information-overload and confusion with contradictory information – which can increase anxiety.
- Listen to your intuition – but also remember that ‘intuition’ is fuelled by fear and distorts our ability to appraise the situation we are faced with. Take the time to really connect with yourself (see 5. above). Ask yourself: What is going on for me right now? Why am I so frightened? Am I really in danger right now, at this point in time? What is that danger or threat? What is the likelihood and imminence? What am I already doing to keep safe as possible under the circumstances?
- Connect with others: Use whatever means you have available to stay connected and do not isolate yourself from others – we are social beings, and personal, supportive relationships are crucial in maintaining perspective, lifting our mood, laughing, helping us focus on everyday activities/issues and the ‘new normal’ issues.
- Structure your day: Ensure predictability and structure in your time. This can help us to create a ‘new normal’ – for however long this period of isolation, quarantine or curfew lasts. Structure also means establishing new routines, or adjusting existing routines so they are workable in this ‘new normal’ times of significant strain, confinement and restrictions . We cannot be afraid 24 hours/day – we can structure our time so that we make specific times to check the news or messages, for example, then connect with how you feel and what is worrying you. Make specific times to talk about Covid 19 (and your responses and worries) to colleagues, and specific times to talk and share your worries with family/friends. Structuring our day is not easy, especially under curfew and prolonged isolation. Review, reinvent and revise your structures and routines, adapting them so they work for the changing circumstances you are in. Living alone, under the current circumstances, creates additional stresses. Days may feel very long and blend into each other. Structuring your time may feel very difficult, but it is essential to still develop a new structure and routines in your day that also allow you time to really and regularly connect with others – colleagues and loved ones.
- Support each other: The current situation may bring out the best and the worst in us. For some, on top of all the stresses they are already experiencing, they may be subjected to threats, accusations, aggression and sometimes racist behaviour (e.g. being called “Corona” or “virus” or being told to “go back to where you came from”). Discrimination and racist, abusive behaviour is always unacceptable. If we hear of this or witness it, do what you can to name and challenge racism, and to support colleagues experiencing racism. If you are experiencing such racism, share with your colleagues and others you trust – and allow them to support you and to challenge this discrimination.
- Allow yourself to be human. Because you are.
- Accept that you are human. We cannot all be positive all the time. We may not always feel like we are able to cope. We may make mistakes, get frustrated, irritable and angry with others, including our children and other loved ones. Recognise that these extreme circumstances can test us all, and our capacity to be human and compassionate with each other.
Supporting loved ones
- Make time to be together –in person, if you are together or virtually. Make time to be together, eat together, laugh, play, read, watch something and share together.
- Connect to each other: Talk and listen, take turns to really listen to each other – what loved ones say, what they don’t say but convey (worries, fears, irritations…). Set times to talk and listen to each other – without distractions, phones, television etc.
- When communicating with loved ones virtually – help each other to really communicate, to talk, to share, to listen. When communicating by social media/messaging avoid superficial friendly exchanges which may look like communication but offer no real connection or support.
- Share the support role: Accept the support and love you are offered – you don’t always have to be the person giving support. Children also feel better when they feel included and that they are able to help in small ways.
- Structure and routine: Help each other to establish and maintain a structure to each day with routines. Structure and routines help us to have some predictability, rhythm and normality in our ‘new normal’ situations and this can help us manage our anxieties and the constant uncertainties we may face around us. As circumstances change, help loved ones to review, reinvent and revise their daily structures and routines.
- Problem-solve together: Discuss challenges or problems which arise, even if you are not necessarily together, share, problem-solve and plan together, wherever possible. Ask: what can we do, who can do what, how, when and when shall we review/re-think?
- Focus on the present: The mantra of ‘one step/day at a time’ is sometimes very useful. Remind each other to take each day and step at a time. Speeding ahead in your mind, rushing and trying to do everything at the same time or at great speed may increase your stress and make you less effective.
- Be patient and kind to each other: Acknowledge that everyone is under strain and we cannot all always be sensitive, calm, happy, jolly, positive or in control.