Mental Wellbeing During The Coronavirus Lockdown

Jim Preen: All right, well, goodness knows we're living through some strange times at the moment. In the UK, we're now in week three of the lockdown and I'm talking to you from Central London. It's a beautiful bright clear early spring day and I've lived in London for the majority of my life, but right now it doesn't look like the London I know, it looks pretty much like a ghost town. Everything we- I take for granted seems to be shifting beneath our feet. COVID-19 is taking us to a new and most unwelcome territory.

I think it's fair to say that nobody alive today has lived through an emergency which literally involves the whole world. Which is why I'm delighted to say I'm joined today by Dr. Liz Royle to talk about the psychological stress of living with COVID-19. What we're going to talk about is how you can maintain your mental well-being during the lockdown. I'm in an extraordinary circumstances. Our prime minister is now in intensive care just a mile away from where I'm speaking from, St Tomas' Hospital, which shows what an awful democratic disease this is. It can take anyone and it's pretty frightening for people.

It makes people extremely fearful, which is why I'm delighted to welcome Liz today. Liz, can you hear me okay?

Dr. Liz Royle: I can hear you, Jim Preen. Thank you. Thank you for having me today. Looking forward to the conversation.

Jim Preen: That's fine. I'm really looking forward to this as indeed I'm sure as our whole audience. Before we get underway, Liz, I'm going to put a slide up here. Oops, I was going to put this slide up here. I am pretty good slider. I hope you could always see, by the way, put a slide up here about this. This is who I'm talking with Dr. Liz. There's it, people can read the slide up there but could just tell us a little bit about yourself, please.

Dr. Liz Royle: In a nutshell. I have 23 years experience of working in crisis mental health with psychological trauma and tended to work across the whole range. I had two organisations response to level of hands-on work, lots of work at the coal face and so across a lot of clinical work with people with PTSD, so very much a specialist in that field. We've got a passion for innovating as well. We've always looked at mental health services. I looked up how come you improve them, how can you make them more accessible? Strangely enough, all the work that we put in place for that is now needed that we can reach people who all working remotely or having to change the methods. It's certainly interesting times.

Jim Preen: Hey, no strange interesting and a little scary too. Now I've prepared a few questions for Liz. The point I want to make here is that anybody listening our audience out there, if you want to put a question to Liz, then please do so right away. Hopefully, on the Zoom software, you can see a Q&A box there. I'm looking at one here and if you want to pop a question in that, please do so and do it right away. As I say, we're not going to wait until the end for questions. I'll put your question to Liz and I'm sure she'll do, excuse me, how best to answer your questions.

I guess I better get underway on this. My first question for Liz is you've written that emotional distress is a natural reaction to what is a very abnormal event and goodness knows it is abnormal. How can you unpack that for us a bit? What do you mean by that and how does it manifest itself?

Dr. Liz Royle: This is a phrase that is commonly used in the world of psychological trauma. It basically means that when something happens that's unexpected, distressing or shocking, and when we feel we've got little or no control in changing it and of course we're going to react, that would be quite a natural thing to do. I think you'd agree that the current crisis takes all of those boxes. The first thing to remember is that the emotional reaction can manifest in different ways. In the middle of the crisis, we're all having a very unique experience and we've all got different backgrounds, resources, coping styles. I'll keep coming back to that. It's very important.

Having said that via an anger or the emotional equivalence of the fight or flight reaction the human response to threat, so we'll see varying degrees of those. Maybe a little anxiety or irritation, right talk to panic and rage. As time goes on, the emotional reaction can include things like low mood, depression, tearfulness, every crisis brings a loss of some sorts. These are natural reactions to that stuff, very [unintelligible 00:04:53], they don't. Depending on how we personally interpret what's happening, you might also feel emotions such as guilt, helplessness or just be known. They're all very natural reactions.

Jim Preen: I suppose and we're going to talk about being stuck in the home and lockdown and working from home and so forth. I suppose the initially, some people may struggle with it straight away, but initially, I think we've certainly in our family found a bit of fun. Everyone's around the dog has certainly loved having everybody around. I guess as time goes on, that doesn't apply and it becomes much more stressful. Would that be true to say?

Dr. Liz Royle: I think everybody goes through the process in a different way. It's very important to recognise the differences.

Jim Preen: Okay. No, fine. Absolutely. You can see I've got another slide up here. We're obviously living through a health emergency. Would you characterise it as a mental health emergency or is that too extreme?

Dr. Liz Royle: Well, mental health and physical health are very closely linked. I suppose it would depend on how we define an emergency. I think there are two issues. Firstly, the need for supporting mental health is higher than ever because people will be having these strong reactions and they will be having them at different times in different ways. We need to look at ways of reaching a lot more people with crisis informed psychological education so that they can help themselves and understand what's happening. The second issue is that mental health services are traditionally delivered face-to-face.

Mental health is not an area that lends itself very easily to change. It's very slow-moving profession. That's a particular challenge for people who've got crisis and trauma because it's a specialist field as well. [crosstalk]

Jim Preen: Can I ask you Liz are you doing-- When you obviously have clients and so are you talking people like over Zoom or over Skype or something? Does that work?

Dr. Liz Royle: It works to a point. What we're having to do, I work with some very high-risk people with PTSD that's post-traumatic stress disorder, very good on acronyms in mental health. We're having to change the way that we work. Having to step back from doing active trauma work into a lot more stabilizing containments that work. We slowing things right down because it's just not safe to do some of the work at that level by Zoom. Well, a lot of crisis mental health work although it's very different to general stress and resilience, lots of it starts with normalizing symptoms and offering appropriate strategies to use them.

I think as we navigate through this crisis, we can learn a lot from the field of psychological trauma and recovery with the principles of that.

Jim Preen: Okay, good. Well, let's get to the meat of this if we will. Can you walk us through what it is about the current situation that makes people so fearful and vulnerable? Obviously it's the threat of catching COVID-19 is one of them, but I think I'm not saying it's more than that as well, isn't it?

Dr. Liz Royle: Yes. There were a lot of complex factors, but a lot of it is the lack of control and a lack of predictability.

Jim Preen: Sorry to jump right in on you here, but I totally get that. One thing that I got right away is if we knew that this was going to go away in a set time, we kind of deal with that. If we said, all right, this is going to be held for two months, six months or whatever, but then it's over, but nobody knows. I think that's very unsettling to people.

Dr. Liz Royle: It's very unsettling because we all like to have control and predictability. Alongside that, this is the fear that all basic needs won't be met. If you think about it in psychological terms, we all have an unspoken, implicit belief system, and that's what keeps us psychologically safe. It's things like, I've got some control of my life. I can predict the consequences of my actions. Good things happen to good people. All of those subconscious assumptions that we have to have in order to cope with life has suddenly been sheltered, and I'm going back to trauma work. We talk about sheltered assumptions that's what makes something so difficult.

Realising that we don't have control, we don't have influence on what happens to us. All the things that we used to rely on, the routines we talked around said, even things like, the ability to get your hair cut or your nails done, the quite trivial in the great scheme of things. Well, they are the little familiar routines that make up lives. and impact around the influence.

Jim Preen: Liz, there's a question come in which is very pertinent and it's exactly what you're talking about now. I apologise for interrupting but it just seems like the moment to do it. The question and comment is very much this week I have zero energy, says this in their fourth week at home and I'm suspicious that I don't feel like working. I don't actually think that's it but what else can it be? I'm not anxious in any way but just the person asking the question just has zero energy and I guess, that's a symptom, is it?

Dr. Liz Royle: It is and I think later we'll be talking a bit more detail about the fight or flight response and when we can't fight and we can't run away, we sometimes get into a more of a passive state that is just, what's the point? What's the point of doing anything because it's not going to influence anything I can't control, I can't influence. It's almost like feeling helpless but maybe not connecting with the emotional side of it but it comes out in your body and another possible cause can be the stress hormones. We live with such a high degree of stress generally. We quite often don't even notice it. We just accept it as background noise but the fluctuating stress hormones can be exhausting and-

Jim Preen: Sorry, go ahead.

Dr. Liz Royle: -learning all the new things that we are having to learn. It's just emotional and informational overload.

Jim Preen: Because of the stress, people are feeling physically exhausted.

Dr. Liz Royle: Yes and that is very, very common with acute levels of stress, that wariness.

Jim Preen: Can we suggest anything to help or can you suggest anything? I wouldn't like to suggest.

Dr. Liz Royle: I think maybe we'll cover that later when we actually talk in a bit more detail about the physical response because yes, you can. There lots of simple things that we can do to help ourselves but what I would say is the first thing and I'll keep repeating this right throughout, the first thing we have to do is accept that that's actually where we are and that that is a natural reaction. We've had our control taken away. We've had our familiar structures taken away. We've got insecurity, unpredictability on these. Of course, we're going to have some reaction to it. We'll vary dramatically in the reactions that we have but that's because we're all unique.

It's about not feeling that there's something wrong with you but saying actually, this is a signal that I actually need to do something to help myself.

Jim Preen: We got another question coming in and you're probably are going to say we'll talk about this later but I can't help but engage our audience. Are there any tips to prevent loss of sleep due to worries about the current situation?

Dr. Liz Royle: Yes.

Jim Preen: Are you going to share it [laughs]

Dr. Liz Royle: Yes. I started thinking, do we just throw all these questions away that we preferred because it is just, we are going to cover these. Yes, let's engage the audience but maybe let's encourage them to listen in a little bit longer.

Jim Preen: Fine. I'm going to tell you when these questions come and we can take a few. I think we can move on towards this fairly.

Dr. Liz Royle: If I can just add one little bit about what is making this such an unusual. It's not just to out the shattered assumptions. It's the losses and the potential loss of basic needs, financial, social, the need to belong, freedom and being surrounded by stories of other people's losses, people that we know or we can empathise with. It's such a lot to take in over a short period of time and some people will react with denial, it's just a flu rather than face reality or it can all just be a little bit surreal and both of those things are ways of coping with the current situation. There's no right or wrong way of doing this about accepting that that's the natural human response that's trying to protect us.

Jim Preen: All right, let's dig a bit further into this. You're already fight or flight. Neither of these things are really available to us with the coronavirus. The coronavirus doesn't care and all of these can create chronic stress symptoms, which we've been talking about. Can you talk about some of the common symptoms and how do we recognise them and then, when we've done that perhaps we can talk a little bit about that, how we can overcome them?

Dr. Liz Royle: Yes, I think that would be good. What we have to think about is the chronic stress symptoms are the continued activation of this fight or flight response. If I could just give you a brief overview of the physical changes in the fight or flight response because understanding it is actually, it's quite empowering. If the human body, the human mind is basically threat it will make changes in your body and some of you will know this. It won't be new to you but one of the things is that our body will change the way that we breathe. It'll breathe shallow. It'll breathe quickly. It'll also take in oxygen to power our muscles up.

That's a really helpful thing when you're faced with a tiger but when it's chronic what you might notice is that our breathing stays shallow and rapid. You might feel light-headed or dizzy and that's a sign that we're not breathing well. If we understand that, then we can look out, "Okay, how can I change my breathing?" It gives us a rationale for doing some breathing exercising, learning how to calm our breathing because that will calm our nervous system as well. Another symptom can be that if we're fighting a tiger we want our heart rate to be high. We want our muscles to be tensed up.

We want to be ready to act but over a chronic time, we might notice a tight chest because our chest muscles or our back muscles will be tense. You might get headaches because of that. We can find that we've got a racing heart or palpitations and we can have all kinds of things like tingling fingers. These are all signs that are very, very familiar to anybody who's in a crisis situation, long time you'll notice these and in an emergency situation with a tiger then we're going to have changes to our digestive system. Our liver is going to release fatty acids and sugar to give us a quick energy boost and our digestive system is going to shut down.

In a chronic situation, we might that our appetite is really not as it usually is. We might have irritable bowel or the back and forth to the toilet or we might just crave fatty and sugary foods and I don't know if anybody has noticed that they're snacking more and they're not snacking necessarily on apples.

Jim Preen: Liz, I've just eaten a chocolate biscuit. I have. I really have actually.

[laughter]

Dr. Liz Royle: We crave them. That is your body trying to replenish the stocks that your liver is releasing into your bloodstream. It's not just a case of will power. It's a case of actually this is my body saying. It's a signal of distress even things like you might get skin rashes, eczema might flare of. These are all caused because the blood's being diverted away from our skin to help protect us in an emergency situation but in a chronic situation it changes in our skin. We get clammy. We get sweats that can cause this kind of rashes and skin problems.

Some of the really small things that we don't attribute to chronic stress are actually a symptom of this continued activation of the fight or flight but it's at a chronic level. The good news is yes, we can do something. Going back to the person who's saying about sleep. If you're faced with a threatening situation, the last thing that your brain wants to do is sleep because it doesn't make sense, does it? Your brain wants to keep you awake. You're in your survival system here and your brain's saying, "Don't rest, don't sleep, don't relax. Focus on the threat." That is your survival thinking and your survival thinking actually shuts down some of your higher-level thinking, your problem solving, your focus, your concentration.

Again it's recognizing that we've got to retrain ourselves. There are two really important things as part of this. One is to avoid triggering the fight and flight response by excessively watching the news, excessively talking about it and thinking about it. I think we're going to talk about that later but the other thing is that when you're in your fight or flight system you're actually you're activating a different part of your nervous system. If you think of, put it very simply, if you think of your nervous system as waft in two.

You've got your sympathetic nervous system and that's responsible for fights of flight responding to threats, and you've got your parasympathetic nervous system that's responsible for calming and soothing the body and the mind. You need to be in your parasympathetic nervous system if you're going to sleep or relax or you're to think really clearly, but at the moment, we're way too far in the sympathetic. Now, what we can do is we can take active steps to rebalance.

Anything that will activate the parasympathetic nervous system is going to feel really alien to us because our brain is saying, "No. No. No. Think about the problem. Think about the threat." That's hardwired to do that. We've got to deliberately say, "I'm going to do some calm steady breathing because as I deepen my breathing and I slow my breathing down, I'm activating my parasympathetic nervous system. I'm tipping the balance in my favor." We work with the system with the body rather than fighting it. Breathing exercises can calm it. We can burn off stress hormones with exercise. That will not only burn off the exercise, it sort of kids your body into thinking that you've done some fighting or running.

In fact, those two exercises are things that we do recommend people who've got PTSD. If you've got a punching bag, that's fantastic or a cushion. You use your fight. Your brain is very very clever but it is also very easily tricked into thinking it's had that fight or run. Anything cardiovascular. You might not be able to run outside but you might be able to run up and down the stairs or do some high-intensity exercise. It will vary from person to person. That might be just not available to somebody. We've got to think of it more creatively about how can you do some exercise but that will calm your nervous system. It also has a definite knock-on effect with sleep.

Now, there are no quick fixes with this because you've probably been for at least two weeks having this stress hormone the fight or flight flooding through your system. What you're having to do is a little bit like turning a tanker. You have to keep making these small steps of exercise, routine breathing exercises and putting them in through the day and slowly but surely if you're persistent with these and if you're structured and you keep going, they will start to have a knock-on effect.

Now, there are two other things that I definitely recommend. First of all if your body and brain are in a state of high response, you don't want to push it any further. Avoiding stimulants. Avoiding caffeine. I don't know how many people are drinking more coffee than they normally would and alcohol. It seems to be that people are drinking more alcohol when they're actually at home all the time and it is becoming almost more socially acceptable. I've been reading it in the paper about certain celebrities who were just waiting for wine o'clock and saying in a jokey way as well that that's perfectly perfect. They're okay.

We can buy into that but what it will do is it will push our levels of arousal, our levels of physical response even higher at a time when we're trying to bring them down. Does that sound sensible? I'll run to do a little bit that.

Jim Preen: That's okay. It's a response. I just want to pick up on one thing you mentioned which I've been thinking about as well. We're about to talk about working from home, but I think one of the things that some people miss from working from home is the fact that they have no routine and that's the word that you've just used. Is there any way? Is it worthwhile trying to establish some routine? People talk about actually getting dressed and you're not staying in your pajamas all the time and actually going to work as if you would. Is there anything beneficial in that?

Dr. Liz Royle: Yes, definitely. Again, if you think about it from the psychology of it, from the crisis side of it, crisis take away all control. That's been said a few times, but it's very very true. If we bring in some structure to our day, that's our way of actually trying to recreate that level of structure, routine, and control. It can make us feel as though we have some level of influence over what happens in our day. I've seen a few times people have said when you've got no control, when there are big things you can't control, look for the things you kind of control.

It's a good sentiment but it's actually a better way of thinking if we say look for what choices you can make because some people will still feel as though they have no control, but we always have choices. I can choose to get up at the same time as I normally would. I can choose to allow myself half an hour lying in bed because I'm not commuting, but I'm doing it for me or I can still get up at the same time. Having a routine. Start your day as you would normally, the normal time. Finish your day at the normal time. Take a lunch break. That might not be a part of your work routine, but do it now. Put those breaks in.

Definitely, routine is very very important. If we can mirror what it would normally be then that's even better.

Jim Preen: It's so interesting. It's such a new dynamic. In my past life in other jobs, I've worked from home quite a bit and I'm quite used to it and I'm quite happy. In fact, when I started doing it about 15 years ago, it was considered frantic weird and basically you can't do anything you just hang around at home which I didn't do, I hate sometimes. I think for some, my wife, for example, can't bear working at home. She likes the cut and thrust to the office, has always had that. I think a lot of people struggle with it. It sounds like a nice idea to work from home but it can be a struggle for some people.

Dr. Liz Royle: Definitely. I've worked from home for the past 10 years and it took me a long, long time to adjust, and part of that was having that routine but even for those of us who are used to it, what might now be the problem is that we're sharing our workplace with all the displaced people. I now can bring in all new set of problems. I'm used to everybody else would leave the house and go to work and I have the place in my own and suddenly I'm having to now share that.

Jim Preen: Negotiate. Yes.

Dr. Liz Royle: Yes, and that negotiation is really important. I think having your own space is very important. That's great if you live in a really nice big house that you can all have your own workspace but even if you all come together making sure that you have that own little bit of space of your own, it's really important.

Jim Preen: Yes. It is really hard for people if they don't have a garden or something like that.

Dr. Liz Royle: Yes. I think again that's where we have to look at the variety of responses. Some people will be having a very different experience to others. We've got to recognise that.

Jim Preen: One thing we're doing in our company which I just shared which I think has worked really well, we have twice weekly meetings where everybody jumps on Zoom, puts their cameras on and we just have a chat and it's not necessarily, in fact, it isn't about business since we're not looking at business, we're just connecting, just telling any little stories that may have come. Basically replicating the kind of stories you might tell each other when you first arrive at work or when you go to make a coffee or at the water cooler or something like that.

It's just that kind of way that we all communicate with each other during the workday. It's not quite the same admittedly, but I like it all the same. Have you come across that?

Dr. Liz Royle: Yes. I think that's really important, and humor. You'll probably laugh at this and it is a bit silly but we have because we're three of us now working from home. I find that the tolerance and humor really help. We have a pretend tea trolley service. A really silly little ritual whereby I tend to be the tea lady for some reason. I don't know why. I will go around the various places that people are working. We have this little game where I'll say, "Tea trolley. Morning tea trolley." I'll go through the selection of cold drinks and warm drinks and everybody always order just the same as they did yesterday but we have to listen to what's on offer. It's a silly, silly ritual.

It makes no sense at all, but it's just a chance for us to check-in, have a bit of a bouncer and a bit of escapism. We've got used to it now. This morning tea trolley and afternoon tea trolley. Sometimes it is those silly things. It's recreating what you would normally have.

Jim Preen: Well, I think that was a great practical pieces. Let’s hear it for the people.

Dr. Liz Royle: It would be nice if somebody else did. Somebody else took a turn on it. It's just a bit of fun and sometimes you just need a bit of surrealism.

Jim Preen: Exactly. Just a little craziness to stop you going crazy. Is there anything else you want to say about working from home? Is there anything else or are we good with that?

Dr. Liz Royle: Well, I notice on your slide that you've got advisory companies, do you want me to include that one?

Jim Preen: Yes, actually that would be really helpful is if you would please because I know a lot of people who are working from home are listening to this. Yes, anything from the company's aspect would be great.

Dr. Liz Royle: Again, I do keep hanging on about this, but recognise that your staff will be having different experiences, and they're going to be working from diverse settings. They will have a variety of needs, they might have very different levels of safety and privacy and workspace. Start with the basic needs. I imagine most organisations will have spent a lot of time sorting out equipment, workspace, talking about sitting on the sofa, so they don’t get a bad back, that kind of thing.

Actually ask people what they need now, you've got through that very practical bet. Ideally, they all want to own settings, checking in with them, help them got what they need. I consider the individual. You've given an example of how you do it, which is normal for your company. Well, if you're trying to bring in new things that people wouldn't do it work.

I've seen things, about people sharing a little bit more about themselves and the pets and stuff and that's fantastic if that's your workplace culture. If you've got somebody in your company who really values the privacy, that might be a bit intrusive for them. It might be peer pressure to behave in a particular way.

It seems to be a lot of bravado and, "Oh yes, we're all with spirits and we're all in it together," and not leave people feeling like they'd be left behind if they're not at that stage yet. Always keeping in mind, you don't want to fragment your group, you want to [crosstalk]

Jim Preen: That's such a good point as I hadn't thought of that and that's a good. Not everybody wants to do this stuff. [crosstalk] may find it really something they might even dread doing, which I will say that hadn't occurred to me.

Dr. Liz Royle: Yes. It can lead people conceiving their emotions, which is actually what we don't want to do. Video call were possible because 70% of the communication is non-verbal, but it's actually interesting because it's a different kind of stress when we video conference. There's no hiding place. It's harder to meet people and as if you were in a proper betting and you might have tech difficulties or distractions. There's always the thing that, when you first start doing it, it takes a while before you settle out of that stock, just looking at yourself and critiquing how you look and concentrate on what you're doing.

It can actually be, it's a new thing that can be stressful from that point of view. Just expect a loss of productivity at the beginning, the brain space is going to be taken up with other concerns. Just accepting and normalizing that. It can be good, start a day with a check-in and end it with a review because a lack of communication and collaboration is the top issue for remote workers. That having them feel like they belong, we're doing it in a way that never as your usual practices as become. I think the social breaks as you mentioned, if that's what they do normally, then they're fantastic.

People can have a virtual lunch break or virtual tea break. This also leads to the question of scaling up the managers. You need to be able to scale up your managers, new team leader as quickly and easily, so they can recognise these kinds of issues and be able to support the staff. I think we've just all got to be quite innovative at this time. One of the problems is that the creative brain, the problem-solving brain is lightly hampered when we're in distress, recreation must be crucial for this. Does that help?

Jim Preen: Yes, that's nice. That's excellent. We've talked about, you can see the next question or comment. It more to do with families, and we've talked about this one, this is a very tricky issue to deal with. Because some families, these are a loving family may even have a route, but if you are in a very stressful situation, maybe suffered a recent bereavement or one of the other ones mentioned there. Can you talk about that briefly, please?

Dr. Liz Royle: Yes, it is. Again, I think some of the media messages are very sorts of happy and smiley, and this is what you can do, they're very action-focused. The danger is if we focus too much on, actions and solutions before we've actually looked at where people are, they just don't buy into it, because they're stalking what we're feeling. Similar to the workspace, the best thing to do, is to find yourself private space and agree that that's your only retreat place. That might be a room that you can shut the door on, or it might be a corner of a room where you can put headphones on, but everybody needs an emotional bolt hole.

We've got to respect everybody's need about if you know that about a person if they got into that room and shut the door, they just need a moment or 10 minutes. Respecting that, being more tolerant. When we can't control the big things, we can't get obsessed with the small things, and suddenly it can be really important how somebody stock the dishwasher, but actually it's not really that important. If you recognise that it's just the need for control, and we're going to put us onto things. I was getting irritable about little things and spotted that, pretty quickly and just having to step back and say actually, "Is this really important? Does it really matter?"

For instance, just almost saying to myself, "Okay, this is just me trying to get some control." If it doesn't matter, then use that as a reason to sit down and have a conversation about some basic rules. Sharing tasks, creating a routine, they will all help. Well, I think one thing to points out about this wider family and the wider social network, again, the disparities, one thing that I've noticed is these huge differences. Someone who's working, who's physically exhausted, who's really, high work-loads, it can be so frustrating when you're hearing about all the family members or friends sitting in the garden, catching all the DIYs spring cleaning. You've got a fracture there in your social network.

Jim Preen: If they're in the same house, they're doing very different things.

Dr. Liz Royle: Yes, definitely.

Jim Preen: Yes, I get it.

Dr. Liz Royle: Maybe financial worries. From one household that they're really concerned. Another one, thinking actually, "Yes, we're fine and we're getting full pay we're just chatting about what we'll spend the time doing." Recognizing all of the different coping styles I and things. There's no right or wrong way to do it, it's about saying," They're doing it differently. They're coping in the way that they can and tolerating that." Well, the people who are already having issues at home, and then all of the issues we've talked about are amplified.

If we're already stressed, anxious or depressed, we might find that this becomes overwhelming, and I think it's so important to acknowledge that some people will be more vulnerable. The raised tensions at home lead to increases in alcohol abuse and domestic violence, and I think employers need to remember that their staff and not immune for this. It's always impulsive when we put safety first and give people the opportunity to access the poles and feel secure. Maybe just checking, having those individual check-ins with people, giving them the opportunity to raise any issues and looking at how we can support them.

Hopefully, managers or team leaders would have some idea of what's happening to people at home. Not always, but I think it's really important just to look at the context when you're checking in on people's well-being.

Jim Preen: Yes, indeed. I'm just going to move you to another goal, we've dealt with this a little bit before, but it's an extension of what you've been talking about, just sort of practical ways of helping and settle your thoughts or your emotions and you already mentioned limiting, you're watching the news too much, what else can people do on a more practical level of reducing the stress?

Dr. Liz Royle: You mentioned the word mindful and I don't know that some people may not be aware of what mindfulness is.

Jim Preen: I'm not sure I am, I'm using [crosstalk] what that it means, so tell me, tell us about it.

Dr. Liz Royle: It all sounds pink and fluffy, I think sometimes mindfulness and meditation. I thought both legal techniques, the calming, I was thinking on what they'll do is they'll just temporarily switch off the worry about the future. Mindfulness, meditation are very, very simple strategies to learn and really what all we're doing is to help me out with thoughts to slow down and then we engage in our calm thinking. You don't have to sit on a yoga mat and burn incense sticks. You can be mindful anywhere, it's about noticing. Mindfulness is very much about noticing your surroundings, looking at it and really, cry vivid details what you're experiencing right now.

Not saying, if he sits on a chair where your body is supported by the chair that sort of the temperature of the air. If you have a drink, what does that taste like, really focusing all your senses on what you can hear, what you can see and you'll notice that your mind, rounds off into all the things? It just about keep bringing it back.

Jim Preen: This sort of like meditation, is it?

Dr. Liz Royle: Very much like meditation. Meditation is simply about focusing on something that is such a fairly neutral, it might be a sound, it might be breathing, it might be, flickering flay and just something fairly neutral, focusing on it and every time your mind wanders off you just bring it back and you focus again. It's about building or extending that space between your thoughts. Everybody can learn it, the reason that most people say or can't do that is because they think that they're meant to sit there with a blank mind and that's not the case at all.

It's just about building those spaces and every time you slow your thoughts down, you're re-engaging your parasympathetic nervous system, you're calming it and this is a great one for sleep and there's loads of results is on the internet, guided, visualisations, guided practices. Don't be put off by thinking they all a bit pink and fluffy because there's the real science behind them. The other thing is at the moment we're on a constant news feed, everything is virus related, even the adverts on the television, everything is virus related so your brain is just constantly being triggered about the threats.

We've got to keep that balance and we've got to take it away and say, "Actually I need to now focus on something else." There is a real-world and a normal world, but it's just being completely squeezed out and we've got to try and squeeze some of it back in. Limiting the news corporate, limiting social media maybe sets a time to say, actually I do need to keep up with the news but I'll only watch the evening or the morning report or I'll check in one point on whichever social media, so just keeping that lowered and also trying to set yourself a challenge of looking for sort of the positive news stories.

Sometimes that can be hard to do, but looking for the stories of recoveries, stories of compassion, all of those things will actually help to retrain our mind into a more balanced perspective. It's not about pretending nothing's happening and being in denial, it is about the balance.

Jim Preen: I've got a comment from one of our listeners. It's not really a question, it's really an observation. They're very obviously not happier, they've tried a routine, very unhappy that they're not going to be able to go to church over Easter and really want it to go back to work but that's tricky, how can managers handle? This must be not uncommon I feel and how can I handle a situation like that?

Dr. Liz Royle: It's very common, everybody's life has been disrupted, all the normal ways that we have of nurturing ourselves and things like our spiritual beliefs, looking after ourselves physically, we've having to look at different ways of doing this and there is anger about that and that's because we've had something taken away from us. Again, it's a natural response, who wouldn't be angry about all of the things that you've built into your life being taken away. We have to be kind for ourselves and say, "It's okay to be angry and to feel angry, I'm a human being." Once we've accepted that and sort of normalise that, it's easier for that is to then say, "Okay, what choices can I make now?"

I can choose to stay angry, sometimes I might want to stay on angry, sometimes that's actually okay. Well, if I don't want to, I can choose to maybe see if there's another way that I can get what I need or another way to do things differently but it is a long slow process in just months and it's very similar to crisis control reaction and there's no quick fix or this, just keep moving forward in the process.

Jim Preen: Well thank you. Can I just say to our audience, if you want to place any more questions, please do so, you can post them anonymously, you have the ability if you don't wish to give your name. As we are sort of coming towards the end of the webinar, just please, if you do want to ask questions now is the time to jump in. Liz, I'm going to move you on here a little bit, you've talked about an emotional crisis, having a three-phase pattern. What is that pattern? What does that mean and how can that help us understand what we're going through?

Dr. Liz Royle: Again, going back to trauma work, one of the key things that we have to offer clients is hope. Now as a trauma therapist, I understand the roadmap to recovery for them and as somebody comes through my door, I can see what stage they're in and I can see where they will be going, what will happen next and I can see ultimately that they will recover and I have to be able to sort of give them that sense of, it is a phase that we work through. I think it helps to know that actually this isn't going to last forever and although we don't know what is going to happen in the wider world.

We can't have some understanding of what's happening for us and how as human beings, our responses will change. The first bit to do is to know whereabouts we are in the phases. An emotional crisis tends to have a beginning, a middle and an end. The first phase is the fear phase is that it's the time when we want things to carry on as they were. We might use denial and disbelief, which struggle to keep things going as we've always done them, even though we can't do them, we focus very much on the, "I can't do that." We want things to stay the same and we resist any changes to a coping strategy.

Now the fear phase is also the phase where people are very angry and very frightened. They're constantly looking at the news, the hoarding because the frightened of having the basic skills taken away, as we move out of that.

Jim Preen: Actually, can I just jump in this?

Dr. Liz Royle: Yes.

Jim Preen: When all the stripping of the shelves in supermarkets, I thought of it that thing is a psychological response to a problem but I guess it is, isn't it?

Dr. Liz Royle: Yes, they are based, it's based on I might not have, and it was interesting that as soon as it was on the news that this was happening that more people on to do it. There's the contagion, it is a fit. It must be fear, it must be a valid fear that then kicks off all the people's fear so yes and then there's the anger about that from people thinking, if only I have to go do what-- not do that, feeling really angry about it. This is very much the early stages of it. As we move forward, we start to accept that we have to adapt, and we start to look for new coping strategies.

We generally can't go into that phase until we've acknowledged the emotional impact of the crisis. This is where the difficulties are, that a lot of the articles and the instructions about, "Do this. Just take that action. Do that," until you've acknowledged your personal emotional reaction, you are less likely to take those steps. We then move into the learning zone, so we start minimizing things like the news coverage, we start stepping back from it. We start letting go of the things that we can't control and being much more aware of ourselves, our emotions and looking at, "What kind I do differently?"

It's still a difficult time, it's still a big period of adjustments, but we start to become a little bit more creative and a bit more motivated. If you haven't got the motivation at the moment, if you're feeling exhausted and you're thinking, "I don't want to do these things," then that's simply a sign that, actually, you're in that first phase, and that's fine.

Everybody moves through it at different times. It's not a sense of, "I'm so much better because I'm in third phase now," that's rubbish. Everybody's different. We move through it in different times.

In the third phase, that's when we're starting to find a purpose, we're starting to look at how can we be more caring of ourselves, how can we be caring of each other. This is where we're getting into the feeling that things will not be the same at the end of this, the world will be a different place.

Jim Preen: Is that a good way to think? I'm a little conflicted about that. Should we be thinking, "Gosh, well, things really aren't going to be the same again"?

Dr. Liz Royle: Well, I think they aren't going to be the same again because all of our assumptions have been shattered. We will have to rebuild our belief systems, and then it will be different. That's not necessarily a bad thing. It's the same with a trauma. In a trauma, people will never be the same again, but that doesn't mean that they're damaged. It means that they can be stronger, they can be wiser, they can be more resilient, they can have changes in their values. That is the thing that we need to hold onto, but you can't fake it. You can't say, "Oh, yes, everything is going to be fine. The world is going to be a better place," if you don't believe that. You won't believe it until you're in that third phase, if that makes sense.

Jim Preen: Yes, it does, absolutely.

Dr. Liz Royle: We can't pull people through it. It's more a case of recognizing where you are and doing the things at the points of that phase that will help us through.

Jim Preen: I've got a question for you, and it's this, is it normal for people experiencing mental health conditions such as anxiety or depression to be feeling heightened symptoms at this time?

Dr. Liz Royle: Well, it's quite an unusual situation actually because, yes, it would be, it would be very usual for that to happen. What we're noticing is, actually, some people aren't. Some people are actually finding it easier because they're feeling less isolated and less stigmatised because they're so used. I'm thinking of people who are at high levels of anxiety and depression, they're so used to being out of step with the world and feel like there's something wrong with them. Suddenly, they're used to dealing with this level of uncertainty in other areas of their lives. Again, it's about we can't make blanket assumptions because we're all individuals.

So yes, some people will find it even more difficult, some people will find it actually a little bit of a relief. That's the complexity of human beings. That's what makes my job absolutely fascinating. Being part of that recovery with them is always a massive privilege.

Jim Preen: That's an interesting response. Well, we're getting towards the end now and I guess I have to ask, obviously, you've been giving us great advice and so forth, but if you do have some severe psychological symptoms as a result of what we're all going through, where can people go or how can people really help?

Dr. Liz Royle: I've been skipping over the surface quite a bit because there's a limit as to what I can say, but what I would say is don't ever be concerned about seeking support. There are lots of different things, different levels of support that people need. Quite often, and with crisis and trauma reactions, the earlier people seek support, the faster they tend to recover, so speak to your employer and look at what support they offer. There'll quite often be employee assistance programs or speak to a health professional, speak to your doctor. There is some good voluntary bodies as well for mental health. Get information. Information is incredibly empowering.

What we tend to find is the psychoeducation that is available for people through various forms, that's one of the programs that we do. I'm not trying to plug it, but what we do is we look at really getting to grips with all the different reactions and normalizing them. That takes the fear out of them because people quite often feel like they're going mad, and then looking at what can you do for those particular symptoms. Look for advice, look for support and expect that we are all going to react to this in different ways. Don't leave it too late. The sooner you ask for some support, the sooner you can start turning things around, getting back on track and getting some control back over how you're feeling.

Jim Preen: All right, Liz. Well, thank you very much. This is going to be the most extraordinary case study for you. I can see another Dr. Liz Royle book coming out of this. I don't know if the book is already started yet?

Dr. Liz Royle: I haven't had a minute to start. It's a very, very busy time for us.

Jim Preen: It is going to be massively interesting. I know to reduce a case study is ridiculous when it's everybody's lives, but it is the most extraordinary event for people like you, I guess.

Dr. Liz Royle: It is, yes.

Jim Preen: Liz, I think we're going to draw this fascinating discussion to a close. Is there anything you want to add or have we covered what we need to cover in this hour?

Dr. Liz Royle: I think so. We have done a longer information sheet that [crosstalk].

Jim Preen: If people want that, how can we get that to them? How can we help with that? I could send.

Dr. Liz Royle: Yes, if you want to send that out. It just gives a little bit more meat on the bones of what we've been talking about.

Jim Preen: If people listening would like an information sheet for Liz, perhaps you could let me know. I don't know. I will get a hold of it and make sure that those who wanted definitely get it because I've actually seen this and it's really good. Liz, our hour is up, I'm going to draw it to a close there. Thank you very much indeed-

Dr. Liz Royle: You're very welcome.

Jim Preen: -for being with us today in this really testing time for us all I think, and giving us some of your insights which have been fantastic. Thank you for that. We'll be running another webinar next month, I think with a former policeman, Chris Phillips, I think is our next guest talking about security in the workplace. In the meantime, Liz, thanks so much for talking with us today. Goodbye to everybody.

Dr. Liz Royle: Goodbye. Bye.

Jim Preen: Bye-bye now.