Self-Care for Allied Health Professionals: From Surviving to Thriving [1 ed.] 0367760142, 9780367760144

Table of contents :
Cover
Half Title
Title Page
Copyright Page
Dedication
Table of Contents
Gratitude List
Introduction
Chapter 1 The science and the art of self-care
DNA and gene expression
The gut microbiome
The stress response
Tuning into our stress response
The mind–body connection
Changing our habits in an unhealthy world
Notes
Section 1 Our physical wellbeing
Chapter 2 Breathe
Breathe through your nose
Unblock your nose
Extend your exhale
Alternate nostril breathing
Notes
Chapter 3 Sleep
Support your body clock
Leave work behind
Download your day
Yoga nidra
Notes
Chapter 4 Move
Spend time outdoors
Playful movement
Restorative yoga
Notes
Chapter 5 Eat
Mindful eating
Eat within a 12-hour window
Eat a rainbow
Eat for hormone health
Build a breakfast
Lunchbox club
Easy dinners
Notes
Section 2 Our emotional wellbeing
Chapter 6 Resilience
Gratitude practice
Random acts of kindness
Cultivate a sense of wonder
Digital detox
Finding flow
Self-talk
Make friends with your body
Riding the wave of emotion
Observing thoughts
Our vulnerability
CBA. Can’t Be Arsed
Notes
Chapter 7 Meditation
Mindful meditation
Body scan
Breathe in the whole of creation
Feel a sense of wonder for your body
We are all made of stars
Loving kindness meditation
Notes
Section 3 Bringing it into the workplace
Chapter 8 Antidotes to stress
Set an intention for your day
Shift your perspective
Small treats
Stop blaming
We are all allowed to make mistakes
Chapter 9 Our work environment
A workstation that works for you
Movement throughout the day
Desk yoga
Support healthy food choices
Leave work on time
Notes
Chapter 10 Team culture
An empowered team
What is urgent and what is important?
Set service objectives as a team
Effective emails
Meetings with a purpose
Meeting etiquette
Space to think
A connected team
Notes
Chapter 11 Conflict at work
Everyone has intrinsic worth
Practicing non-judgement
Pick up the phone!
Stop story-telling
Depersonalise, re-professionalise
Set boundaries for healthy work relationships
Compassionate communication
Notes
Section 4 Our place in the world
Chapter 12 Purpose
Identify your natural gifts and learned behaviours
Align with your values
Find your purpose
Your purpose in pictures
Make a restorative playlist
Set personal goals which have intrinsic rewards
Live life as it if is weighted in your favour
Notes
Chapter 13 Adversity
Writing therapy
Post-traumatic growth
Moral injury
An emergency self-care kit
Distraction behaviours
A protective posse
Forgiveness
Notes
Chapter 14 A better world
Global citizenship
Compassionate communities
AHPs and the future of the world
We have influence
Notes
Index

Citation preview

Self-Care for Allied Health Professionals

Self-Care for Allied Health Professionals brings together a collection of self-care strategies into one easy-to-read volume, supporting Allied Health Professionals to do the best for their patients by caring for themselves. The book offers information and practical strategies to look after your physical and emotional wellbeing at home and in the workplace, exploring topics such as sleep and food, resilience and meditation, stress, conflict and adversity. Written to be a flexible tool that can be read cover to cover or dipped in and out of as needed, it offers rapid response self-care strategies alongside more lasting changes, supporting practitioners to make small steps to build healthy habits for the future. Key features of this book include: ––

A combination of quick response strategies, like a five-minute breathing exercise you can use before a difficult meeting, and opportunities for deeper work, examining your purpose and aligning your role with your values.

––

Combines ancient practices of meditation and mindfulness with the latest research on nutrition, exercise, sleep and wellbeing.

––

Consideration of the challenges professionals face in the context of pandemics and a changing health and social care landscape, helping you to thrive in a challenging world.

Self-care has never been more important. This is a book that every Allied Health Professional and trainee should have on their desk, to improve productivity, enhance job satisfaction and build resilience for whatever the future brings.

Alison Battye has worked as a Speech and Language Therapist for 20 years, working predominantly in the NHS, but also with Local Authorities, charitable trusts and independent practitioners. She ­ currently manages a multidisciplinary team of Allied Health Professionals. Ali is a qualified yoga instructor, and has practised yoga and meditation for as long as she has been an Allied Health Professional. This exploration has informed her approach as a therapist and as a team leader. Ali passionately believes that if we can tune into our own needs, we more effectively meet the needs of others.

Self-Care for Allied Health Professionals From Surviving to Thriving

Alison Battye Illustrated by Caty Battye-Weeks

First published 2022 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 605 Third Avenue, New York, NY 10158 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2022 Alison Battye The right of Alison Battye to be identified as author of this work has been asserted by her in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Names: Battye, Alison, author. Title: Self-care for allied health professionals: from surviving to thriving / Alison Battye. Description: Milton Park, Abingdon, Oxon; New York, NY: Routledge, 2022. | Includes bibliographical references and index. Identifiers: LCCN 2021014101 (print) | LCCN 2021014102 (ebook) | ISBN 9780367760182 (hardback) | ISBN 9780367760144 (paperback) | ISBN 9781003165125 (ebook) Subjects: LCSH: Self-care, Health. | Medicine, Popular. Classification: LCC R A776.95 B377 2022 (print) | LCC R A776.95 (ebook) | DDC 613–dc23 LC record available at https://lccn.loc.gov/2021014101 LC ebook record available at https://lccn.loc.gov/2021014102 ISBN: 978-0-367-76018-2 (hbk) ISBN: 978-0-367-76014-4 (pbk) ISBN: 978-1-003-16512-5 (ebk) DOI: 10.4324/9781003165125 Typeset in Galliard by Deanta Global Publishing Services, Chennai, India

To Stephen, Cate, Ams and Kit



Contents

Gratitude List Introduction

xi xiii

1 The science and the art of self-care

1

DNA and gene expression 2 The gut microbiome 4 The stress response 8 Tuning into our stress response 10 The mind–body connection 13 Changing our habits in an unhealthy world 17 Notes 20 SECTION 1

Our physical wellbeing

23

2 Breathe

25

Breathe through your nose 26 Unblock your nose 29 Extend your exhale 31 Alternate nostril breathing 33 Notes 36 3 Sleep

38

Support your body clock Leave work behind Download your day



40 43 45

vii

Contents

Yoga nidra 47 Notes 52 4 Move

54

Spend time outdoors 56 Playful movement 58 Restorative yoga 61 Notes 69 5 Eat

72

Mindful eating 74 Eat within a 12-hour window 77 Eat a rainbow 79 Eat for hormone health 84 Build a breakfast 87 Lunchbox club 89 Easy dinners 91 Notes 94 SECTION 2

Our emotional wellbeing 6 Resilience

99 101

Gratitude practice 102 Random acts of kindness 105 Cultivate a sense of wonder 106 Digital detox 109 Finding flow 113 Self-talk 115 Make friends with your body 117 Riding the wave of emotion 121 Observing thoughts 124 Our vulnerability 127 CBA. Can’t Be Arsed 129 Notes 132 7 Meditation Mindful meditation Body scan Breathe in the whole of creation viii

134 136 138 139

Contents

Feel a sense of wonder for your body 141 We are all made of stars 143 Loving kindness meditation 145 Notes 148 SECTION 3

Bringing it into the workplace

151

8 Antidotes to stress

153

Set an intention for your day Shift your perspective Small treats Stop blaming We are all allowed to make mistakes 9 Our work environment

154 157 158 162 165 167

A workstation that works for you 168 Movement throughout the day 170 Desk yoga 172 Support healthy food choices 177 Leave work on time 178 Notes 182 10 Team culture

184

An empowered team 185 What is urgent and what is important? 187 Set service objectives as a team 190 Effective emails 193 Meetings with a purpose 196 Meeting etiquette 197 Space to think 200 A connected team 203 Notes 206 11 Conflict at work Everyone has intrinsic worth Practicing non-judgement Pick up the phone! Stop story-telling Depersonalise, re-professionalise

208 210 212 215 218 220 ix

Contents

Set boundaries for healthy work relationships 222 Compassionate communication 225 Notes 226 SECTION 4

Our place in the world

229

12 Purpose

231

Identify your natural gifts and learned behaviours 232 Align with your values 234 Find your purpose 237 Your purpose in pictures 241 Make a restorative playlist 243 Set personal goals which have intrinsic rewards 246 Live life as it if is weighted in your favour 250 Notes 252 13 Adversity

253

Writing therapy 254 Post-traumatic growth 255 Moral injury 259 An emergency self-care kit 261 Distraction behaviours 263 A protective posse 266 Forgiveness 268 Notes 271 14 A better world

272

Global citizenship 273 Compassionate communities 277 AHPs and the future of the world 279 We have influence 284 Notes 287 Index289

x

Gratitude List

Cate, for your illustrations, and our daily coffee during lockdowns. Amelie, for your calm presence and compassionate communication. Kitty, for your ability to go with it. You are a model of equanimity. Stephen, for supporting all of my endeavours. May we always find ‘flow’. My sister Jo, for recognising from an early age that ‘simple things please simple minds’. Now we call this mindfulness. Thank you for being the first reader of this book. My mum and dad, Jan and Phil, for continuing to move and make shapes. Shelly Johnson, philosopher, writer and friend, who introduced me to the concept of ‘playful movement’, which I used in Chapter 4, and ‘intrinsic worth’, which I used in Chapter 11. Shelly’s work can be found on her ‘Love is Stronger’ website. She is the author of three logic and critical thinking textbooks: Argument Builder, Discovery of Deduction (co-author) and Everyday Debate. Caroline Mitchell, who has championed ‘Time to Talk’ in our NHS Trust, and is a constant source of inspiration to me. You and Sal helped me find my inner warrior when I needed it. Sonia Sivyer, for making meditation accessible. Shelley Kerr and Jo Lusher for the invention of CBA self-care. May we always be proud of our ability to spend an entire day in the Bakehouse. Thank you to the KM CAT team, for being a connected team. Especially to Natalie Prior for creating the Wellbeing Team, and to Hester Mackay, Andrea Bell, Sasha Appasawmy and Louise Linkson for continuing this work throughout the pandemic. Sarah Lloyd-Cocks’s 

xi

Gratitude List

compassionate leadership, which allows us to be human as well as professional. Becky Guntrip for our conversations about yoga nidra. Nicole Tumber, for your non-judgement and your infinite wisdom. Now for the yoga teachers. Pat Scammel, my first yoga teacher, who helped her students recognise their power and strength. The teachers who influence the restorative and desk yoga sequences in Chapters 4 and 9. Their phrases now run through my body. Sarah Beston’s invitation to ‘move like you’. Sadia Bruce’s ‘get weird’ and ‘be guided by breath’. Alana Mitnick’s ‘explore the inner landscape’. Kira Sloane’s teachings led to ‘make friends with your body’ in Chapter 6. These teachers can all be found at Yoga Anytime, and on their own websites and social media. Ravi Ravindra’s insight that ‘attention is the mechanism of transformation’ infuses every page of this book. Ravi Ravindra’s books, including The Wisdom of Patanjali’s Yoga Sutras, are highly recommended for all spiritual seekers. Jane Madely, my editor, for reading the entire first draft so carefully, and coming up with suggestions that made all the difference. Leah Burton, editorial assistant, for guidance around quotations and epigraphs, amongst other countless details.

xii

Introduction

How many times have you had this conversation? ‘How are you?’ ‘I’m fine!’ ‘How’s work?’ ‘Busy!’ This has become a ritual call-and-response. It is automatic; it is out of our mouth before we have chance to think. Allied Health Professionals go into the profession to make a difference to others. They are typically empathic and caring, and have the health and wellbeing of others at the heart of what they do. They might struggle with their own self-care. Why is this? Do we know when we are not fine? I want to give you a scenario. I start the day with a school visit to support a young person in school. It takes a while to locate the young person and their teacher has forgotten I was visiting. They are happy for me to join the lesson, and I am able to work with the young person and a teaching assistant, and at the end of the lesson, I have a brief discussion with the teacher. I drive to my office base for a video meeting with a young person, their foster carer, their teacher and two other therapists involved in their care. There are some complex issues to consider and some conflict between the people involved. I type up my clinical records and check my emails before lunch. I need the loo, but I will just finish this email. I’m a bit thirsty, and my water bottle is empty, but here is another email needing a response. 

xiii

Introduction

I’m just about to get up when a team member pops their head round the door. Do I have five minutes to talk about a safeguarding concern? Lunch is in front of my computer screen, and I don’t have time for a walk. I have to go straight into a planned meeting; I am presenting a piece of work and need to be totally on it. After that, I have a flurry of emails generated from the ones I wrote this morning. I’m not sure what one is asking, and another one links with something I was doing last week, but I can’t seem to find the document on the shared drive… By the end of the working day, I have a headache, my neck and back are stiff and sore, and I am thinking about what I need to cook for dinner this evening. As I drive home I worry about a child on my caseload; they have a degenerative condition, and I am wondering about how they and their family are coping… When I arrive home, I feel drained, and I barely have the energy for another conversation. Does this sound familiar? Can we interrupt this sequence of events somewhere (or multiple times) to put in self-care actions that will later prevent the headache, back ache and the general feeling of overload? This is the book I need. If we are distracted by thirst or hunger, how are we going to make good clinical decisions? If we are not aware of our own emotional needs, how are we going to support others? If we aren’t anchored to our purpose and our place in the world, how are we going to enjoy long and productive careers?

From surviving to thriving Most of the time, we just about manage. There are some days that leave us feeling completely drained. This is survival. xiv

Introduction

We might be relying on a few props, like family or friends, supportive colleagues. If all else fails, there is wine, or chocolate or a box-set binge. Ideally we want to aim for more than survival. We want to thrive. We want to be the person that we imagined we would be, when we decided to enter this profession. My personal reasons for focusing on my own self-care include the following, some of which may also be true for you. I want to have the energy to get through a busy working week. I want to do the best I can for our service-users whilst I am at work. I want to show up for my colleagues. I want to model to my team that self-care is important, so that they feel they can also look after themselves. I want to have the energy to be there for my family and friends; I want to be present for them when they need to talk through their day. By showing myself compassion and care, I am training myself in compassion and care for other people, for my communities and the wider world.

Where to start? You do not need to do everything in this book. One change can make a big difference. This book is one you can dip in and out of, or you can read from cover to cover. You can follow the sequence in which it was written, or you can go straight to the chapter that appeals to you. You might read the reasoning behind the practice, or you might skip the theory and just choose a strategy to try out now. Whatever small step you make, you will be improving your own wellbeing now, and building good habits for the future. If something looks weird now, it might seem more relevant in months to come. Not everything in this book will be for you; I would like you to tune into what you need, and adapt your approach to suit your lifestyle. If you are currently overwhelmed, and feel like you are only just keeping your head above water, choose a self-care strategy from the ‘Breathe’ or ‘Sleep’ chapters. These strategies are ‘rapid response’ selfcare. You will get an instant benefit. Later chapters contain strategies that might involve more time, thought or effort. They may be ‘slowburn’, but their impact may be profound. xv

Introduction

Future proofing Many people find these practices when they have come to some sort of crisis. If this is the case, you have a strong incentive to look after yourself. Many chronic conditions, such as high blood pressure, diabetes, auto-immune conditions, digestive problems, depression and anxiety can be helped by the strategies in this book. Alternatively, you may be thinking long-term. It is a brilliant idea to build in helpful habits now. We don’t know what life is going to throw at us. Whether it is illness of a family member, relationship breakdown, domestic abuse, bereavement, financial crisis, a pandemic… these things are often out of our control. How we respond to them is not. This book aims to build resilience. Start the practices now, and you are future proofing your own wellbeing.

Tuning in This involves consciously ditching the automatic ‘I’m fine’ for ‘what is going on for me right now?’ It involves switching from the unconscious ‘busy!’ mode to one which is more attuned, more aware of our physical, mental, emotional and spiritual needs, and more able to deal effectively with whatever shows up in our workplace today.

Some useful questions to ask ourselves when we are tuning in: –– –– –– –– –– –– ––

xvi

How is my body feeling? Where am I feeling it? What’s going on with my breathing? What thoughts are coming up? What feelings are coming up? What is this reminding me of? What is the wise thing to do in this moment?

Introduction

Self-compassion We wouldn’t talk to others the way we talk to ourselves. We wouldn’t still be in our jobs. We tend to berate ourselves for the food choices we make, for our lack of exercise, for our over-reliance on coffee, alcohol, chocolate, social media. We will discover in the coming chapters how our environment is working against us, and making it difficult for us to make healthy choices. As soon as we know this, we can forgive ourselves. If you are currently exhausted, you need to be extra kind to yourself. If you are managing caring responsibilities, a difficult relationship, a health condition, financial pressures, a transition or uncertainty about the future, you need to be extra kind. Think of how you would talk to a small child, an elderly patient or a carer who is doing the best they can with the resources they currently have. This is how you need to talk to yourself. This person will make mistakes because they are learning. We learn from making mistakes. When I am feeling tired or down, I have a few phrases that I find helpful to say to myself: –– –– –– –– –– ––

I am enough. I am a work in progress. This too will pass. Mistakes are proof that I am trying. I learn from my mistakes. We can do hard things. 

Upward spirals When we add a self-care strategy to our day and we tune into the effects, there is an upward spiral. We notice that we feel better, and this makes us feel that we have agency: we can influence how our day unfolds. The awareness of the benefit is likely to magnify the benefit. We are signalling to ourselves that we are worth it, just like nurturing a small child, an elderly patient or a tired carer is worth it. xvii

Introduction

Figure 0.1  I am enough

One self-care strategy will have multiple benefits. These will span our physical health, our emotional health, our performance at work, our life satisfaction and our sense of purpose and meaning in the world. Our awareness of these multiple benefits is likely to help us to tune into what else we might need. We might make another change, which will generate a further upward spiral. Occasionally there will be a downward spiral. You will have a bad day, a series of challenges or even a catastrophic event. Having had experience of tuning in and knowing what you can do to make yourself feel a little bit better will prepare you for these times. You can interrupt the downward spiral with a self-care practice. As soon as you interrupt the downward spiral, you have broken it. You have agency. Even if you feel five or ten percent better, this is xviii

Introduction

empowering. Tune in, magnify the benefit by bringing your awareness to it, and you will have an upward spiral.

The ripple effect In addition to an upward spiral, there is a ripple effect too. When we adopt a self-care strategy, we are not the only person to benefit. We are likely to feel better, physically and emotionally. This will influence our interactions with others. We are likely to be more attentive, compassionate and appreciative of others. They will feel this, and are in turn more likely to be more positive in their interactions with others. With one kind action, we can initiate dozens, if not hundreds, of other kind actions. With every self-care strategy we use, we have an opportunity to model self-care for those around us. We are showing our partner, children, friends, colleagues, patients and managers the importance of selfcare. This is a kindness that ripples outwards. We are reducing the rate of burn-out in our profession. We are enabling ourselves and colleagues to enjoy long and fulfilling careers. We can do a lot of good in the world by the simple choices that we make every day.

Can one book meet the needs of all Allied Health Professionals? I have written this book for all Allied Health Professionals. This is a bold move. Allied Health Professionals are diverse. We are Art Therapists, Drama Therapists, Music Therapists, Physiotherapists, Occupational Therapists, Speech and Language Therapists, Dieticians, Radiographers, Podiatrists and Chiropodists, Orthoptists, Prosthetists and Orthotists, Osteopaths, Operating Department Practitioners and Paramedics. Our day-to-day work may look very different from one AHP to another, but we are all dealing with the same issues. We are all trying to do the best for our service-users, our colleagues and ourselves. We are trying to make best use of the resources we have available. We are trying to balance competing demands on our time and attention. We know that to have maximum impact we need to empower service-users. We might need to work on our own empowerment in the process! xix

Introduction

This book is arranged into sections. ––

Section 1 considers our physical health. There are chapters for how to breathe, sleep, move and eat to optimise our physical health.

––

Section 2 considers our emotional health. There are chapters for building our resilience through cultivating gratitude, kindness and wonder and acknowledging our thoughts and feelings. There is a chapter where we explore simple meditation techniques.

––

Section 3 is about how we bring these practices into our working day. There are chapters around our work environment, our team culture and dealing with conflict. This is self-actualisation, as we bring our best self to work.

––

Section 4 is about finding our place in the world as an AHP. This is the bigger picture: how we are part of our community and how we might contribute to social change. We move into the realm of self-transcendence.

At the end of each chapter in Sections 1 and 2, you will find some specific ideas for how to ‘apply this at work’. These are for you, but also for your service-users and their carers, and sometimes for your colleagues. These are suggestions only. You are best placed to think of ways to use the strategies in your role. I recommend that you try out a strategy for yourself first. If you feel it could be useful for service-users, you might discuss it with your colleagues and manager, read any related research, and maybe carry out a project to explore the benefits. Section 3 contains general strategies for managing our working life as an AHP. There are common themes for all AHPs, regardless of clinical speciality. Section 4 considers what each of the disciplines might offer, as our roles evolve to incorporate social prescribing and public health. Again the suggestions are there to get you thinking. You are invited to bring your own creativity and innovation to this work.

I’m not sure this stuff is for me… Just by skim-reading this book, you will pick up on some ideas. You might not be aware that you have processed them, but they will be xx

Introduction

lodged in your subconscious. Our brain has a knack of storing information away for future use. If it’s not useful now, it might come in later. There will be some trigger that reminds us of something we once read. If the time is right, we will make use of it. Unless this book was thrust into your hand by a well-meaning colleague or friend, you were probably drawn to it in some way. You probably recognise that self-care is important. Maybe you feel that you have been neglecting your own needs. Maybe you have been getting away with it for a long time, but feel that you might not always get away with it. Maybe you have already started your self-care exploration and want to go further. I want you to take a moment to think about your own reasons for taking care of yourself.

Ask yourself the following questions: –– –– –– –– –– –– ––

Do I give myself the time and attention that I give to others? Do I know what my body needs on any given day? Do I regularly take time to tune into my feelings? What is the impact of this? On me? On the people around me? What is stopping me? What support do I have? What would be a good outcome for me?

Writing down the answers to these questions can be powerful. We see that this is important because we’ve taken the time to write it down. We are also more likely to remember something we have written, even if we never read it back. You might feel comfortable exploring these questions with a trusted friend, family member or colleague. You can take it in turns to answer each question, taking a minute for each question. Be clear about whose turn it is, so that there is a speaker and a listener, and don’t interrupt one another whilst the other person is speaking. This gives you time to really explore your thoughts. Often we say something aloud that we have not really been conscious of. Somehow having the space to talk without interruption brings issues to the surface. xxi

Introduction

Making self-care a habit We have many self-care routines which we do without fail each day. They are built into our day, and we only forget them on rare occasions when something major has disrupted our day. Examples include brushing our teeth, putting the kettle on, letting the dog out, feeding our children, putting clothes on, brushing our hair, checking our phone, picking up our keys before leaving the house, locking the door… One way of making self-care a habit is to attach it to a habit we already have. You might march or jog on the spot whilst the kettle is boiling. You might look up at the sky and notice the trees when you are waiting at the bus stop. You might take a moment to extend your exhale before you enter your place of work.

Figure 0.2  Stitched together

xxii

Introduction

Self-care your way Self-care practice will evolve over time. A key concept is tuning in to what you need now. For each strategy in this section of the book, you and reflect upon how this practice will see a reminder to ‘tune in’ affects you. If you want to ‘go deeper’ with a particular practice, there are also suggestions for further reading or resources. Don’t get too obsessed with any particular aspect of self-care. You don’t want to increase your stress by thinking you have to do things perfectly. As the writer Augusten Burroughs says, ‘I, myself, am made entirely of flaws, stitched together with good intentions’. Aim to be ‘good enough’ rather than perfect. You are a work in progress. We are all works in progress. 

xxiii

1

The science and the art of self-care

This chapter will provide a revision of the key physiological processes that are involved in health and wellbeing practices. This will include relatively recent scientific findings. We will first look at the role of DNA and the role of lifestyle in our gene expression. We will then explore the gut microbiome and its links with every aspect of our health and wellbeing. We will revise the autonomic nervous system and the stress response. We will approach the concept of the mind–body connection. We will consider how we can become more aware of what is going on in our bodies and minds in response to self-care practices. You can become a scientist of your own mind and body, and start to see patterns in how you are responding to self-care practices. The art of self-care is then to tweak the practices so that they work for you and your lifestyle. If you enjoy reading scientific papers, I have referenced relevant research. Most of these papers are available to read and download for free on PubMed. Type in the name of the first author and the title of the paper. Related articles will also be available. Research into the gut microbiome is a particularly ‘live’ topic, with new discoveries being made all of the time. Many of the practices in this book can be related back to ancient practices, particularly those associated with Eastern medicine and philosophy. These practices tend to work on a broad level, across bodily systems. We might be changing our diet to address a pre-diabetic state, but we notice that our blood pressure goes down. We note that we are DOI: 10.4324/9781003165125-1

1

The science and the art of self-care

sleeping better, and we feel like moving more. Our hormonal and skin health improves too. Scientific research is now able to look at how and why these practices work. We can measure blood pressure or blood sugar changes in response to exercise, diet, breathing or sleep. We can measure the levels of stress hormones before and after meditation.1 We can measure the length of telomeres at the end of our chromosomes2 and see that physical activity results in younger telomeres. We can measure the modulation of brainwaves in response to yoga practices.3 Science is supporting the wisdom of ages. Adopting self-care strategies will not mean that we are guaranteed perfect health. We reduce our risk of developing health conditions, but we do not eliminate the risk. If we do become ill, self-care practices will support our recovery. If we have to manage a long-term health condition, self-care can ease pain and discomfort and emotional distress. We have a range of options available to us to help us feel better. Most importantly, we have agency in our health and wellbeing. If you would rather skip to the self-care practices, then go ahead. You can always come back to this chapter later.

DNA and gene expression There is a common misconception that our health is determined by our DNA, and that we can’t do much to alter our long-term health outcomes. When DNA (deoxyribonucleic acid) was discovered in 1962 by Rosalind Franklin, James Watson and Francis Crick, it was believed that DNA sequencing would unlock the secrets to health and disease. In the decades which have followed, it has become clear that you cannot match disease with one, or even a few genes. There is very little correlation between our DNA and our risk for cardiovascular disease4 and diabetes.5 Our genes are thought to account for only three to ten percent of cancers.6 Our genes account for less than one percent of our risk of Alzheimer’s.7 Environment plays a much larger part than DNA in the development of autoimmune diseases such as arthritis, asthma and eczema.8 There is an interplay between our DNA and the environment. Factors in our environment and in our lifestyle influence whether 2

The science and the art of self-care

particular sequences of DNA, or genes, are switched on or off. This is a whole new field of medical research called epigenetics. If you like a metaphor, then DNA is the available lights in the light show. Our environment, including our lifestyle choices, determines which lights are switched on, and when. DNA contains the instructions to our cells about which proteins to make. Specific proteins have specific functions in the cell, and in our bodies. All our cells contain the same DNA (this is our genetic code) but only some parts of the DNA are read. This is gene expression. The ways in which gene expression can change include: 1. A chemical group may be added to or removed from a specific section of the DNA strand. The chemical group blocks that part of the DNA from the proteins which would otherwise ‘read’ the gene. The gene can be methylated (turned off), or demethylated (turned on). 2. DNA is coiled very tightly around proteins called histones. If the DNA is wound very tightly around the histone, the gene cannot be read, and the gene cannot be expressed. If the DNA is not wrapped tightly, the histone can be read, and the gene is expressed. 3. RNA (ribonucleic acid) acts as a messenger molecule which takes instructions from the DNA into the cell and instructs the cell to make particular proteins. RNA may recruit proteins to modify histones so that genes are switched on or off. Changes to gene expression can arise because of environmental and lifestyle factors.9 Examples of these include: –– –– –– –– –– –– ––

Exposure to environmental toxins, such as air pollution. Exposure to tobacco smoke, alcohol or drugs. Exposure to viruses and bacteria. What we eat, how much we eat and when we eat. How much and what sort of physical activity we get. Exposure to stress and our response to stress. The amount and quality of our sleep.

Genes are being switched on or off every day, every hour, every minute. Gene expression dictates what sorts of cells are made, and which chemicals are being produced in the cells. This includes digestive enzymes, 3

The science and the art of self-care

hormones and neurotransmitters. Our genetic expression determines our body composition, the health of our cardiovascular system, our digestive system, our bone density, our hormone balance, our hair and skin health, our immune response, the levels of inflammation in our body, even our cognition and our mood. We might have a poor night’s sleep one night which results in certain genes being switched on, but then we get a good night’s sleep the next night, which results in those genes being switched off again. If we are only exposed to a toxin, drug or stress for a small amount of time, we are at less risk than if we are exposed continuously over many years. Similarly, there will be a cumulative effect of positive lifestyle choices over time: more beneficial genes will be switched on more often. This reduces our risk of developing health problems and diseases, and enhances our general health and wellbeing. We are likely to live well for longer. Gene expression is influenced by all the behaviours we will consider in this book. To summarise, this encompasses: ––

The way we breathe, sleep, move and eat in order to look after our physical wellbeing (Section 1).

––

The balance between being alert and active and being relaxed and rested in order to look after our emotional wellbeing (Section 2).

––

How we balance our personal needs with the relentless demands of work (Section 3).

––

How we find purpose and meaning in life, and how we connect with our community (Section 4).

This is an empowering message. We have much more control over our health than we previously thought. Our bodies have an amazing capacity to repair themselves. We can help this process along by the choices we make every day. The more positive choices we make, the more we improve our body’s ability to bounce back.

The gut microbiome We are not alone. It turns out that we have a lot of genetic material in our bodies which is not human. 4

The science and the art of self-care

Our gut microbiome, housed in our large intestine, is a diverse ecosystem of 39 trillion microorganisms. They include friendly bacteria, yeasts, parasites, viruses and archaea. We also have a microbiome on our lungs, skin, mouth, nose, ears, between our toes, inside our tummy button … These microbes evolved with us, in a mutually beneficial relationship. We couldn’t survive without them. We wouldn’t have a functioning immune system without them. Their gene expression contributes to our overall health and wellbeing, because they synthesise and metabolise a vast array of chemicals in our body, including hormones and neurotransmitters. The gut microbiome is crucial to our health because friendly bacteria are able to digest the food that we cannot, and to metabolise micronutrients so that they are bioavailable to us. We used to think that dietary fibre just helped with moving food along the gut. Now we know that our gut bacteria are able to metabolise the fibre to make short-chain fatty acids (SCFAs). There are many different types of plant fibres, in all parts of the plant: the leaves, stems, roots and seeds. Different populations of friendly bacteria are able to make use of different types of fibre to produce SCFAs. SCFAs are crucial to our health. They play an important role in: ––

Protecting the lining of our gut so that it does not become damaged and leak harmful substances into our bloodstream.10

––

Regulating our immune response in our gut, so that we do not overreact to food. This reduces our risk of developing food allergies and intolerances.11

––

Regulating our appetite and our satiation signals.12 Eating a highfibre meal keeps us full for longer, but also reduces the sugar spike after this meal and after the next meal we eat.13

––

Regulating our blood sugar and insulin response, reducing our risk of Type 2 diabetes.14

––

Regulating inflammation in the gut, reducing our risk of colorectal cancer,15 inflammatory bowel syndrome (IBS) and other gut disorders.16

––

Reducing widespread inflammation in the body. This reduces our risk of autoimmune conditions such as asthma,17 eczema and arthritis, and even cardiovascular disease18 and depression.19 5

The science and the art of self-care

––

Enabling our bodies to access vital micronutrients, including vitamins and minerals and even hormones like Vitamin D.20

––

Enabling our bodies to access phytochemicals. Phytochemicals are chemicals from plant foods which have a host of beneficial effects for our bodies, including preventing oxidative damage to our cells and tidying up pre-cancerous cells.21

The more diverse the species in our gut microbiome, the healthier we are likely to be, because different microbes specialise in metabolising different types of fibre, micronutrients and phytochemicals. A diverse ecosystem is more effective at making the most of available resources. Healthy populations of friendly bacteria can easily outcompete harmful bacteria, making us less likely to fall prey to infections. We can increase the diversity of our microbiome by eating a wide variety of plant-based foods. Every time we eat fruit, vegetables, nuts and seeds, pulses and wholegrains, we will feed the microbes which thrive on these foods. These microbes will reproduce more, and there will be healthy populations in our gut. A useful question to ask before any meal is “how am I going to feed my friendly bacteria?” There is a lot of research currently going into the gut microbiome, and it seems that the gut microbiome influences every body system.22 Improving the diversity of our gut microbiome is likely to simultaneously benefit all of our body systems: our cardiovascular health, our digestive health, our hormone health, our brain health. It is easy to increase our microbiome diversity: we just need to eat a wide range of plant foods. We should aim for at least 30 different plant-based foods per week. This can include fruit and vegetables, nuts and seeds, pulses and wholegrains, herbs and spices, and even coffee, tea and chocolate!  Highly processed foods do not feed our health-giving microbes. Processed foods feed microbes which are harmful to our health, and they deplete the populations of healthy microbes. When samples are analysed, people who eat more processed food have less gut diversity, and suffer more health problems as a result. Fermented foods, like live yoghurt and kefir, miso and tempeh, sauerkraut and kimchi, can boost our populations of friendly bacteria (probiotics). The plant-based foods we consume will then keep these 6

The science and the art of self-care

Figure 1.1  The gut microbiome

populations alive (prebiotics). We don’t need to spend lots of money on pills that contain probiotics or prebiotics; we just need to eat a diet rich in plant-based foods, ideally with some fermented foods. Cocoa and coffee are fermented foods! There is a clear message about the standard Western diet: we need to reduce our consumption of processed carbohydrates, such as refined flour and sugar. We need to reduce our consumption of meat and dairy. We need to reduce our consumption of high-fat and high-sugar foods such as burgers, nuggets, milkshakes, ice-cream, fried foods, white bread, cakes and confectionary. Artificial sweeteners, alcohol and antibiotics also deplete our microbiome. There is interesting evidence to suggest that our gut microbiome can influence the foods we crave.23 The more we eat healthy food, the more we increase the populations of friendly bacteria. The more friendly bacteria we have, the more they signal to us to eat healthy 7

The science and the art of self-care

food. Our food choices today will influence our food cravings tomorrow. We can start to tip the balance with the next meal that we eat. Every meal is an opportunity to feed our health-giving microbes. You will find strategies in the ‘eat’ chapter of the book which will help you to increase your consumption of microbiome-supporting foods. It is easier than you think.

The stress response When we perceive a threat, our autonomic nervous system is activated into a sympathetic response. This is the ‘fight, flight or freeze’ mode. The threat might be a physical threat, for example a car veering towards us, or it might be a psychological threat, for example an email that we perceive as criticising us. Whether the threat is real or perceived, our body’s physiological response will be the same. When we perceive a threat, the pituitary gland in our brain produces adrenocorticotropic hormone (ACTH), which initiates a cascade of biochemical reactions in our body. The adrenal glands in our kidneys release adrenaline and cortisol into our bloodstream. Our heart beats faster and our arteries narrow. Our blood pressure increases. Our breath becomes quick and shallow. Blood and oxygen are diverted away from the digestive tract and towards the skeletal muscles and lungs. Glucose and fatty acids are released into the bloodstream in readiness for physical action.  Once the threat has passed, and whenever we are calm and relaxed, our nervous system is activated into a parasympathetic response. This is its ‘rest and digest’ mode. Our body and brain send signals back and forth to communicate that everything is as it should be. There is no threat to our safety, and therefore our body can concentrate its energy on the digestion of food, the distribution of oxygen and nutrients to where they are needed in the body, regulating our hormones, and organising the immune system’s daily repair of tissues and removal of dead or damaged cells. If the threat persists, or we go on perceiving a threat, then more cortisol will be released into the bloodstream, and we will remain in a state of ‘fight, flight or freeze’. We will be at risk of having chronically raised blood pressure and raised blood glucose and lipids. Our digestion, hormones and immune system may be compromised. 8

The science and the art of self-care

Figure 1.2  Stress response

Our nervous system ensures that there is constant messaging between our brain and body to analyse the current threat level. Our brain receives updates from our sense organs, like the eyes and ears and skin receptors. It also receives updates from our heart and lungs and our digestive organs, via the vagus nerve. Even our excretory and sexual organs are involved in the messaging system. There is not a part of the body that doesn’t take part in this constant dialogue. When we have adequate time in our ‘rest and digest’ mode, the body has time to recover from the normal activities of living. Each time we eat a meal there will be some inflammation in our digestive tract. Each time we exercise there will be damage to muscle tissues. Inflammation and tissue damage are normal and inevitable, and we 9

The science and the art of self-care

can manage the process of repair if we have cycles of short sympathetic followed by longer parasympathetic activation. It is important that we do regularly have some time in sympathetic activation, because this gives us our drive to wake up in the morning, to move our bodies and to get things done. However, when we are chronically stressed, there is less time for physiological repair work to be undertaken. This leaves us susceptible to physical illness and disease. The raised cortisol levels in our blood have an effect on all of our body systems. Our raised blood pressure puts us at higher risk of heart attack or stroke. We have an increased appetite, and may gain weight. We have higher blood glucose, which can lead to insulin resistance and, ultimately, diabetes. If we are not spending sufficient time in a ‘rest and digest’ state, then our body cannot digest food effectively and so we will not be wellnourished, and our immune system will be unable to regulate its activity. Our hormone balance is compromised because our body prioritises cortisol production over all other hormones. We are at increased risk of developing neurological diseases and auto-immune conditions. Our body is spending less time repairing oxidative damage24 and destroying precancerous cells.25 We are more likely to suffer from chronic inflammation. This is linked with autoimmune conditions such as asthma, eczema and arthritis, and is also linked with our risk of depression.26 A key theme that will reappear throughout this book is how we can consciously bring ourselves out of a stress response, and back into a calm state. We need the ‘flight, fight or freeze’ mode to make automatic decisions in a time of crisis, and in order to motivate us to act. However, this is a ‘reactive’ state. Our thought processes are automatic. We need the ‘rest and digest’ mode to make considered, wise decisions for the long-term benefit of ourselves and others. This is a ‘responsive’ state. We are able to think, learn and communicate in this state. When we spend sufficient time in this state, we are not just surviving. We are thriving.

Tuning into our stress response What we perceive as a threat is very individual to us. What one person perceives as stressful, another will perceive as stimulating, or fun. For 10

The science and the art of self-care

example, rock climbing to me is stressful, but it might make you feel energised and alive. At certain times, we may view a situation as energising and fun, but at other times in our life it is stressful. When I was 20, going to a nightclub and dancing until 4am was energising and fun, but now the late night would be stressful. Last month, getting a request to cover a new clinical area would have been stressful, because I was feeling overloaded. This month, I have a little more capacity, and the idea sounds exciting. A little stress can be a good thing. It keeps us feeling stimulated, energised, motivated, inspired, challenged. How much we are up for the challenge very much depends on our current capacity. If we feel we can’t handle it right now, we will feel stressed. If we feel we are ready for the challenge, we will feel nervous, but excited. You might have experienced this if you have ever prepared really well for a test, exam or sporting challenge. You might have started with butterflies in your stomach, but you didn’t feel overwhelmed by nerves. You were primed, charged up and ready to perform. If stresses like these are short-lived, and if they don’t appear too often, then occasional stress will be stimulating and energising. If we had no challenge in our lives, we would risk becoming bored and under-stimulated. When we become aware of feeling stressed, we should tune in. This is really important information. Very often in life, we don’t realise that we are stressed until we do something silly. We lose our keys, we speak sharply to someone, we forget to pay for parking, we send an email without thinking it through. Usually this happens because we were stressed but we weren’t really aware of it. We didn’t tune in. When you recognise that you are feeling stressed, ask yourself what has triggered it. It might not be immediately obvious. You might have to trace back when you started to feel stressed. –– ––

Was it something that someone said? Was it something that made you feel out of control? 11

The science and the art of self-care

–– –– –– ––

Was it something that exceeded your current capacity to cope with it? Was it a worry about an imminent event? Was it something you have forgotten to do? Was it a long-running stress about family, finances, career?

Rather than judging yourself for feeling stressed, think “hmm. Interesting”. Imagine yourself being a compassionate researcher. You have just discovered what stresses out this particular human being. As a compassionate researcher, you can start to notice patterns. It might be that you always feel stressed when you open your emails on a Monday morning or after annual leave. You can anticipate this, and take steps to mitigate the risk. You might block out time in your diary to deal with the increase in emails at that time. It might be that you always feel stressed when interacting with a certain colleague. You can anticipate that you will need to monitor your own behaviours, aiming for considered responses rather than reflex reactions. As a compassionate researcher of your own stress triggers, you can offer understanding rather than judgement. “Of course I would find this situation stressful. I am always triggered by sudden changes in the plan”. The awareness that we are feeling stressed and what has triggered it brings us out of our ‘reactive mode’ and into ‘responsive mode’. We are going from sympathetic to parasympathetic activation in one thought. We can start to recognise ‘good stress’ from ‘bad stress’: the difference between feeling energised and excited, or feeling overwhelmed and exhausted. Awareness is the mechanism of change. Once we are aware of a stress trigger, we can pause. We might take a few calming breaths. We don’t have to immediately react. We can think through our options. What would a wise person do right now? Once we have experienced this pause, we have this resource at our disposal forever. We can interrupt reactivity. We have increased our capacity to cope with the perceived threats that we will inevitably encounter. 12

The science and the art of self-care

When we know that we can consciously bring ourselves into a parasympathetic ‘alert and responsive’ state, we will be less afraid of challenges. We will know that we can sometimes step out of our comfort zone without being overwhelmed by stress and anxiety. We can use strategies in this book to bring ourselves back into a parasympathetic state. When we have this ability, we will find the odd challenge exciting and energising, which will ultimately lead to a more fulfilled life.

The mind–body connection What is happening in our minds will affect our bodies, and what happens in our bodies will affect our mind. This is the mind–body connection. Babies are completely controlled by their physical sensations. If they are hungry, tired, in pain or they just need holding, they will communicate their need by crying. Most of the time, their caregiver will be able to respond to this and give them what they need in order to soothe them. If you watch a happy baby, they are completely at one with their body. They roll around, catch their feet, let them go, roll over, push themselves up, explore the shapes their body can make. Emotions pass through their whole body. If you talk to a young baby, their whole body moves with excitement. They kick their legs and wave their arms. If they are angry, their whole body convulses with rage. The emotion passes through quickly. They can move from one emotional state to another with ease. As babies grow into toddlers, they will begin to be socialised into eating and sleeping when the family eats and sleeps. They will be encouraged to use the potty or toilet. When children go to school, their bodily needs are even more regulated. There are stricter windows for eating, drinking and going to the toilet. Now they have to sit still, in a particular way. They must walk and not run. They must not burp or fart. They are not allowed to seek physical comfort from others, except when their distress is extreme. This regulation can affect their breathing patterns, posture and muscle tone. Older children and adolescents can become even more disconnected from their bodies. They notice strange physical changes and might feel that their body is not their own. They are subject to sexual urges, which are both delightful and embarrassing. Girls 13

The science and the art of self-care

have to manage periods and pain, and cultural secrecy around this. Adolescents might start to compare their bodies and feel inadequate, or valued for the wrong reasons. Adolescents typically need more sleep, but struggle with transitions between being awake and asleep. They might stop listening to their body’s needs for rest, food or movement, as the pressure to conform to what their friends are doing is more powerful. By adulthood, many of us have stopped experiencing our bodies as joyful, energetic sources of pleasure. We have forgotten what stretches and movements can bring ease or wake us up. We don’t register the gut sensations that signal when we are full or hungry or when we need to relieve ourselves. We no longer let emotions pass through our bodies easily by crying or shouting or asking for help. We have lost touch with what our bodies need in order to thrive. The strategies in this book are all aimed at re-establishing our innate mind–body connection. At first it might be difficult to tune into our body’s needs. We have probably become really good at ignoring them. Those neuronal and nerve pathways are under-used. However, our brains and bodies are endlessly adaptable. By just focusing on a part of our body, we wake up that neuronal and nerve pathway. We make it more responsive simply by giving it our attention. If you are comfortable to do so, close your eyes. ––

Stretch out your hand in front of you.

––

Can you feel the aliveness of your fingers and thumbs?

––

Stretch out your fingers and then turn your hand so that your palm faces upwards, and then downwards.

––

Can you feel the movement up your forearm, upper arm and into your shoulders?

––

You might even be able to feel a connection with your hip.

––

Press your feet into the ground.

––

Do you feel a lift through your upper body?

––

Do you feel how this stretches out your spine and neck?

If you do this exercise for three days in a row, you will be more tuned into the sensations by the third day. You will be more aware of the 14

The science and the art of self-care

tingling energy in your body. You will be more aware of the space in your body when you lengthen and stretch. You will be more aware of the connections between distant body parts, so that when you press down with your feet, the lift is felt throughout your body. This subtle level of body awareness is a source of energy and joy. We can tap into it simply by bringing our awareness to it. The body influences the mind, and the mind influences the body. Pick one of the negative or positive emotions listed below. Imagine yourself feeling this emotion intensely. It might help to create a story which will help you feel the emotion. For example, you might imagine yourself investing time and energy into a special event in order to generate the feelings of ‘excited’ or ‘disappointed’. ––

Excited

––

Disappointed

––

Triumphant

––

Frustrated

––

Proud

––

Ashamed

––

Hopeful

––

Fearful

––

Interested

––

Disgusted

––

Compassionate

––

Despairing

Think about how this emotion manifests itself in your body. ––

Where do you feel it? In your chest, stomach, arms, legs, head?

––

Is it an energy? A sensation?

––

Can you describe it? Is it warm, cold, heavy, light, tight, floaty, aching, jittery, expansive, crushing? Does it have a colour or a sound?

––

How intense is that energy or sensation in your body?

––

How does it affect your breathing?

––

How does it affect your posture or your muscle tone?

Anything that affects our breathing, posture or muscle tone is likely to influence our nervous system. This will in turn affect our digestion, metabolic health, cardiovascular health, musculoskeletal health, hormone balance, immune system and body repair mechanisms. This is the mind–body connection. 15

The science and the art of self-care

Thoughts will often generate feelings. We have on average 6,200 thoughts per day27 and thoughts generally generate emotions. That is a lot of emotion affecting our body each day. Imagine you have just had an argument with your partner. You each leave the house and go to work, feeling misunderstood. As we travel to work, we will replay the argument in our heads. We might start telling the story of how we are generally under-appreciated. We might add a whole history of complaints against our partner. This will generate more negative feelings. With awareness, we might recognise what is happening. We can acknowledge the negative feelings. We can identify how it feels in our body, like we did in the exercise above. We can sit with that feeling for a moment. We have interrupted the negative spiral of thoughts and emotions, which would otherwise go on affecting our body. Awareness brings us out of the story. We realise what we are doing. We realise that we are more than our thoughts and feelings, and that we can bring ourselves out of this negative spiral. We can offer ourselves compassion for our human frailty. We might even be able to offer our partner compassion for their human frailty. This will change the feeling in our body. Imagine you have had an energising and engrossing conversation with a colleague. You go on to your morning round of home visits feeling full of enthusiasm for your day. Your patients pick up on this; they enjoy interacting with you, and you can see that you have made a positive impact on their day. This reinforces your sense of wellbeing. With awareness, we can make the most of our positive thoughts and feelings. We can tune into how they feel in our body, and we can revel in them. This will generate even more positive thoughts and feelings, and more positive sensations in our body. We can feel gratitude for our colleague, for our conversation, for our interesting job and stimulating caseload. This will affect our breathing, posture and muscle tone. We will be in a parasympathetic state, which will support cardiovascular, metabolic, musculoskeletal, digestive, hormonal and immune health. All of the strategies in this book are intended to help us to tune into the mind–body connection. 16

The science and the art of self-care

At any time, we can ask ourselves: –– –– –– –– –– –– ––

How is my body feeling? Where am I feeling it? What’s going on with my breathing? What thoughts are coming up? What feelings are coming up? What is this reminding me of? What is the wise thing to do in this moment?

The more you tune in, the more you tune in. You will become more aware of how breathing, sleeping, moving and eating affects your body. You will appreciate what makes you feel good, and you will seek this out in your everyday life. This is a positive upward spiral. You will find a section at the end of each strategy which invites you to ‘tune in’. This is to build awareness of the mind–body connection. What works for you might be different from what works for me. Once you have a habit of tuning in, you can use your awareness to assess any new wellbeing strategy and its effect on you.

Changing our habits in an unhealthy world At this point in your life, you might be feeling a bit broken and burntout. You are not alone. We are living in a time and culture when we have never been so disconnected from our bodies. Our minds are overwhelmed with information. As our minds have become more active, our bodies have checked out. The epidemic of stress, depression and anxiety disorders is perhaps related to the over-use of our minds and under-appreciation of our bodies. We did not evolve to want to move. We evolved to want to conserve energy. Food was in short supply, so it would have made no sense to exercise for the sake of exercising. We moved to meet our basic needs. We moved to hunt, to forage, to tend our animals and crops, to build shelter, to collect water and firewood and to move away from danger. We moved to express gratitude and joy, in the form of dance or celebratory rituals. 17

The science and the art of self-care

If you don’t feel like exercising, don’t feel guilty. You are normal. We did not evolve to reject food. We evolved to feast when food was plentiful. We also evolved to graze, eating what was seasonal and fresh. We held on to fat reserves to see us through times of famine. If you feast or graze, or do both, don’t feel guilty. You are normal. We did not evolve to coop our bodies up inside, sitting down. We evolved to move naturally through the day to perform essential tasks. We evolved to breathe naturally, through our noses. We took long, peaceful breaths when we were resting, and deep, energising breaths when we were moving. This affected our posture, movement and sleep. If you don’t breathe well, don’t feel guilty. You are normal. We did not evolve to live in houses with artificial lighting and blue screens. We evolved to rise with the sun and rest with the moon. We evolved to follow seasonal changes. We did more in summer when the days were long, and did less in the winter when the nights drew in. If you feel permanently exhausted, don’t feel guilty. You are normal. We didn’t evolve to deal with threats that are not real but are in our heads. We did not evolve to ruminate and obsess. We evolved to have short bursts of stress, which quickly subsided. We evolved to act on our impulses and release our emotions quickly so that we could move on to the next thing. If you feel permanently stressed, anxious or depressed, don’t feel guilty. You are normal. Our modern lives are so different to the environments that our minds and bodies are adapted to, it is no wonder that we struggle. The good news is that we are beginning to understand this. We can make small changes which will start to bring us back into our natural state. The more unhealthy or stressed out you feel, the bigger impact a small change will make. Our minds and bodies are meant to heal themselves. Making lifestyle changes may be slow to take effect, but the effects are likely to be profound. We have got used to relying on medication to take away pain almost instantly, and this is an amazing modern development. It is especially useful for acute conditions which threaten our lives. Medication is also 18

The science and the art of self-care

useful for chronic conditions because it can ease our symptoms. It does not necessarily tackle the cause. If you have a medical condition, continue to take your medication. Add one or two lifestyle changes into your life and tune into the response. We may need practice with tuning into the subtleties of our bodies. Medication can dull our sensitivity to how our body is feeling: we feel pain or we don’t feel pain. With awareness, we can reawaken the feeling of aliveness in different parts of our body. We can bring a sense of space, or lightness or relaxation, just by bringing our attention to it. If we change the way we breathe, sleep, move or eat, the effects are likely to be felt across different body systems. We might see gradual improvement in our energy levels, digestion, cardiovascular system, hormonal health and immune response, but it will take time. The effects may be subtle, but profound. Your body is an organism which is constantly regenerating. Each day we replace old cells with new cells. Intestinal epithelial cells are replaced every five days. Red blood cells are replaced every 120 days. Liver cells are replaced every 300 to 500 days. The entire skeleton is replaced every ten years. We literally have a different body now to the one we had ten years ago. We are not limited to our DNA. We may feel that heart disease, stroke, diabetes or cancer are our personal inheritance. Lifestyle is a more significant predictor of our health than our genetic inheritance. Our lifestyle affects our gene expression. We can mitigate the effects of disease by breathing, sleeping, moving and eating well. This will support and enhance any medical treatment we receive. Our neurons can make new connections. We can shape our brains by focusing on some activities rather than others. We can increase our mind–body connectivity by tuning in to how our body is feeling. We can get better at judging whether something is good for us, be it eating different foods, different types of exercise, breathing patterns or sleep habits. We might have unhelpful habits or negative thought patterns, but we can change this. Our brain is hard-wired to acquire new skills. We can cultivate self-compassion and gratitude, and we will get better at it after just a few days. The pathways we use the most get reinforced and become more efficient. The pathways we don’t use will atrophy. 19

The science and the art of self-care

If you currently have a vexed relationship with your body, choose to make friends with it. Your body is doing the best it can in a challenging world. You are not your body. You are not even your mind. Your body and mind are always changing, but you have a centre of awareness which is stable and enduring. We sometimes sense this, but it is subtle and elusive. The essential you is an incredible being with incredible potential, connected to other incredible beings with incredible potential. I know that you know that because you are a health professional. You see evidence every day that human beings are incredible. Let’s start exploring.

Notes 1 Turakitwanakan W, Mekseepralard C, Busarakumtragul P. ‘Effects of mindfulness meditation on serum cortisol of medical students’ Journal of the Medical Association of Thailand 2013 Jan;96 Suppl 1:S90–95. 2 Arsenis NC, You T, Ogawa EF, Tinsley GM, Zuo L. ‘Physical activity and telomere length: Impact of aging and potential mechanisms of action’ Oncotarget 2017 Jul 4;8(27):45008–45019. 3 ‘Desai R, Tailor A, Bhatt T. ‘Effects of yoga on brain waves and structural activation: A review’ Complementary Therapies in Clinical Practice May 2015;21(2):112–118. 4 Yu E, Rimm E, Qi L, Rexrode K, Albert CM, Sun Q, Willett WC, Hu FB, Manson JE. ‘Diet, lifestyle, biomarkers, genetic factors, and risk of cardiovascular disease in the nurses’ health studies’ American Journal of Public Health 2016 Sep;106(9):1616–1623. 5 McCarthy MI. ‘Genomics, type 2 diabetes, and obesity’ New England Journal of Medicine 2010 Dec 9;363(24):2339–2350. 6 Research summary from Cancer Research UK. See webpages: ‘Family History and Inherited Cancer Genes’ and ‘Causes of Cancer’. 7 Research summary from The Alzheimer’s Society. See webpages ‘Alzheimer’s Disease and Genes’. 8 Nyenhuis SM, Dixon AE, Ma J. ‘Impact of lifestyle interventions targeting healthy diet, physical activity, and weight loss on asthma in adults: What is the evidence?’ Journal of Allergy and Clinical Immunology in Practice 2018 May–Jun;6(3):751–763. 9 Alegría-Torres JA, Alejandro J, Bollati V. ‘Epigenetics and lifestyle’ Epigenomics 2011;3(3):267–277. 10 Blaak EE, Canfora EE, Theis S, Frost G, Groen AK, Mithieux G, Nauta A, Scott K, Stahl B, van Harsselaar J, van Tol R, Vaughan EE, Verbeke 20

The science and the art of self-care K .‘Short chain fatty acids in human gut and metabolic health’ Beneficial Microbes 2020 Sep 1;11(5):411–455. 11 McKenzie C, Tan J, Macia L, Mackay CR. ‘The nutrition-gut microbiome-physiology axis and allergic diseases’ Immunology Review 2017 Jul;278(1):277–295. 12 Hu J, Lin S, Zheng B, Cheung PCK. ‘Short-chain fatty acids in control of energy metabolism’ Critical Review of Food Science and Nutrition 2018 May 24;58(8):1243–1249. 13 Gabrial SG, Shakib MR, Gabrial GN. ‘Effect of pseudocereal-based breakfast meals on the first and second meal glucose tolerance in healthy and diabetic subjects’ Macedonian Journal of Medical Science 2016 Dec 15;4(4):565–573. 14 Canfora EE, Jocken JW, Blaak EE. ‘Short-chain fatty acids in control of body weight and insulin sensitivity’ Nature Reviews Endocrinology 2015 Oct;11(10):577–591. 15 O’Keefe SJ. ‘Diet, microorganisms and their metabolites, and colon cancer’ Nature Reviews Gastroenterology and Hepatology 2016 Dec;13(12):691–706. 16 Wong JM, de Souza R, Kendall CW, Emam A, Jenkins DJ. ‘Colonic health: Fermentation and short chain fatty acids’ Journal of Clinical Gastroenterology 2006 Mar;40(3):235–243. 17 Cait A, Hughes MR, Antignano F, Cait J, Dimitriu PA, Maas K R, Reynolds LA, Hacker L, Mohr J, Finlay BB, Zaph C, McNagny K M, Mohn W W. ‘Microbiome-driven allergic lung inflammation is ameliorated by short-chain fatty acids’ Mucosal Immunology 2018 May;11(3):785–795. 18 Li M, van Esch BCAM, Henricks PAJ, Folkerts G, Garssen J. ‘The antiinflammatory effects of short chain fatty acids on lipopolysaccharideor tumor necrosis factor α-stimulated endothelial cells via activation of GPR41/43 and inhibition of HDACs’ Frontiers in Pharmacology 2018 May 23;9:533. 19 Zalar B, Haslberger A, Peterlin B. ‘The role of microbiota in depression - A brief review’ Psychiatria Danubia 2018 Jun;30(2):136–141. 20 Lattimer JM, Haub MD. ‘Effects of dietary fiber and its components on metabolic health’ Nutrients 2010 Dec;2(12):1266–1289. 21 Rowland I, Gibson G, Heinken A, Scott K, Swann J, Thiele I, Tuohy K. ‘Gut microbiota functions: Metabolism of nutrients and other food components’ European Journal of Nutrition 2018 Feb;57(1):1–24. 22 Sirisinha S. ‘The potential impact of gut microbiota on your health: Current status and future challenges’ Asian Pacific Journal of Allergy and Immunology 2016 Dec;34(4):249–264. 23 Ricardo Leitão-Gonçalves et al. ‘Commensal bacteria and essential amino acids control food choice behavior and reproduction’ PLOS Biology April 25, 2017. 24 Klaunig JE. ‘Oxidative stress and cancer’ Current Pharmaceutical Design 2018;24(40):4771–4778. 21

The science and the art of self-care 25 Lovejoy NC, Roche N, McLean D. ‘Life stress and risk of precancerous cervical lesions: A pretest directed by the life stress model’ Oncology Nursing Forum 1997 Jan–Feb;24(1):63–70. 26 Lee CH, Giuliani F. ‘The role of inflammation in depression and fatigue’ Frontiers in Immunology 2019 Jul 19;10:1696. 27 Tseng J, Poppenk J. ‘Brain meta-state transitions demarcate thoughts across task contexts exposing the mental noise of trait neuroticism’ Nature Communications 2020;11:3480.

22

SECTION 1 Our physical wellbeing Allied Health Professionals help others to function at their best. We have an appreciation for how physical health can impact upon a person’s activities, participation and wellbeing. We are trained to look holistically at a person, and we know that making a small tweak in one aspect of health can impact upon a patient’s general quality of life. It is surprising how often we neglect our own physical needs. We don’t set out to do this. We may have got into the habit of not eating well or not exercising just because we are so busy all the time. We are acclimatised to a work environment where resources are limited and the whole team is over-stretched. Patient care comes first, sometimes at the expense of self-care. I don’t want to add another ‘to do’ list to your already busy life. I want you to be able to weave one or two strategies that will bring about profound change. In this section, there are chapters on our physical needs: the need to breathe, the need to sleep, the need to move, the need to eat and drink. Your self-care will look very different to another person’s self-care. You probably know which area needs some attention. The good news is that if you make one change in one area, it is likely to support another. For example, focusing on your breathing is likely to impact upon your sleep quality. Getting more sleep is likely to help you to want to exercise and to make good food choices. You might instinctively know the area where you need to make a change. Making a small change can have a big impact. It is empowering DOI: 10.4324/9781003165125-2

Our physical wellbeing

to tune in and notice the difference you feel. You might even want to start writing a self-care journal so that you can note how you feel now, and how you feel after you start a self-care practice. This will enhance the physical benefits, and you will gain an emotional benefit from knowing you are looking after yourself. We never perfect self-care. Our practices will evolve with us. As circumstances change, we will tweak things. The key is tuning in. As AHPs, we are experts at observing patients. Now we need to observe ourselves.

24

2

Breathe

Inhale, then exhale. That’s how you’ll get through it. Anonymous Breathing is automatic. It is under the control of our brain stem, like our heart-rate, our sleep cycles, hunger and thirst and our temperature. We won’t forget to breathe. But we might forget to breathe well. Breathing can be optimised by bringing it under our conscious control. We can use the breath to calm ourselves down, or to energise ourselves. We can change the breath to either activate our sympathetic or parasympathetic responses.1 When we are relaxed, we take longer, deeper breaths. We either have an equal inhale-to-exhale ratio, or our exhale is slightly longer. This signals to our brain and our body that everything is fine; no drastic action needs to be taken. Our body is likely to be in ‘rest and digest’ mode, allowing the body to put its energy into digestion of food and body maintenance. Being in this mode for most of the day is optimal for physical and mental health. When we are stressed, we take shorter, more shallow breaths. We might gasp at air, or unconsciously hold our breath. This sort of breathing activates our stress response. We instinctively know that our breath can be used to help us when we are stressed. We will tell a child who is hurt or upset to ‘breathe’. We sigh when we need to release tension, and we take a deep breath when we are preparing ourselves for action. In the following pages you will find techniques for optimising the breath. By bringing breathing under our conscious control, we can DOI: 10.4324/9781003165125-3

25

Our physical wellbeing

reduce our stress, control anxiety and relax our nervous system so that we spend more time in the ‘rest and digest’ rather than ‘fight, flight or freeze’ zone. At first it will seem unnatural to change the breath. We have habitual patterns of breathing, and to consciously change this may bring anxiety and resistance at first. Like anything, the first time you try, it feels weird and difficult. The second time will be easier. Tune in to how you feel after five minutes of breathing practice. Just a short amount of practice, five minutes per day, is enough to increase your breath awareness. This will start to carry over into your breathing in other parts of your day. Start small. If you tend to breathe through your mouth, start with short periods of nose-breathing. If you find yourself getting stressed, extend your exhale. If you need to distract yourself from overwhelming emotion or anxiety, practice alternate nostril breathing. The breath is a fabulous resource for our self-care. It costs nothing and it is always there for us. Once we tune into it, we can consciously breathe into different parts of our lungs: the bottom, the sides, the shoulders, even into our backs. We can visualise bringing breath into different parts of our body, and this allows us to relax, or brings us energy or sensation. Start having fun with the breath, and tap into this amazing resource.

Breathe through your nose The nose is for breathing. The mouth is for eating. Proverb We may assume that it doesn’t much matter whether we breathe through our mouth or nose. Either way, we are getting air to our lungs and out again. Our nasal cavities are shaped with structures called ‘turbinates’. These bony structures resemble the inside of a shell. The shape is important: it helps to direct the air in a circling pattern, as it moves through our nasal cavity. The ‘shelves’ of the turbinates are covered with soft tissue and mucous membrane. Hair-like cells pulsate, directing the air through the nostril. This action serves to filter out dust, pollen and pollutants. Because the journey through the nasal cavity is 26

Breathe

long and winding and has a rich supply of blood vessels, the air is gently warmed and humidified. The air is perfectly prepared for our lungs. None of this happens if we breathe through our mouth. Because the turbinates direct the air around the bends in our nose, we breathe slower and deeper when we breathe through our nose. Slow, relaxed breathing means that air is taken deep into our lungs. Gas exchange is most efficient when we do this. Efficient gas exchange means oxygen is distributed throughout the tissues in our body, not just to our vital organs. If you suffer from cold hands and feet, then the chances are, you are not breathing well.  Mouth-breathing activates our sympathetic nervous system, triggering a ‘fight, flight or freeze’ response. Nose-breathing activates our parasympathetic response, maintaining our steady ‘rest and digest’ state. We need to be in this state for most of the time in order for the body to carry out its basic house-keeping. This includes bringing oxygen and nutrients to all tissues throughout the body, repairing cell or tissue damage, keeping hormones balanced and regulating our immune response.

Figure 2.1  The turbinates of the nostrils 27

Our physical wellbeing

We don’t need to take deep breaths. We can breathe slowly and quietly. We might initially feel ‘air hunger’ if we are not used to nosebreathing. ‘Air hunger’ is when our body registers increased carbon dioxide in our blood. If we are habitual mouth-breathers, we will have a very low tolerance for raised levels of carbon dioxide, and we will gasp at air to get more oxygen into our lungs. With daily practice of slow, quiet nose-breathing, we build our tolerance for carbon dioxide, and we no longer feel ‘air hunger’. Our breathing and our gas exchange will become more efficient. The change can start to happen in just a few days. Over a few weeks of practice, we can chart how much slower our breathing rate has become (see also ‘Extend your exhale’ later in this chapter). You might check in with your nose-breathing at key times during the day. You could set a timer or put a post-it note or a sticker in a prominent place to remind you to check in with your breathing. You might check in with your breath –– –– ––

Every time you reach for your phone or every time you get a notification. Every time you open a particular application on your computer. When you are travelling to and from work, at a set place along the way.

At first it will be effortful to change our breathing pattern. We might feel ourselves feeling ‘air hungry’. This is because we are used to taking short and shallow breaths, and we have a very low tolerance for changing the breath. Over time we learn to tolerate this feeling, and gas exchange becomes more efficient. If we practice regularly, we can help nose-breathing become our habitual pattern.

  Tune in How does nose-breathing feel, compared with mouth-breathing? Do you feel the breath deeper down in the lungs when you nose-breathe? How does it feel in the rest of your body? Do you feel less stressed when you slow the breath with nose-breathing? 28

Breathe

  Go deeper Read all about the science of nose- or mouth-breathing in James Nestor’s book ‘Breath’.2 If you take part in sports or fitness training, you might like Richie Bostock’s book ‘Exhale’.3

Unblock your nose This technique is truly magical. Within a few seconds you can unblock your nose and begin to experience the joy of nasal breathing. Your sense of smell and taste are likely to improve, and you will be less susceptible to coughs and colds. It is called the Buteyko method, and you can find video clips online which show the method described below. Take a small breath in through your nose and then out through your nose. Even if your nose is congested you can usually do this! Lightly pinch the top of your nose, between finger and thumb. Hold your breath whilst you slowly nod your head up and down. Continue to do this for several seconds, continuing to hold your breath, nodding your head up and down and pinching your nose, until you feel a strong urge to take in another breath. Let go of your nose and breathe in through your nostrils. If you are prone to upper respiratory tract infections or from allergies, practice this regularly. It will help to establish nose-breathing. Breathing through the nose more often will improve the health of your nose and open up the airway. The tissues and nerves will be stimulated by feeling air passing through the nose. This will bring a better blood supply, which will lead to repair of congested and damaged tissues. Just like with the previous strategy, you may initially experience ‘air hunger’, because you are not used to breathing in this way. Practice nose-breathing for a few minutes each day, and your tolerance will quickly improve. 29

Our physical wellbeing

Once you have learnt this technique and feel comfortable with conscious nose-breathing, you can check that you are nose-breathing at other times during the day. You could set a timer every couple of hours, or have a post-it note or sticker that prompts you to check your breathing. It could be that each time you look at your phone or check your emails, you also check your breathing.  Once you are comfortable with nose-breathing for everyday activities, you might try it during exercise. At first it will feel as though you are hungry for air. Reduce the intensity of your workout for a while, so that you can continue to breathe through your nose. After a couple of weeks, you will find that you are able to train harder. Ultimately you will have better stamina and strength, because you are getting much more efficient gas exchange in your lungs. You might also check your breath when you are going to sleep. Mouth-breathing is associated with poor sleep, snoring and sleep apnoea. Repeat the Buteyko method when you lie down to go to sleep. You can re-programme yourself to breathe through your nose when sleeping.

Figure 2.2 Breathe

30

Breathe

  Tune in Feel the air entering your nostrils, and imagine tracking the passage of the air through the turbinates of the nostrils, into your throat and into your lungs. Focusing on this tends to slow down and deepen the breath, further enhancing the quality of our breathing.

  Go deeper Do you suspect you may be a mouth-breather when you are asleep? Clues include if you snore, or if you wake up thirsty or wake up with a dry mouth. If you want to check whether you are breathing through your nose at night, try putting a very small piece of medical tape, the size of a postage stamp, across your closed lips. The idea is not to seal your lips shut, but to give yourself an additional sensory cue to keep your lips closed. If this is comfortable, then try lying down. If you are still comfortable with breathing through your nose, experiment with sleeping like this. At any point in the night you can take the tape off. Note how you feel after a night of nose-breathing. Are you less thirsty on waking? Do you feel more refreshed?

Extend your exhale This is the easiest but most profound breathing practice. It can be applied anywhere, without anyone noticing. Slow breathing has multiple benefits. It calms us down.4 It slows our heart-rate and lowers our blood pressure. It switches us into our ‘rest and digest’ mode, with all the health benefits this entails.5 A slower breathing rate is associated with a feeling of being able to cope with the current situation.6 This is invaluable for a health professional. We can’t control the difficult situations we find ourselves in. We will always be confronted

31

Our physical wellbeing

with pain, loss, anger, frustration and disappointment in our work with service-users. We can’t change that. But we can change our response to the stress of this.

Try this exercise for three to five minutes: –– –– –– ––

Breathe through your nose. Take a slow breath in. If it helps, count slowly to four. Breathe out slowly. If it helps, count slowly to six. Continue this way of breathing for three to five minutes.

Breathe quietly and calmly. The aim is a slow, gentle, relaxed breath.

As we spend time on the breath, we are able to extend the exhale a little further. After a couple of weeks, you may adjust the count to six on the inhale and eight on the exhale. We might check in with our breathing a few times every day. We might use a timer, post-it note or a sticker to remind us to breathe well. We might consciously choose a routine trigger, like every time we get up to call in the next patient to our clinic room, we take some slow breaths. If there is a working day that you know is going to be stressful, you could visualise yourself at a key point in the day practising breathing. You are more likely to remember the technique if you have visualised it beforehand.

  Tune in How do you feel? Has this changed since the start of the exercise? How do you feel in your body? In your head? Do you feel able to manage the current situation? When are the most stressful times of your day? Opening emails? Delivering a diagnosis? Presenting a case at a multi-disciplinary meeting? Prepare for these times by consciously extending your exhale for a couple of minutes. You can also use this when someone challenges you. Rather

32

Breathe

than immediately reacting, exhale first. Your response will be calmer and more considered for taking the time to breathe.

  Go deeper The optimal breathing rate, once you have learned how to extend your exhale, is 5.5 breaths per minute. This is for optimal cardiovascular health.7 Typically we take 12–16 breaths per minute; more if we are stressed. 5.5 breaths per minute is something to aim for, but don’t get obsessed by it. That would be counterproductive. Play with your breath. Make it fun. See how long you can extend your exhale, and then see if you can add a second to the length of the exhale. It takes weeks to train your breath in this way, so be patient.

Alternate nostril breathing This yoga technique is my favourite for coping with intense stress or anxiety. It requires concentration. You cannot help but be distracted from whatever is overwhelming you. If you find yourself replaying a stressful conversation in your head, wishing you had said something different, then this is the technique for you. It is also useful at the start or end of a working day. It has a balancing and calming effect on the whole body. Alternate Nostril Breathing, also known as Nadi Shodhana, takes a bit of practice, but is well worth adding to your breathing ‘box of tricks’. –– ––

–– ––

Sit in a comfortable upright position. Place your thumb gently over your right nostril and place your ring finger and little finger over your left nostril. You can rest your index and middle fingers on the space between your eyebrows. Don’t close the nostrils yet. Exhale completely through both nostrils. Use the thumb to gently close the right nostril. Breathe in slowly through the left nostril.

33

Our physical wellbeing

––

–– –– ––

Use the ring finger to gently close the left nostril. Breathe out slowly through the right nostril. Pause. Breathe in through the right nostril. Close the right nostril. Breathe out through the left. Pause. Breathe in through the left. Close the left nostril. Breathe out through the right. Pause. Breathe in through the right. Repeat this for five minutes.

The pattern is: ––

In through left. Out through right. In through right. Out through left. Repeat. 

If you don’t want to attract unwanted attention from others, you can practise alternate nostril breathing it in a subtle way by not using your fingers to close off the nostrils. Imagine yourself taking the breath through one nostril and then out of the other, and then follow the same pattern as is shown above. This will have the same effect of quieting the mind in order to deal with a stressful or anxiety-provoking situation.

Figure 2.3  Alternate nostril breathing

34

Breathe

  Tune in How do you feel after five minutes of breathing in this way? Did it bring you relief from troubling thoughts? Do you feel more balanced? Calm? Centred? Able to cope? How was the pause between breaths? Did this open up space in your lungs, chest and abdomen? You might have felt lighter or clearer in your head or body.

  Go deeper We have erectile tissue in our nostrils, and at any one time, one nostril’s tissues is more engorged and erect than the other. The non-erect one will be more ‘open’ and air will flow more freely. There will be a cycling between the nostrils throughout the day, so that the right nostril is more open for a period of time, and then the left nostril will be more open. A good distraction from any stress you are experiencing is to work out which nostril is more open. If you experience a lot of nasal congestion, you might like to experiment with using a Neti pot. A Neti pot is used to gently rinse out the nostrils and sinuses with body temperature saline. You can find videos of how to do this online. It feels a little strange at first, but can be very helpful to clear out congestion during allergy season or if you have a bad head cold. Apply this at work ––

––

Paramedics: as you are arriving at a situation, take three long cycles of breath, extending your exhale. Breathe through your nose to bring the air deeper down into the lungs. If you have frightened patients or carers, this might be a useful thing to do together. Diagnostic Radiographers: if patients have to maintain a still position for a long time, for example in an MRI or CT scan, you might teach them a version of alternate nostril breathing where they don’t touch their nose, but just feel the breath going in one nostril and out the other. This technique 35

Our physical wellbeing

––

––

––

––

––

requires concentration, so might be a useful distraction for them. Orthoptists: you have to get close to patients and look into their eyes, which can be quite uncomfortable for the patient. You might encourage patients to extend their exhale before the start of your examination, and during your assessment. If you notice they are holding their breath, cue them to exhale. Maintain a calm, quiet, low-pitched voice for this. You will extend your exhale too, which will benefit your state of relaxed, alert attention. Operating Department Practitioners: as you prepare patients for surgery, you might encourage them to extend their exhale. You might extend your exhale during surgical procedures to maintain a state of relaxed, alert attention. For hospital-based AHPs: when you have had a distressing case or a challenging shift, you might try five minutes of alternate nostril breathing before you leave work. This might help you to calm down in order to transition home more easily. If you have a colleague who is interested, you might sit together and teach them alternate nostril breathing. This can be a really bonding experience, reminding us that we are in this together, and that we can help to ground one another. Physiotherapists and Osteopaths: if you know that your work with a patient might generate anxiety or discomfort, can you carry out some breath work with them before you start? Can you teach them to breathe during your exercises with them so that they can gain maximum benefit from stretches? Occupational Therapists and Speech and Language Therapists working with respiratory or voice patients: do you use these breath practices with your patients? Can carers be involved so that they can cue the patient when you are not there?

Notes 1 Russo MA, Santarelli DM, O’Rourke D. ‘The physiological effects of slow breathing in the healthy human’ Breathe 2017 Dec;13(4):298–309. 2 Nestor J. Breath: The New Science of a Lost Art Penguin Life 2020. 36

Breathe 3 Bostock R. Exhale: How to Use Breathwork to Find Calm, Supercharge Your Health and Perform at Your Best Penguin Life 2020. 4 Sharma VK, Trakroo M, Subramaniam V, Rajajeyakumar M, Bhavanani AB, Sahai A. ‘Effect of fast and slow pranayama on perceived stress and cardiovascular parameters in young health-care students’ International Journal of Yoga 2013 Jul;6(2):104–110. 5 Zaccaro A, Piarulli A, Laurino M, Garbella E, Menicucci D, Neri B, Gemignani A. ‘How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing’ Frontiers in Human Neuroscience 2018 Sep 7;12:353. 6 Zaccaro A, Piarulli A, Laurino M, Garbella E, Menicucci D, Neri B, Gemignani A. ‘How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing’ Frontiers in Human Neuroscience 2018 Sep 7;12:353. 7 Lin IM, Tai LY, Fan SY. ‘Breathing at a rate of 5.5 breaths per minute with equal inhalation-to-exhalation ratio increases heart rate variability’ International Journal of Psychophysiology 2014 Mar;91(3):206–211.

37

3

Sleep

My favourite quotation about sleep is attributed to writer and entrepreneur E. Joseph Cossman. ‘The best bridge between hope and despair is a good night’s sleep’. A good night’s sleep means that we wake up firing on all cylinders. A poor night’s sleep might lead to some misfiring! Most adults need 7–9 hours of sleep. Good sleep is important for our mood regulation,1 immune system, 2 hormone regulation,3 optimum metabolism4 and cognition.5 There is correlation between disrupted sleep and metabolic disorders such as cardiovascular disease and diabetes6,7 and new research suggests a relationship between the quality of our sleep and our risk of developing Alzheimer’s.8 In particular, sleep is vital for brain health. Whilst we are asleep, parts of our brain are more active than when we are awake. They are carrying out essential house-keeping to keep our brains performing well, and to maintain the long-term health of our brain. This includes: ––

Processing new information, moving learning from short-term to long-term memory, allowing us to easily access information when we need it.

––

Making new and creative connections between different parts of our brain, allowing us to have innovative ideas when we wake up.

––

Clearing out damaging molecules which are associated with neurodegeneration.9 The accumulation of such material is believed to increase our risk of diseases such as Alzheimer’s.10

38

DOI: 10.4324/9781003165125-4

Sleep

There are four stages of sleep in a sleep cycle: ––

––

–– ––

The first stage is falling asleep. We become increasingly drowsy, and we start to fall asleep. This typically takes five to ten minutes. It is common to experience dream-like images or sounds in this stage, and we may waver between consciousness and sleep a few times. The second stage is light non-REM (Rapid Eye Movement) sleep. Our core body temperature drops and our heart-rate slows. We spend about half of our total sleeping time in this stage. The third stage is deep non-REM sleep. Our muscles relax, our heart-rate, breathing rate and blood pressure reduce further. The fourth stage is REM sleep. This is when we dream. Our brain becomes more active, but our body is in its most relaxed state. This typically accounts for about 20 percent of our total sleep time.

Each of these cycles of sleep takes about 90 minutes, and we have 4–6 cycles per night if we are sleeping well.

We may struggle to fall asleep, or we may wake up in the night and find it difficult to get back to sleep. At these times, our minds start racing with all the events of the day. Our brains have a negative bias. We tend to focus on the negative, worrying about how we have behaved or resenting the behaviour of others. This is an adaptive response: we evolved in social groups and so it was important that we worried what others thought of us, and that we cared about our social standing. We are probably more prone to obsessing at bed-time because this is the first time we have just sat with our thoughts for that day. Sleep might seem like a far-off dream if you are caring for young children or other family members who have disrupted sleep. To a certain extent, we have to accept that there will be times in life when our sleep is compromised. Having a baby or toddler is one of those periods. It is best not to stress too much about your sleep quality at this stage of life, but make sure that you have other self-care strategies in place, such as breathing well, in order to conserve your energy. Support your body clock during the day to make the best use of time in bed (see p.40). 39

Our physical wellbeing

We will sleep again. We need to congratulate ourselves on surviving a challenging stage of life. These strategies might help other family members with their body clock. You might like to share these strategies, and have some agreed routines to support everyone’s sleep. Sleep patterns change through the life-cycle. Teenagers might struggle with the transition between being awake and asleep, and then the transition between being asleep and awake. As we get older, we might sleep less: the evidence is unclear whether this is a natural process or whether is it is a cause for concern.11 We can’t talk about sleep without talking about menopause. Menopause has diverse symptoms including headaches, muscle aches, anxiety, brain fog, hot flushes and difficulties sleeping. The disruption to sleep might be enough to cause other health and wellbeing problems. All of the self-care strategies in this section are relevant for menopause, but this chapter is especially important. In this chapter you will find some practical tips for developing good sleep habits. There are techniques to allow you to wind down after work, and a yoga nidra practice to help you find a profound sense of rest, and to help with insomnia. Sleep is the bedrock of wellbeing. We may have spent years not prioritising sleep, but we can begin today.

Support your body clock We all have an internal body clock located in a part of our brain called the suprachiasmatic nucleus (SCN). The SCN responds to stimuli including light levels, and communicates with the pineal gland, which synthesises a hormone called melatonin. Melatonin levels rise through the late afternoon and evening, helping us to settle down and feel sleepy at bed-time. The SCN also helps to regulate our appetite and thirst, so that we eat and drink during the day. In addition, it responds to seasonal changes in light, so that we may feel more sleepy in the winter compared with the summer. If you struggle with settling down to sleep and staying asleep at night, you might benefit from spending more time outdoors. The light exposure will give clear messages to your SCN and pineal gland about when to secrete more melatonin. 40

Sleep

Exposure to natural light in the morning and early afternoon is especially helpful in setting our body clock, but any amount of natural daylight is better than no daylight. Morning light contains more blue light, whist evening light contains more red light. Screen-based devices, like televisions and phones, emit blue light. Our SCN and pineal glands are potentially confused into not producing melatonin if we have too much screen time in the evening.12 We can choose to turn screens off, or we can set them to ‘night mode’, or we can wear special glasses to filter out the blue light. We can also support the work of our body clock by keeping to a regular schedule of bed-time and waking time. Ideally, this should be kept within an hour’s window, so say between 10pm and 11pm for bed-time and between 6am and 7am for waking time. If we have a late night or sleep in at the weekend, we are likely to suffer from ‘social jet lag’. Strategies to support your body clock: ––

––

–– –– –– ––

––

Keep to a regular bed-time and waking time, within a one-hour window. Of course you can occasionally step outside of this, but use it as a guide. Try to get exposure to natural daylight. This could be a morning or lunchtime walk, or just sitting outdoors with a cup of tea between clinics. Avoid caffeine after 2pm. Depending on your personal biochemistry, caffeine’s effects can last up to nine hours. Avoid a heavy meal before bed, ideally eating at least three hours before bed-time. Avoid alcohol, as this interferes with the restorative functions of the brain during sleep.13 Avoid very strenuous exercise in the evening. It can be difficult to wind down after a workout. Choose gentle exercise such as a walk or yoga instead. Avoid overstimulating content on social media or television in the hours before bed. Monitor how you feel after watching different types of content.

41

Our physical wellbeing

––

––

––

––

Reduce screen time in the evening, or mitigate blue light exposure by using ‘night mode’ or filtered glasses. Reduce the brightness of artificial lighting in the evening. We are familiar with setting an alarm clock to wake up, but could we set a reminder signalling that it is time to start preparing for bed? The process might take half an hour, or longer, if you factor in all the tasks you do before bed. Keep the routine very similar each night, so that you signal to your brain what is coming. Carry out routines like brushing your teeth, folding clothes, and maybe meditating, writing or reading to quieten your mind before bed. Keep your bedroom cool. It is easier for us to fall asleep and stay asleep if the temperature is 18°C or slightly below.14

If you are a shift worker, sleep is going to be challenging. If it possible to keep to a consistent waking and sleeping pattern that works for your shift pattern, then do this. Early research suggests that bright light treatments may mitigate the long-term risks of night-shift work.15 Night-shift workers are advised by the British Medical Journal to stay hydrated but not to eat between midnight and 6am.16

Figure 3.1  Support your body clock

42

Sleep

Tune in How does it feel when you think about your sleeping pattern? Do you instinctively know when you are not getting enough sleep? How does it feel in your body? How does it feel in your mind? Contrast this with a time when you have felt truly rested. If this is difficult to remember, think of a holiday or time away from work when you were able to sleep for longer. How did this feel in your body? How did it feel in your mind? How important is sleep to you? Is it time to prioritise your sleep?

Go deeper You might keep a sleep journal for a couple of weeks to chart how much sleep you are getting and how you feel. This might help you to identify what helps you to get a good night’s sleep. Consider the strategies above and whether any of these factors is contributing to your sleep quality. A word of caution, though: it is easy to become obsessed by sleep. Sleep trackers on fitness devices can be the worst thing for wellbeing! Monitor whether this is the case for you. Instead of focusing on the number of hours asleep, or what your sleep tracker says, focus on strategies for a restful night’s sleep. Focusing on your breathing (see Chapter 2) or on meditation (see Chapter 7) can be more helpful than focusing directly on sleep.

Leave work behind Being an Allied Health Professional is stressful. Some people’s life situations really get to you, and it is difficult to just park them when you get home. At the end of the working day, it might be useful to review what you have done that day. You might want to write a short list of things to remember for tomorrow. By making a note of these things, you make it more likely that you can leave work at work. You are signalling to yourself that you have completed work, and that your mind does not have to hold onto information through the evening and night. You might make a mental note of three things that went well today, or three things you are grateful for. We have a natural tendency 43

Our physical wellbeing

to focus on the negative. By regularly thinking about or writing about positive things, we get better at noticing and focusing on them.17 It can be useful to have a transition activity which marks the end of work for you. Commuting is a good transition activity. If you work from home, you might have to build in a transition activity to mark the end of a working day. It might be a short walk. It might be ten minutes of singing or dancing to a playlist. It might be a short yoga or workout session. It might be changing into home clothes. It might be sitting down for a cup of tea. It might be cooking dinner. The transition activity is probably something you need to do alone. You have spent the working day responding to other people’s needs. You have put a lot of effort into doing the right thing by other people, whether they were service-users, family members, your colleagues or other teams you work with. Your transition time should be about your needs and your preferences. If you are going home to family members, you will need to communicate that you need a short transition activity, and then you will give them your attention. This is challenging if you have young children. However, it is important to model a child that you are taking time out for yourself to process your thoughts and emotions after a busy day. If home life is stressful, then it can be equally useful to have a transition activity before you enter the workspace. –– –– –– –– –– –– ––

44

Decide what your transition activity is going to be. Make it a consistent activity, so that your brain starts to recognise that this is the time to shift gear. Carry out the activity in a consistent place. You can have a phrase that you repeat to yourself, if this is helpful. For example ‘I’m leaving it all behind’. You might want to practice a round of calm breathing. Go for your walk, dance to your playlist, practice your yoga, or whatever your transition activity is. Ten minutes is enough. Congratulate yourself for having done this for you and those around you.

Sleep

Tune in How do you feel when you pack up your work at the end of the day? It might be worth spending a few moments thinking about this. What are the thoughts or worries going through your mind? Once you have completed your transition activity, check in with yourself again. How do you feel now? Is it helpful to spend your leisure time worrying about work? Can you use this time in a more free and selfcompassionate way? What difference will this make when you come back to work in the morning?

Go deeper If you work from home, you might want to visually signal to yourself that work is done. You might pack up your laptop and notebook, or put a cover over them. If possible, make it look attractive so that your home feels like home again. Focus on putting your laptop to bed because it needs a rest. It has been working hard all day, and needs to refresh itself for tomorrow. You might also want to change into home clothes, to signal to yourself that it is time to relax.

Download your day Often when we get into bed, our mind starts sifting through the events of the day. This is fine if we have had a fulfilling day. If our day has been full of frustration or disappointment, this is not ideal. We can anticipate this, and download our day before we get into bed. ––

––

Sit in a comfortable position, be it cross-legged on the floor, or on a chair. You want to feel balanced so that your hips are reasonably even and your spine is reasonably straight. Ground yourself by feeling where your feet or your bottom are making contact with the floor. Feel as you gently press into the 45

Our physical wellbeing

––

––

––

––

––

floor how your spine, chest and head are able to lift up slightly. Feel that space in your body. Focus on taking easy breaths in and out. Focus on how different parts of your body feel. If there is discomfort, what can you do to ease it? Feel free to wiggle and stretch. As you come into stillness, observe your thoughts. Thoughts will come and thoughts will go. When you realise that you are thinking a thought, observe this. Say to yourself ‘that’s interesting’. You can observe yourself having the thought, as if you are a researcher. For example ‘That’s interesting. Ali is worrying about what was said in the meeting this afternoon’. As soon as you observe the thought, you bring yourself out of the thought. You are the observer. You can observe what is preoccupying your mind. After five or ten minutes of observing your thoughts, you will have a good idea of what is troubling you about the day. This is useful information. Allow your thoughts to drift away once you have observed them. You might imagine them as clouds, waves or bubbles.

Tune in How does it feel to allow yourself to explore your thoughts before you get into bed? Does it surprise you which thoughts come up? Is it easier to let them go when you are an observer of yourself thinking your thoughts? What imagery works best for you when imagining your thoughts drifting away?

Go deeper There are some excellent apps which have guided meditations or sleep stories to help you relax before sleep. If you struggle with switching off your thoughts, it can be helpful to have another person’s voice telling you what to think about. Try the ‘Calm’ or ‘Headspace’ apps. There might be a free 46

Sleep

Figure 3.2  Observe your thoughts

trial period so that you can find an app which works for you. Remember to take your phone downstairs or switch it off once you have finished. You might also try the next practice, Yoga nidra.

Yoga nidra Yoga nidra is a powerful restorative practice which soothes the mind and body into a deeply relaxed state. Yoga nidra has been shown to change the brain’s activity from the awake and alert beta waves to calm and restful alpha waves. Yoga nidra promotes the release of serotonin and dopamine in the brain and initiates a shift of the autonomic nervous system into the parasympathetic response.18 Yoga nidra has been shown to improve blood sugar in diabetic patients,19 to improve cardiovascular health and menstrual health 20 and to help in the recovery from trauma.21,22 47

Our physical wellbeing

Figure 3.3  Yoga nidra

Yoga nidra is my go-to practice if I find myself unable to fall asleep after waking in the night. Yoga nidra removes the pressure of trying to fall asleep. It anchors your mind, so that your thoughts are not flying off in different directions. You are actively trying to stay present for the script. You have the knowledge that yoga nidra is as restorative as sleep, so that anxiety about not getting enough sleep is eased. By the end of the practice you are in a deeply restful state, or you are asleep. The first couple of times you try yoga nidra, you will need to listen to a recording. You can find a recording online, or you can record yourself speaking the script below. There are variations, so find a script that appeals to you. With practice, you will be able to internalise the yoga nidra script so that you can say it to yourself in your head. This is helpful if you are experiencing insomnia. First practice yoga nidra during the daytime, when you can take half an hour to fully relax. Lie on your back with your arms and legs comfortably outstretched, or with your knees slightly bent. You can use a pillow under your head and maybe under your bent knees. Your chin is tucked slightly so that the back of your skull is resting on the pillow. Take the time to get really comfortable. Wiggle around to find your most comfortable position. It is helpful to cover yourself with a blanket, because this makes you feel more grounded and anchored to the floor.

Yoga nidra script It is time for yoga nidra. Gently close your eyes. Become aware of your body in space. Feel the parts of the body that are making 48

Sleep

contact with the ground, or your bed. Imagine them softening into the support, as if they are slightly melting. Feel your body breathing. Your body is being breathed, and there is no effort on your part. Feel the slight gap between inhale and exhale, between exhale and inhale. Feel the space in this gap. Feel the gentle ripple of the breath as it moves your whole body. The next breath comes easily and naturally; it is like a tide moving in and out. You will move your awareness to different parts of your body when you hear them named. Feel the heaviness or the lightness in that part of your body, and then move on. –– –– –– –– –– –– –– –– –– –– –– –– –– –– –– –– –– –– –– ––

Feel the whole of the right foot. Feel the sole of the foot, the big toe, second toe, third toe, fourth toe, little toe, top of the foot. Feel the whole of the right foot. Feel the right ankle, shin, calf, knee-cap, back of the knee, thigh. Feel the whole of the right leg. Feel both buttocks, hips, lower back, mid-back, upper back. Feel the whole of the back body. Feel the right shoulder, upper arm, elbow, forearm, wrist, back of the hand. Feel the whole of the right arm. Feel the right thumb, forefinger, middle finger, ring finger, little finger, palm, wrist. Feel the whole of the right hand. Feel the right forearm, inside elbow, upper arm, shoulder, shoulder-blade. Feel the whole of the right arm. Feel the back of the neck, back of the head, top of the head, forehead, eyes, cheeks, nose, lips, jaw, chin. Feel the whole of the head. Feel the left shoulder, upper arm, elbow, forearm, wrist, back of the hand. Feel the whole of the left arm. Feel the left thumb, forefinger, middle finger, ring finger, little finger, palm, wrist. Feel the whole of the left hand. Left forearm, inside elbow, upper arm, shoulder, shoulder-blade. 49

Our physical wellbeing

–– –– –– –– –– –– ––

Feel the whole of the left arm. Throat, upper chest, lower chest, abdomen. Feel the whole of the front body. Left thigh, back of the knee, knee-cap, calf, shin, ankle. Feel the whole of the left leg. Right top of the foot, little toe, fourth toe, third toe, second toe, big toe, sole of the foot. Feel the whole of the left foot.

Feel your whole body filled with a warm light. With each inhale, the warmth and the light gets stronger. Your body is recharging and refuelling. It is taking what it needs from each inhale, and giving back what it doesn’t need with each exhale. Imagine every cell of your body renewing and refreshing itself with this warm light. You are supported in this space. Feel the heaviness of your body where it touches the ground. Feel the lightness on your body where it is being breathed. You are supported. Take the breath and the warm light to the places in your body where it is needed. If you have any part of your body which is not at ease, or which needs your attention, take the warm light there. Feel the warm light holding your body, supporting your body. You might count your breaths, counting on both the inhale and the exhale. As you count, feel your body relaxing a little more. [Pause for a few minutes] Wherever you are in your counting, you can let go, and stop counting. You might like to visualise these images in turn: a beautiful sunset, birds taking flight, rocky mountains, pebbles on a beach, footprints on wet sand, a rockpool with swirling seaweed, a coral reef full of life, waves on the shore, a seedling pushing up through the earth, leaves unfurling, an open flower, sunlight through trees, sun on your face. Bring your awareness back into this room. Imagine the objects around you. Feel yourself being held and supported by this space. This is the end of the yoga nidra. You can start to wiggle your toes and fingers, and move your body, if you want to wake up, or you can stay where you are and continue to rest.

50

Sleep

Tune in How did you find this yoga nidra? Did you find a comfortable place to practice? Is there anything you can do to feel more at ease?

Go deeper You can search for longer yoga nidra scripts online. Yoga nidra can take a full hour for an even deeper experience. It can include a longer focus on the breath, different visualisations, and setting an intention for how you want to be in the world.

Apply this at work ––

––

––

Shift-workers: can you keep to a regular pattern for a few days? Can you talk to your team and manager about how your shift patterns might work with your body clock a little more? Get some natural light if you can so that you are not permanently existing in artificial lighting. Stay hydrated, and avoid eating between midnight and 6am. Try not to eat immediately before you go to bed, but leave 3–4 hours between eating and sleeping. See Chapter 5, ‘Eat’ for more ways to support your digestion. Therapeutic and Diagnostic Radiographers: your work is inherently emotional and thought-provoking. ‘Download your day’ will be important. See also ‘Riding the wave of emotion’ and ‘Observing thoughts’ in Chapter 6 for a deeper version of this practice. You might focus on the difference you have made to a patient in their darkest hours. Never underestimate the power of human connection, just from eye-contact, a smile, holding a hand and a kind word. Orthotists, Prosthetists, Podiatrists and Paramedics: you too are making decisions that are potentially life-changing, and so you need to have a way to ‘Download your day’. Occasionally you might wake at 2am with doubts. Every situation in life 51

Our physical wellbeing

––

––

is suffused with misery at 2am. It is the doom hour. In the day-time you can see the positives, but you just can’t in the middle of the night. Remember this, and tell yourself that things will look different in the morning. See also ‘Self-talk’ on p.113 and ‘Forgiveness’ on p.268. AHPs with young children, caring responsibilities or health conditions which interfere with sleep: whilst you cannot change your situation, you are allowed to put yourself first to establish an evening routine which sets you up for rest. If you are lying awake, use the time to practise ‘Yoga nidra’. Art Therapists, Music Therapists, Drama Therapists, Occu­ pational Therapists and Speech and Language Therapists: is sleep an issue for the people you work with? Can you share any of these strategies to support service-users or their carers?

Notes 1 Lima MG, Barros MBA, Ceolim MF, Zancanella E, Cardoso TAMO. ‘Sleep duration, health status, and subjective well-being: A populationbased study’ Revista de Saude Publica 2018 Sep 3;52:82. 2 Besedovsky L, Lange T, Born J. ‘Sleep and immune function’ Pflugers Archiv: European Journal of Physiology 2012 Jan;463(1):121–137. 3 Morris CJ, Aeschbach D, Scheer FA. ‘Circadian system, sleep and endocrinology’ Molecular and Cellular Endocrinology 2012 Feb 5;349(1):91–104. 4 Poggiogalle E, Jamshed H, Peterson CM. ‘Circadian regulation of glucose, lipid, and energy metabolism in humans’ Metabolism 2018 Jul;84:11–27. 5 Killgore WD. ‘Effects of sleep deprivation on cognition’ Progress in Brain Research 2010;185:105–129. 6 Sharma S, Kavuru M. ‘Sleep and metabolism: An overview’ International Journal of Endocrinology 2010;2010:270832. 7 Tamakoshi A, Ohno Y; JACC. ‘Study group. Self-reported sleep duration as a predictor of all-cause mortality: Results from the JACC study, Japan’ Sleep 2004 Feb 1;27(1):51–54. 8 Andrew SP, Lim MD, Kowgier M, Yu L, Buchman AS, Bennett DA. ‘Sleep fragmentation and the risk of incident Alzheimer’s disease and cognitive decline in older persons’ Sleep 2013 July 36;7:1027–1032. 9 Xie L, Kang H, Xu Q, Chen MJ, Liao Y, Thiyagarajan M, O'Donnell J, Christensen DJ, Nicholson C, Iliff JJ, Takano T, Deane R, Nedergaard M. ‘Sleep drives metabolite clearance from the adult brain’ Science 2013 Oct 18;342(6156):373–377. 52

Sleep 10 Mendelsohn AR, Larrick JW. ‘Sleep facilitates clearance of metabolites from the brain: Glymphatic function in aging and neurodegenerative diseases’ Rejuvenation Research 2013 Dec;16(6):518–523. 11 Dzierzewski JM, Dautovich N, Ravyts S. ‘Sleep and cognition in older adults’ Sleep Medicine Clinics 2018 Mar;13(1):93–106. 12 Cajochen C, Frey S, Anders D, Späti J, Bues M, Pross A, Mager R, Wirz-Justice A, Stefani O. ‘Evening exposure to a light-emitting diodes (LED)-backlit computer screen affects circadian physiology and cognitive performance’ Journal of Applied Physiology 2011 May;110(5):1432–1438. 13 Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. ‘Alcohol and sleep I: Effects on normal sleep’ Alcoholism, Clinical and Experimental Research 2013 Apr;37(4):539–549. 14 Okamoto-Mizuno K, Mizuno K. ‘Effects of thermal environment on sleep and circadian rhythm’ Journal of Physiological Anthropology 2012 May 31;31(1):14. 15 Horowitz TS, Tanigawa T. ‘Circadian-based new technologies for night workers’ Industrial Health 2002 Jul;40(3):223–236. 16 Rimmer, A. ‘What should I eat on my night-shift?’ British Medical Journal 2019;365:12143. 17 Graziano Breuning L. Habits of a Happy Brain: Retrain Your Brain to Boost Your Serotonin, Dopamine, Oxytocin, & Endorphins Levels Adams Media Corporation 2015. 18 Markil N, Whitehurst M, Jacobs PL, Zoeller RF. ‘Yoga nidra relaxation increases heart rate variability and is unaffected by a prior bout of hatha yoga’ The Journal of Alternative and Complementary Medicine 2012;18(10):953–958. 19 Amita S, Prabhakar S, Manoj I, Harminder S, Pavan T. ‘Effect of yoganidra on blood glucose level in diabetic patients’ Indian Journal of Physiology and Pharmacology 2009 Jan-Mar;53(1):97–101. 20 Monika, Singh U, Ghildiyal A, Kala S, Srivastava N. ‘Effect of yoga nidra on physiological variables in patients of menstrual disturbances of reproductive age group’ Indian Journal of Physiology and Pharmacology 2012 Apr-Jun;56(2):161–167. 21 Stankovic L. ‘Transforming trauma: A qualitative feasibility study of integrative restoration (iRest) yoga nidra on combat-related post-traumatic stress disorder’ International Journal of Yoga Therapy 2011;(21):23–37. 22 Pence PG, Katz LS, Huffman C, Cojucar G. ‘Delivering integrative restoration-yoga nidra meditation (iRest®) to women with sexual trauma at a Veteran’s Medical Center: A pilot study’ International Journal of Yoga Therapy 2014;24:53–62.

53

4

Move

When we move, all of our body systems are stimulated: our breathing, our circulation, our metabolism, our immune system. When we move, it raises our energy levels1 and our mood.2 If we do regular physical activity, we significantly reduce our risk of developing coronary heart disease and stroke,3 Type 2 diabetes,4 cancer,5 and depression.67 With moderate intensity weight-bearing exercise, we maintain our bone health8 and muscle mass,9 support our immune function10 and hormone regulation11 and we even protect our brains from cognitive decline.12 If we are not exercising regularly, there is a good reason. We have evolved to conserve energy. If we take the lift and not the stairs, it is not our personal laziness. It is our evolutionary inheritance, telling us to take the easy option. It is only in the last century that we have had to build exercise into our day. Previous to this, movement was part of our day. We had a range of activities that we didn’t have to plan; walking, lifting, bending, stretching, pushing and pulling were all part of our daily routine. It is completely normal to not want to exercise. Even elite athletes report that they do not want to get up and go for a run first thing in the morning. On top of this rational resistance, the rest of us non-elite athletes are likely to have a whole load of hang-ups about exercise. We might carry memories of being the last to be picked in school sports. We might worry that we are so unfit we are going to keel over and have a heart attack. We might be self-conscious about our bodies and about other people seeing us exercise. We might worry that won’t be good at our chosen activity. We might have had a big push towards fitness in the past, and that this either led to injury, or we lost our drive. As Allied Health Professionals, we will almost definitely feel that we don’t have enough time in the day. 54

DOI: 10.4324/9781003165125-5

Move

The good news is that we only need to be a little bit more active than we are already. We don’t need special clothing or equipment. We don’t need gym membership, or even an app. Physical activity is more important than exercise. We don’t need to train for a marathon, we just need to find something that is enjoyable and sustainable, and makes us feel good. Moving more has a host of health benefits. These include: –– –– –– –– ––

Improving our cardiovascular health and reducing our risk of disease.13 Improving our insulin response and reducing our risk of diabetes.14 Reducing our risk of all types of cancer.15 Improving our immune response and regulation of the immune system.16 Improving our mood and reducing our risk of depression.17

The language that is used around exercise can be problematic. We hear the language of combat or punishment. This does not necessarily inspire us to joyful movement. We want to appreciate and celebrate our bodies as they are now. We have lungs, a heart, bones, muscles, tendons, joints. They coordinate to produce an incredible variety of movements. This movement is specific to us, depending on our internal urges and creativity. We are already works of art. Stretching and feeling into our body is a tremendous source of pleasure. B.K.S. Iyengar, the teacher who is credited with bringing yoga to the UK, said ‘it is through your body that you realise you are a spark of divinity’. Take a moment to ground your feet, pressing into the floor. Explore pressing down different parts of the feet: the toes, the heels, the inner foot and then the outer foot. You can feel a connection up your legs into your hips, spine, shoulders, neck and out through your head. It is like lighting up a string of fairy lights, or turning a garden hose on and water rushing in to fill the hose. We always have this feeling of ‘aliveness’ and energy at our disposal. We have a whole internal landscape of sensation to explore, if we open our awareness. Consciously cultivate appreciation for the way you move. No one dances like you. No one walks, runs, swims, practices yoga or plays 55

Our physical wellbeing

sport like you. Move like you. As dancer Erol Ozan says, ‘dancing is creating a sculpture that is visible only for a moment’. You are a unique piece of art, which is constantly changing. Have fun with this. If you enjoy an exercise class, then go to an exercise class. But if you don’t enjoy exercise classes, you can still access movement, and joyful movement at that. In this chapter, we explore getting outside, and being playful with movement. We find out how to incorporate movement into our working day. Finally, there are some restorative yoga movements to try at the end of a busy day. Ultimately we want to fully experience our body. We want to embody our body! We have a unique and incredible body, and movement is one way we can enjoy it.

Spend time outdoors Spending time in green spaces such as parks, open grasslands, woodland, gardens, allotments, or tree-lined streets, is associated with a host of health benefits,18 including: ––

Reduced levels of stress, both perceived and objective measurements.19

––

Reduced heart-rate and blood pressure.20

––

Improved sleep duration and quality.21

––

Reduced anxiety and depression 22 and enhanced mood and self-esteem.23

––

Reduced risk of cardiovascular disease, Type 2 diabetes and premature death.24

Research into the Japanese tradition of ‘forest-bathing’ corroborates anecdotal evidence that spending time in green spaces activates our parasympathetic response. Seeing natural colours and patterns, hearing bird-song, smelling damp earth or wet leaves and touching natural textures of bark and stone all seem to contribute to a sense of wellbeing and connectedness.25 Research suggests that the more connected we are with nature, the happier we are.26 Green spaces make us feel like moving. We don’t notice that we are exercising when we are strolling through a park noticing flowers, birds 56

Move

or insects. Gardening, looking after outdoor animals, foraging, naturespotting, litter-picking and nature-based arts and crafts all lead to ‘green exercise’ and the associated physical and mental health benefits. When we are outdoors we are breathing in phytochemicals from plants and getting exposure to the microbiome of the air and the earth, and these microbes enhance our lung microbiome. There is evidence that this supports our immune system 27 and may help in the treatment of respiratory conditions.28 Not only that, but time spent outdoors improves our problemsolving and our creativity.29 Natural settings activate our parasympathetic response, leading us into a relaxed state of alertness. When we are in this state, we can respond thoughtfully to situations. Because we are not stressed, we have the mental space and emotional freedom to be open to new ways of thinking.

Figure 4.1  Spend time outdoors 57

Our physical wellbeing

How might we increase our time outdoors? We might take a short walk before or after work, or at lunchtime. We might sit outside to drink a coffee or eat our lunch. If our working day involves driving between sites or home visits, we might find green spaces to stop for lunch. If it is not possible for us to get outside, we might sit by an open window, gaze upon a natural space and breathe in fresh air. Observe the continuities in nature. The branches, roots and leafveins in a tree are exactly like our circulatory system or our lungs. Patterns in nature have been shown to have a soothing effect on our nervous system. Just looking at photos of green spaces like parks and gardens is enough to activate our calming parasympathetic response.30

Tune in What do you notice from spending ten minutes outdoors? Can you focus in on each of your senses? What patterns or colours do you notice? Can you hear bird-song or insects buzzing, or leaves rustling? Are there any smells from the earth or vegetation around you? Can you reach out and touch natural materials? Do you feel like moving your body when you are outdoors? What does it feel like to breath in fresh air and feel the breeze on your skin? What does it feel like to have the ground beneath your feet? What does it feel like to have the sky over your head?

Go deeper If you want to learn more about the interconnectedness of living things, you may be interested in books like ‘The Hidden Life of Trees’31 and ‘The Inner Life of Animals’,32 both by Peter Wohlleben.

Playful movement No child sets out to exercise. They just accidentally move. They show curiosity in their environment, walking over to look at something interesting, and maybe crouching down or reaching up to it. Children set themselves playful challenges. Do you remember jumping from stone to stone, swinging on a branch or balancing on a low wall? Children wonder if they can do something, and they try it out. They have 58

Move

a movement mind-set of curiosity and exploration. We can adopt this too. Rather than asking ‘Am I doing this right?’, ask ‘I wonder if I can… ’ Children are impulsive. If they feel like skipping, or jumping up to touch a branch, they will. Can we do this too? Can we rediscover the delight of playful movement? It is easy to be playful outdoors. We can step over cracks, jump from paving stone to paving stone, balance on kerb-stones, weave in and out of obstacles, splash in puddles and kick leaves. There are fewer temptations to move playfully in an indoor space, but it can be done. You have to get creative. Here are a few ideas for playful movement at work: ––

––

––

Have movement breaks at least every hour in a meeting. Agree this at the start of the meeting, and encourage people to walk twice around the room, or wriggle and jiggle in their seats. When you tidy up after seeing a patient, exaggerate any movements you need to make. Wipe surfaces clean with gusto. When you put equipment away, have a stretch at the same time. Between seeing patients, move around the room in a different way. Try squats or lunges. Sway from side to side. Bounce on your feet. Shake out your arms and legs. Make sure you have enough space to move safely, and then make the most of your space to move in a fun way.

You will probably feel free to be more silly at home. Try five minutes of playful movement each evening. This might be whilst you are watching TV or putting your children to bed. –– –– ––

Bear-crawl on your hands and feet. Then flip it over so that your hips and chest are facing the ceiling. Do you remember the ‘Ministry of Silly walks’? Try inventing your own. Create an obstacle course in your living room. Step over or crawl between furniture.

59

Our physical wellbeing

–– –– –– –– –– –– –– ––

How long can you stand on one leg? In how many different shapes? Move like different animals or insects or sea creatures. Move like a swamp monster or a robot. Move like a ballet or tap dancer. Match your movement to your mood. Put a cereal box on the floor. Can you crouch down and pick it up with your mouth? Can you sit on the floor without using your hands to get there? Can you get up without using your hands? Roll around on the floor. Lie on your back and hug your knees in. Take hold of your feet and rock around, like happy babies do.

Figure 4.2  Move like you 60

Move

I love this quotation from philosopher Alain de Botton: ‘There’s a whole category of people who miss out by not allowing themselves to be weird enough’. We bring joy to ourselves if we move freely. We potentially bring joy to others, if they see us in action!

  Tune in How does playful movement feel? How does it feel in your body? How does it feel in your head? Does it make you feel more appreciative of your body?

  Go deeper Are you able to move like you? If you feel silly, what is that about? We might be inhibited by our inner critic. Giving your inner critic an identity of their own might be useful. Once you have named that person you can say to yourself ‘that’s just Moody Margaret talking’. Over time, the power of your inner critic might diminish. You might create an inner ally to counteract the critic. See also ‘Self-talk’ on p.113.

Restorative yoga Yoga has been shown to be as effective or more effective than cardiovascular exercise in improving heart-rate variability (HRV), blood glucose, blood lipids, salivary cortisol and oxidative stress.33 A 12-week yoga practice has been shown to reduce cellular ageing, as measured by markers of DNA damage, oxidative stress, antioxidant capacity and the length of chromosome telomeres.34 Yoga has been shown to be an effective treatment for depression, anxiety and coping with chronic health conditions.35 Yoga can be translated as ‘oneness’, ‘wholeness’ or ‘the yoking of mind, body and breath’. Yoga incorporates movement, but also awareness of breath and a meditative mind-set. Yoga is not just what we do on the mat. It spills into our daily lives. Yoga affects how we stand, sit, move, breathe and feel through the day. It makes us more aware of our body and breath. It helps us to be more responsive and less reactive. Yoga invites curiosity, wonder and appreciation for our bodies. 61

Our physical wellbeing

Try to come at this practice with a mind-set of ‘I wonder what I will find out about my body?’ If you find yourself slipping into worries like ‘am I doing this right?’ or ‘do I look like the picture?’, gently bring yourself back to ‘I wonder what I will find out about my body?’ and ‘how can I move like me?’ There will be some days when all you want to do is rest in child’s pose. Go with it. Yoga encourages us to tune into what our body needs right now. We can linger in a certain shape if it feels good. We can explore what happens if we stretch or soften a particular part of our body. It is all about exploration. Deep, dull aches are normal. Stop if you feel any sharp or sudden pain. You will learn to move and stretch in a way that you find interesting: enough sensation to feel a satisfying stretch, but not so much that your breath becomes ragged. If you’ve gone too far, ease out and find a place where you can breathe deeply and comfortably. You will need a yoga mat and a blanket. Practice yoga in bare feet and comfortable clothes which stretch a little. 1. Child’s pose Put the blanket under your knees if you have sensitive knees. Kneel down, and come onto all fours. Your hands are directly under your shoulders, and your knees are directly under your hips. Sink your bottom down so that it touches your heels. You can put a cushion between your heels and bottom if your bottom doesn’t reach your heels. Sink your weight down. Put your forehead on the floor and stretch your hands out in front of you. Breathe slowly, deeply, and quietly. Feel the stretch along the length of your arms and back. Play with putting weight into the outside or inside of your hand, and feel how this changes the stretch along your back. Different muscles will be activated. Stretch out longer with each inhalation, and sink into the floor with each exhalation. Walk your hands to the right, keeping your left hip down. Feel the stretch along the left side of your body. Breathe. Walk your hands to the left, keeping your right hip down. Feel the stretch along the right side of your body. Find space on the inhale, and soften with the exhale. Breathe. 62

Move

2. Cat and cow Come up onto hands and knees again. Your hands are directly under your shoulders and your knees are directly under your hips. Inhale and imagine that you have a tail that you are lifting up. Your tummy will slightly drop towards the floor. Your spine is dipped in the middle, in the shape of a hammock. You can also bring your chest forwards of your shoulders, if that feels good. You are making space in the front of your body. This is ‘cow’ pose.

Figure 4.3  Child’s pose

Figure 4.4 Cat 63

Our physical wellbeing

Figure 4.5 Cow

Figure 4.6  Calf stretch

Exhale and pull your tummy up towards your spine. Your spine is in the shape of a rainbow. Push down with your hands to create space between the shoulderblades. This is ‘cat’ pose. Repeat this a few times, moving like you. Initiate the movement from your tailbone, and let it ripple up through your spine. Inhale and drop your tummy, exhale and lift your tummy. 64

Move

Explore where you need to stretch your spine. It might be between your shoulder-blades, or in your lower back. It will be different on different days. 3. Pelvic rotations and shoulder rolls Come back into your hands and knees position. Imagine drawing circles with your pelvis. Start with small circles and make them bigger. Do this clockwise, and then anti-clockwise. Your arms and knees will stretch in different ways as your hips circle. Breathe as you move. Roll your shoulders backwards or forwards in a way that feels natural for you. Slow it down or speed it up as you feel the urge. Make the movements as big or small as you like. You might make ‘barrel rolls’ with your rib-cage, circling clock-wise and then circling anti-clockwise. There is no wrong way to do this: move like you, and get weird! 4. Calf-stretch Come back to hands and knees. Your hands are flat on the floor. Imagine you are trying to open a jam jar with each hand. You are imagining twisting the hands outwards, but they not actually moving. Explore how this wakes up the muscles in your arms and shoulders, and even into your back and your tummy. Stretch one leg behind you, so that the toes touch the floor, but your knees are off the floor. Stretch out the back of the calf. You can tip the foot onto the big toe side, and then the little toe side to feel the stretch in different parts of your calf and hamstrings. Switch sides and stretch the other leg back. Breathe, and enjoy the stretch. 5. Sphinx Lower your knees and pelvis to the floor. Bring your forearms down the floor, so that they are now where your hands were. Your forearms are slightly forward of your shoulders. You are looking forwards. Press your pelvis down into the mat and bring your chest forward. Breathe deeply, feeling the movement along your spine as you inhale and exhale. 65

Our physical wellbeing

Figure 4.7 Sphinx

6. Child’s pose Push back with your hands, and bring your bottom back onto your heels. Bring your forehead to the ground and stretch out your hands in front of you. With the inhale, lengthen your spine. With the exhale, sink into the floor. Breathe deeply. 7. Reclined twist Turn over so that you are lying on your back with your knees bent. Bring your feet to the edges of the yoga mat, so that they are wider than your hips. Let your knees roll to the right and lower them towards the floor. You will feel a stretch in your hips and down the left-hand side of your body. If you want to extend this stretch through your upper body, take your arms over your head. Breathe. Let your knees roll to the left and lower them towards the floor. You will feel a stretch in your hips and down the right-hand side of your body. Breathe. Move from side to side with your breath. Initiate the movement with an inhale, and sink down to the floor with an exhale. Linger in any position that feels interesting to you. This will deepen the stretch, and allow you to soften into it. 8. Constructive rest You are still lying on your back. Bend your knees and bring your feet to the edges of the yoga mat so that they are wider than your hips. Let 66

Move

Figure 4.8  Reclined twist

Figure 4.9  Constructive rest

your knees fall together so that they are gently resting against each other. Curl your tailbone under slightly and let the small of your back feel heavy on the floor. Bring your arms to a comfortable position for you: this might be on the tummy, or falling out to the sides. Take easy breaths in and out of the nose. Feel the movement of breath in your body. Your tummy might lift as you inhale and lower as you exhale. Feel space in your body as you inhale, and let your weight sink into the floor as you exhale. Stay here for as long as you need.

Tune in Do you feel how a movement in one part of your body affects the rest of your body? Pressing into the floor with one part of the body creates a lift somewhere else. Do you feel how the breath moves the whole body? The body is never completely still; there is always a movement from the breath, which ripples across the whole body. 67

Our physical wellbeing

With practice, this awareness will grow. You will feel more attuned to what your body needs in order to feel energised, or to feel at ease. Your body is yours to explore.

Go deeper It is really hard to read instructions for yoga! It is much easier if you have a video to watch. There are free videos available online. Search any of the postures named above and you will find a video showing them. There are also whole yoga classes available online, many of them free. ‘Yoga with Adriene’ is very popular. The ‘Yoga Anytime’ app offers a free trial period, and has an incredible variety of yoga classes with excellent teachers. There are classes for all levels. The instructions are sensitive to different body types, and encourage you to explore your version of yoga.

Apply this at work ––

––

––

68

Speech and Language Therapists: have a march around, or a wobble and a shake with the children that you work with. This will improve their attention and listening for your planned activities. If you are working on verbs or prepositions, bring movement into your session. Use role-play or story-telling, incorporating movement into this. Paramedics: start a fitness challenge with your colleagues, which might be step-counting or high-intensity bursts of activity. Request fitness equipment or yoga mats from charity funding. If you are standing around with other emergency services, can you engage your core muscles, bounce on your feet, stretch your arms and shoulders and roll your head to ease neck tension? Radiographers and Orthoptists: you might be tied to static screens and large pieces of equipment for much of the day, so can you take the long walk around the hospital when you need to visit other departments? Can you sway your body and transfer your weight from one leg to the other when you are operating equipment?

Move

––

––

Art, Music and Drama Therapists: can you incorporate larger body movements into your work? Can you move more when you are setting out equipment and tidying up? Can you carry out any of your work outside, seeking inspiration from nature? Osteopaths: you are the experts in the interconnection between bones, joints, muscles, ligaments and fascia, and so are in a perfect position to promote the idea of joyful movement and integrated body awareness. Can you create resources for your colleagues in the multi-disciplinary team to prevent and treat common complaints like headaches and back and neck pain?

Notes 1 Puetz TW. ‘Physical activity and feelings of energy and fatigue: Epidemiological evidence’ Sports Medicine 2006;36(9):767–780. 2 Guszkowska M. ‘Wpływ ćwiczeń fizycznych na poziom leku i depresji oraz stany nastroju’ [Effects of exercise on anxiety, depression and mood] Psychiatria Polska 2004 Jul-Aug;38(4):611–620. Polish 3 Kyu HH, Bachman VF, Alexander LT, Mumford JE, Afshin A, Estep K, Veerman JL, Delwiche K, Iannarone ML, Moyer ML, Cercy K, Vos T, Murray CJ, Forouzanfar MH. ‘Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013’ BMJ 2016 Aug 9;354:i3857. 4 Cotman C, Berchtold N, Christie L. ‘Exercise builds brain health: Key roles of growth factor cascades and inflammation’ Trends in Neurosciences 2007;30:464–472. 5 Hofmann P. ‘Cancer and exercise: Warburg hypothesis, tumour metabolism and high-intensity anaerobic exercise’ Sports 2018;6:10. 6 Ströhle A. ‘Physical activity, exercise, depression and anxiety disorders’ Journal of Neural Transmission (Vienna). 2009 Jun;116(6):777–784. 7 Poole L, Hamer M, Wawrzyniak AJ, Steptoe A. ‘The effects of exercise withdrawal on mood and inflammatory cytokine responses in humans’ Stress 2011 Jul;14(4):439–447. 8 Guadalupe-Grau A, Fuentes T, Guerra B, Calbet JA. ‘Exercise and bone mass in adults’ Sports Medicine 2009;39(6):439–468. 9 McGlory C, Phillips SM. ‘Exercise and the regulation of skeletal muscle hypertrophy’ Progress in Molecular Biology and Translational Science 2015;135:153–173. 69

Our physical wellbeing 10 Simpson RJ, Kunz H, Agha N, Graff R. ‘Exercise and the regulation of immune functions’ Progress in Molecular Biology and Translational Science 2015;135:355–380. 11 Bettio LEB, Thacker JS, Rodgers SP, Brocardo PS, Christie BR, GilMohapel J. ‘Interplay between hormones and exercise on hippocampal plasticity across the lifespan’ Biochima et Biophysica Acta Molecular Basis of Disease 2020 Aug 1;1866(8):165821. 12 Klimova B, Valis M, Kuca K. ‘Cognitive decline in normal aging and its prevention: A review on non-pharmacological lifestyle strategies’ Clinical Interventions in Aging 2017 May 25;12:903–910. 13 Myers J, Kokkinos P, Nyelin E. ‘Physical activity, cardiorespiratory fitness, and the metabolic syndrome’ Nutrients 2019 Jul 19;11(7):1652. 14 Aune D, Norat T, Leitzmann M, Tonstad S, Vatten LJ. ‘Physical activity and the risk of type 2 diabetes: A systematic review and dose-response meta-analysis’ European Journal of Epidemiology 2015 Jul;30(7):529–542. 15 Matthews CE, Moore SC, Arem H, Cook MB, Trabert B, Håkansson N, Larsson SC, Wolk A, Gapstur SM, Lynch BM, Milne RL, Freedman ND, Huang WY, Berrington de Gonzalez A, Kitahara CM, Linet MS, Shiroma EJ, Sandin S, Patel AV, Lee IM. ‘Amount and intensity of leisure-time physical activity and lower cancer risk’ Journal of Clinical Oncology 2020 Mar 1;38(7):686–697. 16 Simpson RJ, Kunz H, Agha N, Graff R. ‘Exercise and the regulation of immune functions’ Progress in Molecular Biology and Translational Science 2015;135:355–380. doi: 10.1016/bs​.pmbts​.2015​.08​​.001. Epub 2015 Sep 5. PMID: 26477922. 17 Kandola A, Ashdown-Franks G, Hendrikse J, Sabiston CM, Stubbs B. ‘Physical activity and depression: Towards understanding the antidepressant mechanisms of physical activity’ Neuroscience and Biobehavioral Reviews 2019 Dec;107:525–539. 18 Twohig-Bennett C, Jones A. ‘The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes’ Environmental Research 2018 Oct;166:628–637. 19 Shuda Q, Bougoulias ME, Kass R. ‘Effect of nature exposure on perceived and physiologic stress: A systematic review’ Complementary Therapies in Medicine 2020 Sep;53:102514. 20 Lanki T, Siponen T, Ojala A, Korpela K, Pennanen A, Tiittanen P, Tsunetsugu Y, Kagawa T, Tyrväinen L. ‘Acute effects of visits to urban green environments on cardiovascular physiology in women: A field experiment’ Environmental Research 2017 Nov;159:176–185. 21 Johnson BS, Malecki KM, Peppard PE, Beyer KMM. ‘Exposure to neighborhood green space and sleep: Evidence from the survey of the health of Wisconsin’ Sleep Health 2018 Oct;4(5):413–419. 22 Barton J, Rogerson M. ‘The importance of greenspace for mental health’ British Journal of Psychology Inernational 2017 Nov 1;14(4):79–81. 23 Barton J, Rogerson M. ‘The importance of greenspace for mental health’ British Journal of Psychology Inernational 2017 Nov 1;14(4):79–81. 70

Move 24 Rojas-Rueda D, Nieuwenhuijsen MJ, Gascon M, Perez-Leon D, Mudu P. ‘Green spaces and mortality: A systematic review and meta-analysis of cohort studies’ The Lancet: Planetary Health 2019 Nov;3(11):e469–e477. 25 Tsunetsugu Y, Park BJ, Miyazaki Y. ‘Trends in research related to “Shinrinyoku” (taking in the forest atmosphere or forest bathing) in Japan’ Environmental Health and Preventative Medicine 2010 Jan;15(1):27–37. 26 Pritchard A, Richardson M, Sheffield D, McEwan K. ‘The relationship between nature connectedness and eudaimonic well-being: A meta-analysis’ Journal of Happiness Studies 2020;21:1145–1167. 27 Matsui N, Ohira T, Takayama N, Inoue M, Kagawa T, Koyama T. ‘Volatile substances released from forests’ Environmental Health and Preventive Medicine Jan 2010;15(1):27–37. 28 Adami AJ, Bracken SJ. ‘Breathing better through bugs: Asthma and the microbiome’ Yale Journal of Biology and Medicine 2016 Sep 30;89(3):309–324. 29 Atchley R A, Strayer DL, Atchley P. ‘Creativity in the wild: Improving creative reasoning through immersion in natural settings’ PLoS One 2012;7(12) e51474 30 van den Berg MM, Maas J, Muller R, Braun A, Kaandorp W, van Lien R, van Poppel MN, van Mechelen W, van den Berg AE. ‘Autonomic nervous system responses to viewing green and built settings: Differentiating between sympathetic and parasympathetic activity’ International Journal of Environmental Research and Public Health 2015 Dec 14;12(12):15860–15874. 31 Wohlleben P. The Hidden Life of Trees: What They Feel, How They Communicate—Discoveries from a Secret World Greystone Books 2016. 32 Wohlleben P. The Inner Life of Animals: Love, Grief, and Compassion―Surprising Observations of a Hidden World Greystone Books 2017. 33 Ross A, Thomas S. ‘The health benefits of yoga and exercise: A review of comparison studies’ The Journal of Alternative and Complementary Medicine 2010;16(1):3–12. 34 Tolahunase M, Sagar R, Dada R. ‘Impact of yoga and meditation on cellular aging in apparently healthy individuals: A prospective, open-label single-arm exploratory study’ Oxidative Medicine and Cellular Longevity 2017;2017:7928981. 35 Bonura KB. ‘The psychological benefits of yoga practice for older adults: Evidence and guidelines’ International Journal of Yoga Therapy 1 October 2011;21(1):129–142.

71

5

Eat

We are genetically hard-wired to seek out food and eat it. This instinct served us well for most of our evolutionary history, where food was in short supply. In our modern world, food surrounds us. We have full fridges and full cupboards. Our supermarkets are vast. We see cheap multi-buy deals and prominent placement of junk food, sugary drinks and salty snacks in shops and petrol stations. We see advertising and vending machines on train platforms and in the reception area at work. In the staff room, there are tubs of biscuits and chocolate. Everywhere we look, there is high-calorie, high-sugar, high-fat food. No wonder we feel hungry. Highly processed foods, whilst extremely tasty, have had all of the health-giving properties of the basic ingredients removed. All of the nutrients that we find in fresh food: vitamins and minerals, fibre and health-giving phytochemicals, have been stripped out, by the processes of milling, extracting, frying. Cheap fats are used, often trans fats, which are now known to be even more harmful than saturated fat.1 Emulsifiers, stabilisers, preservatives and artificial flavours and sweeteners are added to improve the flavour and texture, and to extend shelflife to weeks or months. Food manufacturers, including fast food outlets, exploit our natural weakness for foods that contain both fat and sugar2 or fat and salt. This combination is known as the ‘bliss point’ of food. It is used in formulations of junk food like pizza, donuts and ice-cream to make them even harder to resist. Our brains reward us with dopamine when we eat these foods. This is the same neural pathway that leads to drug 72

DOI: 10.4324/9781003165125-6

Eat

addiction. It helps us to remember the circumstances where we received this reward so that we can seek it out again and again. To make matters worse, fast food outlets occupy sites at traffic junctions where there is often stationary traffic. They pump out the aroma of fried food, tempting us with instant food. We don’t need to make dinner tonight. We should stop berating ourselves for lack of willpower. Every day we are entering a food zone where clever tactics are employed, and we are completely unprotected. Until now. Once we become aware of these clever tricks, we can start to empower ourselves. This chapter is about exposing ourselves to healthful foods. It is about abundance, not lack. It is about indulgence, not deprivation. We will take time to enjoy food. We will find foods which delight our senses, fill our tummies and provide us with sustained energy. There are going to be times you want and need cake. Over time, you can tune into this and enjoy cake without the unnecessary guilt. I would like us to get back to seeing food as nourishment. It is nourishment for our bodies and nourishment for our souls. I was very cautious about writing this chapter, not least because my audience includes dieticians! Social media is full of arguments between people who practice a particular way of eating and would like to convince everyone to eat that way. Recent research suggests that there are individual differences in how we respond to different foods.3 What works for one person will not necessarily work for another. In the future we may be able to track our blood glucose or blood lipids with body-worn devices.4 But for now, the cheaper and easier option is to tune in. In this chapter, I adopt the principles of a ‘Planetary Health Diet’. The Planetary Health Diet was created by the EAT Foundation and the Lancet.5 Its aims to balance the nutrition needs of the global population and to safeguard the planet’s health. The broad recommendations for a sustainable and healthy diet are that we eat: –– ––

A wide variety of fruits and vegetables. Minimally processed wholegrains and pulses. 73

Our physical wellbeing

–– ––

Healthy fats, from nuts and seeds, olive oil and rapeseed oil. Tap water.

Because of the extra land use, water requirement and carbon emissions associated with these foods, we need to eat less: –– –– –– ––

Meat and fish; eating all parts of the animal to reduce waste. Dairy and eggs. Highly processed foods. Soft drinks.

If you are edging towards a more wholefood plant-rich diet, you can find fact sheets on the British Dietetics Association (BDA) website. There will be good reasons for personalising your own diet based on your own health needs. The strategies in this chapter are ‘broad brush’. If you have a specific health condition, then you should seek up-to-date information from the BDA, or from a registered dietician. If you want to counteract our constant exposure to junk food, fight back. Follow social media accounts that show fresh produce prepared in delicious ways. Try smoothies, noodles, burritos, Buddha bowls. Prepare food in bigger batches so that you can take it to work for lunch. Share ideas and recipes with like-minded colleagues. If you currently eat very little fruit or veg, try one extra portion a week. Your body will gradually adapt to the new tastes and textures, and you will start desiring this food, because it feels good. I would like us to get away from berating ourselves for eating. Eating is a source of pleasure. We can savour the colours, textures, smell and taste of our food. Food is nourishment for the body and the mind. We just need to tune in.

Mindful eating We live in such a fast-paced world. It is easy to buzz from one activity to another without registering we have just drunk a coffee or eaten a sandwich. This is pleasure wasted. 74

Eat

We can get caught up ‘in our heads’ and forget to tune into our body. We need awareness of both. What is going on in our mind affects our body. If we are stressed when we eat, this will affect our digestion. We are more likely to experience indigestion or bloating. We are more likely to overeat, because we have not given our brains or our bodies time to register that we have eaten. By tuning into our food, looking at its colours and textures, smelling and tasting the flavours, chewing slowly and carefully, we allow our saliva to produce the optimal digestive enzymes. Our brain registers that we are preparing to eat. It communicates via the vagus nerve with our digestive tract. This process enables our body to prepare digestive enzymes in order to make best use of the nutrients. When we eat with awareness, we are more likely to observe our fullness signals, and feel a sense of emotional satisfaction from eating.6 Mindful eating is a practice that we get better at over time. Once we have experienced the satisfaction of a meal or snack that is truly savoured, we are less likely to mindlessly grab and wolf down food that is not beneficial to us. We are more likely to tune into how different foods make us feel, both immediately, and after we have eaten. Mindful eating can incorporate food preparation. We might listen to music or a podcast whilst we’re cooking. It’s less stressful to gather all the ingredients before we start, and to have a clear working space for chopping veg. Taking the time to smell, taste and look at the food as we prepare it helps us to make tweaks and engage our creativity.

For mindful eating, consider these points: ––

––

––

Eat at the table. Make an occasion of eating. This subconsciously reminds you that you are important. You need the time and space to nourish yourself. Take a moment to think about where this food has come from. Think about the people who have tended the land, harvested and packed the produce and helped to bring it to your home. Don’t look at a screen. It is far too easy to get drawn into the online world and lose awareness of what you are eating and drinking right now.

75

Our physical wellbeing

––

––

––

––

––

––

Look at the whole plate and appreciate the colours, textures and patterns. Notice how there are repeating patterns in nature and how all living things are similar. Think about each mouthful and chew carefully. Think about how your body is going to make use of the nutrients to help your whole body and mind function well. You can think about other things and engage in conversation. Try to retain some level of mindfulness, giving thoughtful responses, rather than being reactive. If something is worrying or stressing you, then acknowledge it. Note it as interesting and useful information. By doing this, you are slightly distancing yourself from the emotion and not getting caught up in it. Tune into how you feel when you have finished eating. How full are you? How is the food sitting? This conscious thought will help to inform future food choices. If you didn’t prepare the food, then take time to thank the person who did. Even if you didn’t like the food, acknowledge the effort that they put in. Encourage your family members to do the same.

Tune in How does it feel eating in this way? Do you have places or times when it is easier or harder to eat mindfully? Can you make small changes to the environment or your routine? What amount of food is the right amount for you? Is there a point at which you are full and you get no further satisfaction? Does awareness of where the food has come from change the food choices you are making?

Go deeper Investigate where your food comes from. Supermarkets tend to squeeze farmers, and there is a huge amount of waste and excess packaging in 76

Eat

the process. We might buy direct from farmers, using a veg box scheme. You might want to eat more food that is grown locally, or organically, or sustainably, or where there is a higher standard of animal welfare … There are many fruit and veg box schemes across the UK where you can have a weekly delivery of fresh produce. Many of these schemes are extending to meat and dairy, and dried goods. Some offer zero waste, with refillable packaging for dried goods. You can check the sustainability of fish by checking ‘The Good Fish Guide’ online. We can change our mind-set about the food we eat. It is a resource that has been thoughtfully produced with the highest standards. Food is about nourishing us, but also caring for the wider communities who produce food, and caring about the environment which sustains us.

Eat within a 12-hour window ‘Time-restricted eating’ means that we eat within a particular time period in the day. This might be within a 10- or 12-hour window. Recent research suggests that time-restricted eating can have several beneficial effects. These include: ––

Maintaining a healthy weight.7

––

Improving digestion.

––

Improving your sleep.

––

Improving heart health.8

––

Improving blood sugar.9,10

Our body has a better insulin response earlier in the day.11 If we eat two to three hours before bed, then our blood sugar and insulin will be high and will stay high throughout the night. Therefore, it is ideal to start eating at some point in the morning, and to stop eating three hours before bedtime. Within these guidelines you can tweak the exact timings according to your own preferences. You might eat breakfast at around 7.00am, and aim to have eaten dinner by 7.00pm. Aim to keep to a 12-hour window most of the time. You may prefer to eat breakfast later, or even skip it if that works for you. Recent research suggests that skipping breakfast works for some people,12 and doesn’t necessarily lead to reaching for sugary snacks mid-morning. It is best to observe your own needs.  77

Our physical wellbeing

Figure 5.1  Eat within a 12-hour window

You don’t have to be perfect. You can still go out to dinner with your friends. Just aim to do this for most of the week. You can drink water, or tea and coffee without milk outside of this 12-hour window. It is better to drink coffee in the morning rather than the evening if you are sensitive to caffeine. Like all of the strategies in this book, do not get too stressed about them, because that will be counter-productive. Allow yourself some wiggle room. It is more realistic to say you will do this for five out of seven days per week, and then you have the freedom eat out, or enjoy someone else cooking dinner for you.

Tune in How does this strategy make you feel? Are you going to bed feeling lighter? Are you waking up feeling more refreshed? If you generally experience digestive discomfort, have your symptoms improved? 78

Eat

Go deeper If you live with others, you will probably need to recruit their support with this strategy. If you have a shared meal in the evening, then this will be especially important. If you are in the habit of snacking in the evening, it can help to change your routine for a while. Our brains are hard-wired to remember the circumstances where we had a treat. We get a dopamine hit from a sugary, fatty or salty snack which is comparable to the dopamine hit that a gambler or a drug addict gets.13 This helps our brain remember the exact circumstances that led to this treat so that we can seek it out again. We will associate sitting on the sofa with eating crisps or chocolate, and as soon as we sit down we will start to crave this food. An easy hack is to sit somewhere else for a few days, perhaps even in a different room. Try another activity instead of watching TV. Once the habit is broken, you can return to sitting where you like! Just understanding the dopamine reward system is helpful. It might lead you to think about where you eat, so that you don’t inadvertently set up an addictive habit!

Eat a rainbow Our gut microbiome is a diverse ecosystem of up to 36,000 different species of bacteria,14 archaea, viruses and fungi living in our intestines. Each strain of microbe has a different job, and their roles are diverse. Some regulate our appetite, others affect our immune response, some affect our hormone production, others deactivate toxins. We have evolved with these micro-organisms, and our health is dependent upon theirs. The gut microbiota determines how we absorb and make use of specific nutrients.15 It plays an important part in our gene expression (how certain genes are switched on or off). Gut bacteria in our colon feed on fibre. Different sorts of fibre from plant foods are broken down by different sorts of gut bacteria into short-chain fatty acids (SCFAs). SCFAs play a crucial role in dampening down the immune response in our gut, and regulating inflammation in our bodies. Inflammation 79

Our physical wellbeing

Figure 5.2  Eat a rainbow

is linked to all autoimmune diseases, including asthma, eczema and arthritis. It is also linked with cardiovascular problems, diabetes and even depression.16 In order to look after our gut microbiome and ensure its diversity, we need to eat a wide variety of fruits, vegetables, wholegrains, pulses, nuts and seeds, herbs and spices, and even teas, coffee and chocolate!  Different coloured plant foods ensure a diversity of plant chemicals, known as phytonutrients. These phytonutrients often give the fruits or vegetables their colour or flavour. There are tens of thousands of different phytochemicals, and their role is just beginning to be understood. Those studied so far have diverse health benefits. For example, the polyphenols in cocoa, coffee and soy are linked with a reduced risk of cardiovascular disease.17 The sulfurophane and carotenoids in dark leafy greens help repair cellular damage.18 The anthocyanins in red and purple berries, cherries, grapes and plums support our brain health19 and reduce our cancer risk.20 A common suggestion is to try to eat 30 different plant foods in a week.21 This is easier than it sounds, because it includes herbs and spices, nuts and seeds, wholegrains and pulses, and fruits and vegetables.

80

Eat

The benefits of eating a wide range of plant foods include: –– –– –– –– ––

Increasing your sensory enjoyment of food.22 Increasing your intake and uptake of vitamins, minerals, phytonutrients and fibre.23 Improving your gut microbiota, where 70 percent of your immune cells reside.24 Improving your cognition and mood.25 Reduced risk of cardiovascular disease, diabetes, cancer,26 cognitive decline and chronic health conditions.27

We can absorb the beneficial compounds in plant foods most easily if we eat them as close to their natural form as possible. Many of the most beneficial phytochemicals are just under the skin, so if the fruit or vegetable has a thin skin, then eat this too. Chop up the stalks and leaves of vegetables like broccoli and cauliflower and cook these too. Aim to eat something from each colour group per day. The table below gives you a rough guide to colour groups.  Eat seasonally if possible. There is some evidence to suggest that gut microbes have evolved to digest certain plants at certain times of the year.28 To eat seasonally, you might sign up to a regular farm fruit and vegetable box scheme, visit a farmers’ market or you might even grow some of your food. If you, or a family member, do not especially like fruits and vegetables, then build up your repertoire slowly. Some tips include: ––

Sweeter vegetables like peas, sweetcorn, carrots and red peppers are often more acceptable at first.

––

Chop vegetables into smaller pieces so they are not intimidating.

––

Make smoothies to hide vegetables like avocado and spinach, as well as nuts and seeds.

––

Play with your food (this goes for adults and children)! You might go to a pick-your-own farm to spark interest. Cut up the fruit or vegetable to look at the skin, seeds and stalk.

––

Find out the health benefits of different foods, as this is likely to increase your motivation to try new foods.29 81

Our physical wellbeing Table 5.1 Colour groups Red

Orange and yellow

Green

Blue and purple

White and brown

Phytoche­ micals include:

anthoxanthins betacyanins carotenoids lycopene

anthoxanthins betaxanthins carotenoids chalcones curcumin flavanoids limanoids

chlorophyll carotenoids lutein sulforaphane

anthocyanins betacyanins resveratrol

allyl sulphides anthoxanthins phytoestrogens

Fruit

apples cherries cranberries redcurrants red grapes raspberries rhubarb pomegranates strawberries watermelon

apricots lemons mango oranges papaya peaches pineapple sultanas tangerines

green grapes kiwi fruit lime

blackberries blackcurrants black grapes blueberries cherries damsons dates figs plums prunes raisins

bananas

carrots pumpkin squash swede sweetcorn sweet potato

asparagus avocado broad beans broccoli Brussels sprouts cabbage courgettes kale lettuce okra peas rocket runner beans salad leaves spinach spring onions watercress

aubergine beetroot black olives purplesprouting broccoli red potatoes red onions

cauliflower celery coconut garlic Jerusalem artichoke leeks mushrooms onions parsnip pears plantain potatoes spring onions turnip yam

Vegetables radishes red cabbage red pepper rainbow chard tomatoes

Pulses or grains

adzuki beans kidney beans red rice red quinoa

chickpeas red lentils yellow split-peas

green lentils mung beans peas and beans

black beans black chickpeas black rice borlotti beans

butterbeans cannellini beans soya beans tofu and tempeh

Herbs or spices

chilli paprika sumac

ginger turmeric

chives coriander mint parsley

black tea cocoa coffee

a vast array of spices in which phytochemicals are highly concentrated

82

Eat Red

Orange and yellow

Nuts or seeds

Green

Blue and purple

White and brown

pistachios pumpkin seeds

black sesame seeds chia seeds poppy seeds

almonds brazil nuts cashews chestnuts flaxseeds peanuts sesame seeds sunflower seeds walnuts

Recipes can be adapted so that they include a wider range of vegetables. A stir-fry, curry, stew or pasta sauce can have a range of different vegetables, which vary with the seasons. Like all of the strategies in this book, do not get too stressed about this. If you have a beige day, then you can try to eat a rainbow the following day.

Tune in How does eating a rainbow make you feel? Do you like to see different colours on your plate? Do you enjoy looking at your fruit bowl or into the salad tray of your fridge? Have you been inspired to try new foods? Have you cooked any new recipes?

Go deeper Fill your social media feed with healthful food. Look out for ‘Shiso Delicious’, ‘The Happy Pear’, ‘Deliciously Ella’ and ‘Rachel Ama’. If you want dive in deep, read ‘How Not to Die’ by Michael Greger.30 If you enjoy controversy and challenge, read Tim Spector’s ‘Spoonfed’.31 For a holistic and compassionate approach to eating, read Gemma Newman’s ‘The Plant Power Doctor’.32 But. If we get obsessive about healthy food, we risk undermining our best efforts because we are increasing our stress and anxiety. There is a healthy balance to be had, and we are not aiming for perfection. A guideline is to eat healthily 80–90 percent of the time. When you eat pizza or cake, eat mindfully and really enjoy it. 83

Our physical wellbeing

Eat for hormone health What we eat has a profound effect on our hormone health. Our hormones regulate our mood, our energy, our appetite, our sleep and waking cycles, our temperature and our reproductive health. Our bodies produce around 50 different hormones. Hormones are produced by glands and organs in our body. They are released into the blood and they behave as chemical messengers, telling specific parts of our body what to do at different times of the day. They are similar to neurotransmitters. Neurotransmitters are fast-acting, facilitating neuronal activity in a highly targeted way through our nervous system. Hormones are slower-acting. They circulate throughout our whole bodies via our circulatory system, and so have the potential to influence wider bodily functions. Cortisol wakes us up in the morning; melatonin relaxes us so that we are ready for sleep in the evening. Our thyroid hormones regulate our metabolic rate. Our pancreas produces hormones including insulin and glucagon, which regulate our blood sugar and influence whether we use or store fat. Our sex hormones regulate our sex drive, fertility and menstrual health. Progesterone and oestrogen are also involved in maintaining bone density, muscle mass and nerve health. Hormones play a key part in homeostasis. Our bodies need to operate within certain parameters for optimum health. Our endocrine system responds to feedback loops in the body, and releases specific hormones to bring us back into balance. When our hormones are out of balance, a number of body systems are likely to be affected. This is why our periods and menopause can have such a huge impact upon our general health and wellbeing. Signs that our hormone health could be improved include: –– –– –– –– –– ––

84

Sleep disturbances. Mood swings, anxiety and depression. Brain fog. Sudden weight gain or loss. Persistent skin problems. Period pain.

Eat

–– ––

Headaches and migraine. Constant fatigue.

If we are permanently stressed out, our body prioritises making the stress hormone cortisol. It does not have enough raw ingredients to make other lipid-derived hormones. Our hormone health is therefore supported if we try to spend more time in a parasympathetic state (see the ‘Breathe’, ‘Sleep’, ‘Move’ and ‘Meditate’ chapters of this book for strategies to help with this). We need enough healthy fats in our diet to produce lipid-derived hormones including oestrogen, progesterone and testosterone. Healthy fats are also needed for the absorption and metabolism of vitamins and minerals. Monounsaturated and polyunsaturated fats are the healthiest fats, particularly those containing high levels of Omega-3 and Omega-9 fatty acids. Good sources of Omega-3 include walnuts, pumpkin seeds, chia seeds, flax seeds and oily fish. Olive oil is mainly composed of Omega-9. These healthy fats support cardiovascular and metabolic health33 and help regulate inflammation in the body.34 We tend to have too many Omega-6 in our diets in relation to Omega-3, and this is linked with higher levels of inflammation. Palm oil, corn oil and sunflower oil are high in Omega-6. To summarise, ideally we want to reduce saturated fat and Omega6, but increase Omega-3 and Omega-9. If you need an easy way to remember it, ‘three and nine are fine’. Think nuts, seeds, olive oil. A healthy gut microbiome is crucial for hormone health. It is involved in the production of hormones, and also in the deactivation of hormones which are no longer needed. If we don’t have enough fibre in our diet, this function is compromised.35 We need fibre-rich fruit, vegetables, pulses, wholegrains, nuts and seeds for optimum hormone health because these feed our gut microbiome. Another cause of hormonal imbalance is constipation. If we don’t eat enough fibre, drink enough water and move around enough, the oestrogens that would usually be eliminated are reabsorbed back into our body. Excess oestrogens are associated with period pain, menopausal symptoms, breast lumps and some cancers. Drinking plenty of water and moving regularly also supports optimum transit of food and waste hormones through our gut. 85

Our physical wellbeing

We may shy away from eating carbohydrates, fats and fibre because we worry that they will make us put on weight or cause bloating. If we eat fruit and veg, wholegrains and pulses, nuts and seeds, the fibre will help us feel full and prevent us from over-eating. Research shows that eating these foods also improves our insulin response,36,37 reducing our risk of diabetes and cardiovascular disease.38 The UK government recommends we eat 30g of fibre per day, but the average person eats 18g. If we gradually increase our intake of fibre-rich foods, our bodies will adapt. Eating slowly and mindfully, and reducing our stress reduces abdominal bloating. Whilst our bodies are adapting to increased fibre, a lunchtime walk can ease any discomfort! We will experience normal fullness from eating in this way. It is almost impossible to over-eat if you are eating a fibre-rich meal. You will never feel hungry or deprived if you eat a plant-rich diet. Fasting for long periods (a whole day) may interfere with our hormone balance because it starves our gut bacteria of the fibre they need in order to carry out their hormone-balancing work. This impacts upon the hormones which signal to us when we are hungry or full, and those which regulate our blood sugar and fat storage. Fasting overnight (or eating within a 10–12 hour window) is fine, but fasting for a whole day may be detrimental, especially for women. Recent research indicates that eating soy-based foods can be helpful for hormone health.39 The phytoestrogens (plant-derived oestrogens) in soy products (including tofu and tempeh), nuts, seeds, dark leafy greens and whole grains modulate hormone activity. Unlike animal oestrogens, phytoestrogens appear to have a protective effect on our health.40 Consumption of these foods has been linked with reduced risk of osteoporosis, cardiovascular disease and menopausal symptoms.41 The key points for eating for hormonal health are: ––

––

86

Eat plenty of healthy fats. Good sources include olive oil, nuts and seeds. Nut butters are delicious on toast and in overnight oats. Tahini is a brilliant addition to salad dressings and baking. Eat plenty of fibre. Increase your intake gradually, including fruit and veg, wholegrains and pulses, nuts and seeds.

Eat

–– –– –– ––

Drink plenty of water and move regularly to support the transit of food and waste hormones through the gut. Eat phytoestrogens in soy, flax seeds, sesame seeds, dark leafy greens and whole grains. Avoid whole days fasting if you have hormonal problems. Manage your stress by breathing, sleeping, moving or meditating.

Tune in Do you have a resistance to eating fat, carbohydrates or fibre? What is the fear? Where did this come from? Can you try increasing the amount that you eat and noticing the effects? Remember practices to bring you into a parasympathetic state. There is anecdotal evidence that eating whilst stressed increases digestive symptoms. It may also exacerbate food intolerances.

Go deeper For dietary advice about specific conditions like Polycystic Ovary Syndrome (PCOS) or menopause, see fact sheets on the British Dietetic Association (BDA) website. Read ‘Period Power’ by Maisie Hill42 or The ‘Gynae Geek’ by Anita Mitra.43 This is an area that many women (and men) shy away from. Knowledge is power, and if we don’t understand our bodies, we are unlikely to know how to support our optimum functioning. Read ‘Menopause’ by Louise Newson44 or ‘The Good Menopause Guide’ by Liz Earle.45 Both of these books are full of health and wellbeing advice, including information about HRT and other treatments.

Build a breakfast Breakfast might be the meal of the day that I most look forward to. If you are not a breakfast eater, don’t worry. New research suggests that it may be optimal for some people to only eat once your hunger has kicked in, which might be late morning or even lunchtime.46 87

Our physical wellbeing

If you are a breakfast eater, you might like to try ‘overnight oats’. I love overnight oats because: ––

They are prepared the night before, so you don’t have to think too hard in the morning.

––

They can be endlessly varied, so you never get bored.

––

They are a brilliant way to pack in fruit, nuts and seeds, wholegrains and spices, so that you are well on your way to eating a rainbow, and eating 30 different plant foods in a week. The basic recipe for overnight oats is: –– –– –– –– –– ––

Four heaped dessert spoons of rolled oats (or spelt flakes, rye flakes or barley flakes). A mashed banana, or grated apple or pear, or any fruit compote. A dessert spoon of any nuts or seeds you fancy (toasted, raw or in nut butter). A dessert spoon of any dried fruit you fancy. Half a teaspoon of sweet spices like cinnamon, nutmeg or mixed spice. Enough milk or yoghurt to mix in and cover the oats (plant or dairy).

Combine all the ingredients in a bowl or a wide jar, and then store in the fridge for up to three days. The recipe above is for one person, but you can play with the amounts to suit your needs. You can make a few portions ahead of time. Then play with it. ––

Add any fresh fruit you like, chopped or mashed, or lightly cooked into a compote.

––

Add cocoa or even coffee for a different flavour.

––

Add a spoonful of ground flaxseeds or chia seeds to help bring your blood pressure down.47,48

––

Add an extra spoonful of almond, cashew or peanut butter to keep you feeling full for longer.

88

Eat

––

Think of your favourite pudding. Any pudding. Now make it into overnight oats.

––

Cherry Bakewell: dried or frozen cherries and ground almonds.

––

Sticky toffee pudding: Medjool dates and walnuts.

––

Raspberry and lemon tart: frozen raspberries and the zest and juice of a lemon.

Tune in How would it feel to spend this much time preparing your breakfast the night before? Is there a better time of day to do this, say after you have just eaten your breakfast? If you don’t fancy this, can you get excited about other healthy breakfast options? You might like a smoothie, porridge, toast with an egg, hummus, nut butter or avocado, a healthier cooked breakfast with tomatoes, mushrooms and beans? Or maybe you are just into coffee in the morning. That is absolutely fine. Savour the moment.

Go deeper Talk to your colleagues. Could you have a fun challenge to create more interesting breakfasts? You could share your successes and failures in a light-hearted way. If you work shifts, you might eat breakfast together. This is a supportive way to eat healthily at work.

Lunchbox club It is very easy to eat the same old boring sandwich every day for years. If we’re eating the same old same old, it is harder to eat mindfully. And think about all the pleasure we are missing out on. Teasing and tempting our taste-buds with new foods and different combinations enhances our enjoyment of food. It also helps us to eat a rainbow and get our 30 plants per week, which will help our gut microbiome.

89

Our physical wellbeing

Like with overnight oats, here is a basic lunchbox recipe which can be mix-and-matched endlessly. I hope that you will get creative and invent your own taste sensations. These suggested foods are not exhaustive. Chop and change it to suit your preferences. Having a ‘lunchbox club’ where you share ideas and show one another what you are eating might help your work environment to become a more healthy food space. You can inspire one another with new ideas as you tuck into lunch and enjoy some social time. An exciting lunchbox might have the following components: ––

––

–– –– ––

Wholegrains: brown, red or black rice, wholemeal pasta, wholemeal couscous, quinoa, noodles, wholemeal wraps, wholemeal, rye or sourdough bread. Roasted or steamed or raw veg: choose what’s in season. Aim for three different veg, maybe with different colours. Chop it into interesting shapes. Protein: hummus, any lentils, beans or peas, marinated tofu, nut butter, a hard-boiled egg, feta or halloumi. Flavour burst: pesto, harissa paste, kimchi, sauerkraut, Indian pickles, tahini dressing, any other dressing you like. Topping: toasted nuts and seeds, croutons, fresh herbs.

Like with overnight oats, preparation is key. You can prepare a few things at the weekend to mix and match for lunchboxes through the week. Most weekends I roast some veg for this purpose. Toss chunks of veg (I like root veg or Mediterranean veg) with salt and pepper and olive oil. Add aromatic herbs and spices like rosemary, thyme, cumin or paprika, if you like. Roast in the oven at 180°C. Root veg takes about an hour to get soft, sweet and sticky. Mediterranean veg like peppers, courgettes and squash take 30 minutes, but aubergine needs an hour to get silky. Cauliflower and broccoli florets can be quick-roasted in 20 minutes. I might also marinate some tofu or tempeh in equal quantities of soy sauce, rice vinegar and brown sugar, and then fry this until it’s crispy. Any veg can be made into soup. Fry off some onion, then add diced veg. Keep colours fairly distinct for visual appeal. Orange veg like 90

Eat

carrots and pumpkin love cumin and paprika. Root veg loves garlic and rosemary or Indian spices. Dark leafy greens and brassicas love white beans, potato, garlic and lemon. Simmer for 20–30 minutes and then whizz it up with a stick blender to your desired texture. If this all seems like too much, try making extra portions when you cook at dinner time, and have leftovers for lunch. Cook extra rice, pasta or couscous for lunchboxes later. Invest in some good, durable lunch containers. You can find soup or stew pots which can be microwaved. Or you might like stainless steel tiffin boxes if you are avoiding plastic. Reusable bamboo cutlery is also useful for when you are out and about.

Tune in Does your lunch make you feel excited to be able to eat? Is it something you can look forward to in stressful day? Where can you sit so that you are eating in a mindful way?

Go deeper You might find that your workplace does not support healthy lunch habits. How can you make it easier or more appealing to eat a healthy lunch? Can you discuss the issues as a team? Do you need to all allow yourselves a proper lunch break?

Easy dinners I am very likely to get home from work on the edge of hangry. So I really like having a repertoire of recipes where I can just switch in seasonal vegetables. That way no one gets bored, I don’t have to put too much mental effort into cooking, and we get to eat a rainbow. Below are five suggestions, but you will already have your own favourite recipes. Use any combination of vegetables, depending on what you have in the fridge. This works really well if you have a regular veg box delivered. If you don’t, then just try to buy a wide variety of veg, including some frozen and tinned veg standbys. I could not live without frozen peas and tinned sweetcorn. 91

Our physical wellbeing

––

––

––

––

––

Spaghetti bolognese: fry an onion. Add mushrooms, celery, ­carrot or any other veg you can chop up small. Add brown or red lentils, or minced beef or Quorn. Add tinned tomatoes and Italian herbs. Bubble away for 20 minutes until it is thickened. I also add Worcester sauce and Marmite for umami flavour and texture. Stir-fry: chop or slice all your veg first. Go for any combination, ideally with rainbow colours. Make a quick sauce with equal quantities of soy sauce, rice vinegar, brown sugar and toasted sesame oil. Add crushed garlic and ginger, and maybe a squeeze of lime. Stir-fry the veg and add optional tofu. Toasted peanuts or cashews are also nice. Add the sauce at the end. Lazy tray-bake: chop any veg into bite-sized chunks. Have a mix of onions, garlic, root veg or Mediterranean veg. Add olive oil and harissa paste, and chickpeas. Roast on a high heat for 30 minutes. Serve with couscous, bulgur wheat or quinoa. A squeeze of lemon adds zing. Lentil dahl: fry an onion and garlic until soft. Add carrot, celery or any root veg. Add 1–2 teaspoons of curry powder or garam masala. Add a tin of tomatoes and a cup of any lentils or split peas. Add water to cover the lentils if needed. Cook for 30 minutes until the lentils are soft. Add a tin of coconut milk, the juice of half a lemon and a tablespoon of brown sugar towards the end, if liked. Serve with rice. Red Thai curry: fry red Thai curry paste until aromatic. Add a rainbow combination of veg, optional tofu, a tin of coconut milk, some soy sauce, brown sugar and a squeeze of lime. Serve with rice.

Tune in How does it feel to cook from scratch? If it stresses you out, then be kind to yourself and start small. You might learn how to cook one dish. The second and third times you prepare it will be easier than the first. Vary the vegetables in this for 92

Eat

a while. When you feel confident, try a second recipe. Most people have a small repertoire of meals that they cook over and over, so that they don’t have to think about it.

Go deeper Are you too busy on weeknights? Can you reduce some of your activities (or your children’s activities) so that you have more time to cook and eat together? What difference would this make? Can you recruit the help of anyone else in your life? Could you share the cooking with a family member?

Apply this at work ––

––

––

–– ––

Dieticians: share your cooking and shopping skills via videos on your service webpage for patients or an eLearning module for colleagues. Show others how simple cooking from scratch can be. Take your knowledge into schools, colleges, community centres, prisons. Train others to continue this work: you play a vital role in public health and social prescribing (see also ‘Compassionate communities’ and ‘We have influence’ in Chapter 14). Dieticians: campaign for diet to be an integral part of the care package in managing chronic health conditions. Join voices with other health professionals online, like Dr Rangan Chatterjee and Dr Gemma Newman. Occupational Therapists: can you incorporate healthy food preparation and shopping into your functional activities with service-users? Can you work alongside a dietician to create easy recipes? Art Therapists: can you incorporate the colours, shapes and patterns of fruits and vegetables into your projects? All AHPs: have a shared lunch hour once a week where you all sit down and enjoy your food together. If you currently work remotely from home, could you create a recipe-sharing group or even a cook-along?

93

Our physical wellbeing

––

Hospital-based AHPs: can you work with the catering department to transform your food environment? Could healthy options be placed in more prominent positions so that patients see these first, and unhealthy options be hidden from view?

Notes 1 Islam MA, Amin MN, Siddiqui SA, Hossain MP, Sultana F, Kabir MR. ‘Trans fatty acids and lipid profile: A serious risk factor to cardiovascular disease, cancer and diabetes’ Diabetes and Metabolic Syndrome 2019 Mar-Apr;13(2):1643–1647. 2 DiFeliceantonio and Coppin et al. ‘Supra-additive effects of combining fat and carbohydrate on food reward’ Cell Metabolism July 2018;28:33–44. 3 Spector T, Berry S, Valdes A, Drew D, Chan A, Franks P, Asnicar F, Segata N, Davies R. ‘Integrating metagenomic information into personalized nutrition tools: The PREDICT I study’ Current Developments in Nutrition June 2019;3:1. 4 Berry SE, Valdes AM, Drew DA, Asnicar F, Mazidi M, Wolf J, Capdevila J, Hadjigeorgiou G, Davies R, Al Khatib H, Bonnett C, Ganesh S, Bakker E, Hart D, Mangino M, Merino J, Linenberg I, Wyatt P, Ordovas JM, Gardner CD, Delahanty LM, Chan AT, Segata N, Franks PW, Spector TD. ‘Human postprandial responses to food and potential for precision nutrition’ Nature Medicine 2020 Jun;26(6):964–973. 5 The EAT-Lancet Commission on Food, Planet, Health. ‘Can we feed a future population of 10 billion people a healthy diet within planetary boundaries?’ The Lancet 2019. 6 Warren J, Smith N. ‘A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: Effectiveness and associated potential mechanisms’ Nutrition Research Reviews July 2017;30(2):272–283. 7 Rothschild J, Hoddy KK, Jambazian P, Varady K A. ‘Time-restricted feeding and risk of metabolic disease: A review of human and animal studies’ Nutrition Reviews May 2014;72(5):308–318. 8 Wilkinson MJ, Manoogian ENC, Zadourian A, Lo H, Fakhouri S, Shoghi A, Wang X, Fleischer JG, Navlakha S, Panda S, Taub PR. ‘Ten-hour timerestricted eating reduces weight, blood pressure, and atherogenic lipids in patients with metabolic syndrome’ Cell Metabolism Jan 2020;31(1):92–110. 9 Jamshed H, Beyl R A, Della Manna DL, Yang ES, Ravussin E, Peterson CM. ‘Early time-restricted feeding improves 24-hour glucose levels and 94

Eat affects markers of the circadian clock, aging, and autophagy in humans’ Nutrients May 2019;11(6):1234. 10 Moro T, Tinsley G, Bianco A, et al. ‘Effects of eight weeks of timerestricted feeding (16/8) on basal metabolism, maximal strength, body composition, inflammation, and cardiovascular risk factors in resistancetrained males’ Journal of Translational Medicine 2016;14:290. 11 Yoshino J, Almeda-Valdes P, Patterson BW, Okunade AL, Imai S, Mittendorfer B, Klein S. ‘Diurnal variation in insulin sensitivity of glucose metabolism is associated with diurnal variations in whole-body and cellular fatty acid metabolism in metabolically normal women’ The Journal of Clinical Endocrinology and Metabolism 2014;99(9):1666–1670. 12 Spector T. Spoonfed: Why Almost Everything We’ve Been Told about Food is Wrong pp. 26–34 Penguin 2020. 13 Volkow ND, Wise R A, Baler R. ‘The dopamine motive system: Implications for drug and food addiction’ Nature Reviews Neuroscience 2017;18(12):741–752. 14 Bulsiewicz W. Fiber Fuelled: The Plant-Based Gut Health Program for Losing Weight, Restoring Your Health, and Optimizing your Microbiome p. 3, Avery 2020. 15 Singh RK, Chang H, Yan D, Lee KM, Ucmak D, Wong K, Abrouk M, Farahnik B, Nakamura M, Zhu TH, Bhutani T, Liao, W. ‘Influence of diet on the gut microbiome and implications for human health’ Journal of Translational Medicine 2017;15(1):73. 16 Valdes AM, Walter J, Segal E, Spector TD. ‘Role of the gut microbiota in nutrition and health’ British Medical Journal 2018 Jun 13;361:k2179. 17 Katz DL, Doughty K, Ali A. ‘Cocoa and chocolate in human health and disease’ Antioxidants and Redox Signaling 2011;15(10):2779–2811. 18 Kapusta-Duch J, Kopeć A, Piatkowska E, Borczak B, Leszczyńska T. ‘The beneficial effects of Brassica vegetables on human health’ Roczniki Panstwowego Zakladu Higieny 2012;63(4):389–395. 19 Bowtell JL, Aboo-Bakkar Z, Conway ME, Adlam AR, Fulford J. ‘Enhanced task-related brain activation and resting perfusion in healthy older adults after chronic blueberry supplementation’ Applied Physiology Nutrition and Metabolism 2017 Jul;42(7):773–779. 20 Lin BW, Gong CC, Song HF, Cui YY. ‘Effects of anthocyanins on the prevention and treatment of cancer’ British Journal of Pharmacology 2017;174(11):1226–1243. 21 Buschman H. ‘Big data from world’s largest citizen science microbiome project serves food for thought’ Science Daily May 15, 2018. 22 Wahl DR, Villinger K, König LM. ‘Healthy food choices are happy food choices: Evidence from a real life sample using smartphone based assessments’ Nature Research 2017;7. 23 Slavin JL, Lloyd B. ‘Health benefits of fruits and vegetables’ Advances in Nutrition 2012;3(4):506–516. 95

Our physical wellbeing 24 Vighi G, Marcucci F, Sensi L, Di Cara G, Frati F. ‘Allergy and the gastrointestinal system’ Clinical and Experimental Immunology 2008 Sep;153 Suppl 1:3–6. 25 Jacka FN, O’Neil A, Opie R, Itsiopoulos C, Cotton S, Mohebbi M, Castle D, Dash S, Mihalopoulos C, Chatterton ML, Brazionis L, Dean OM, Hodge AM, Berk M. ‘A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial)’ BMC Medicine 2017 Jan 30;15(1):23. 26 Aune D, Giovannucci E, Boffetta P, Fadnes LT, Keum N, Norat T, Greenwood DC, Riboli E, Vatten LJ, Tonstad S. ‘Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and allcause mortality-A systematic review and dose-response meta-analysis of prospective studies’ International Journal of Epidemiology 2017 Jun 1;46(3):1029–1056. 27 Wallace TC, Bailey RL, Blumberg JB, Burton-Freeman B, Chen CO, Crowe-White KM, Drewnowski A, Hooshmand S, Johnson E, Lewis R, Murray R, Shapses SA, Wang DD. ‘Fruits, vegetables, and health: A comprehensive narrative, umbrella review of the science and recommendations for enhanced public policy to improve intake’ Critical Reviews in Food Science and Nutrition 2020;60(13):2174–2211. 28 Hicks AL, Lee KJ, Couto-Rodriguez M. ‘Gut microbiomes of wild great apes fluctuate seasonally in response to diet’ Nature Communications 2018;9:1786. 29 Greger M. How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease Pan Macmillan 2008. See also nutritionfacts​ .o​rg for short videos. 30 Greger M. How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease Pan 2015. 31 Spector T. Spoon-Fed: Why Almost Everything We’ve Been Told about Food is Wrong Penguin Random House 2020. 32 Newman G. The Plant Power Doctor: A Simple Prescription for a Healthier You Ebury 2021. 33 Gillingham LG, Harris-Janz S, Jones PJ. ‘Dietary monounsaturated fatty acids are protective against metabolic syndrome and cardiovascular disease risk factors’ Lipids 2011 Mar;46(3):209–228. 34 Widmer RJ, Flammer AJ, Lerman LO, Lerman A. ‘The Mediterranean diet, its components, and cardiovascular disease’ American Journal of Medicine 2015 Mar;128(3):229–238. 35 Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. ‘Estrogen-gut microbiome axis: Physiological and clinical implications’ Maturitas 2017 Sep;103:45–53. 36 Venn BJ, Mann JI. ‘Cereal grains, legumes and diabetes’ European Journal of Clinical Nutrition 2004 Nov;58(11):1443–1461. 37 Weickert MO, Pfeiffer AFH. ‘Impact of dietary fiber consumption on insulin resistance and the prevention of type 2 diabetes’ Journal of Nutrition 2018 Jan 1;148(1):7–12. 96

Eat 38 Reaven GM. ‘Insulin resistance, the insulin resistance syndrome, and cardiovascular disease’ Panminerva Medica 2005 Dec;47(4):201–210. 39 Messina M. ‘Soy foods, isoflavones, and the health of postmenopausal women’ American Journal of Clinical Nutrition 2014 Jul;100 Suppl 1:423S–430S. 40 Greger M. ‘How phytoestrogens can have anti-estrogenic effects’ Nutrition Facts November 2019. Written By Michael Greger M.D. FACLM on November 21st, 2019. 41 Tham DM, Gardner CD, Haskell WL. ‘Potential health benefits of dietary phytoestrogens: A review of the clinical, epidemiological, and mechanistic evidence’ The Journal of Clinical Endocrinology & Metabolism 1998 Jul;83(7):2223–2235. 42 Hill M. Period Power: Harness Your Hormones and Get Your Cycle Working for You Bloomsbury 2019. 43 Mitra A. The Gynae Geek: Your No-Nonsence Guide to ‘Down There’ Healthcare Thorsens 2019. 44 Newson L. Menopause: All You Need to Know in One Concise Manual: All You Need to Know in One Concise Manual J.H. Haynes and Co. 2019. 45 Earle L. The Good Menopause Guide Orion Spring 2018. 46 Spector T. Spoonfed: Why Almost Everything We’ve Been Told about Food is Wrong pp. 26–34 Penguin 2020. 47 Ursoniu S, Sahebkar A, Andrica F, Serban C, Banach M; Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group. ‘Effects of flaxseed supplements on blood pressure: A systematic review and meta-analysis of controlled clinical trial’ Clinical Nutrition 2016 Jun;35(3):615–625. 48 Alwosais EZM, Al-Ozairi E, Zafar TA, Alkandari S. ‘Chia seed (Salvia hispanica L.) supplementation to the diet of adults with type 2 diabetes improved systolic blood pressure: A randomized controlled trial’ Nutriton and Health 2021 Feb;2:260106020981819.

97

SECTION 2 Our emotional wellbeing It is somewhat artificial to separate our physical wellbeing from our emotional wellbeing. They interact with one another. If we take care of our basic physical needs, we are likely to be more emotionally resilient and vice versa. But it is convenient, for the sake of organising a book, to divide these self-care practices into those which target physical health, and those which target emotional health. We go a little deeper in this section and explore our internal world. This is where lasting change really happens. The strategies in Section 1 are often associated with doing what we are told to do. We might recognise on an intellectual level that breathing, sleeping, moving and eating well are good for us. Unless we really feel it, on an emotional level, that something is helping us, nurturing us, developing us, we are unlikely to really embrace self-care. This section is very much about self-determination and choosing what works for us. You cannot force anyone to carry out a self-care practice. The motivation has to come from within. It is healthy to approach a new practice with some scepticism. We will only really engage once we have felt the effects for ourselves. Not every practice will be for you. This is a menu to choose from, and each item can be adapted to suit you. If you don’t like writing down three things you are grateful for, you can just think about them. If you don’t find ‘flow’ in craft or sport, you might find it in baking or DOI: 10.4324/9781003165125-7

Our emotional wellbeing

running. Self-care is at its most effective when we personalise it. The process constantly evolves in response to our changing needs. Once you start to explore self-care practices, you will doubtless start to hear about more, which are not in this book. I would encourage anyone to build their own personal repertoire of self-care practices. Once we have experienced the benefits of a specific practice, it is at our disposal forever. Something is fundamentally changed in us. We have agency. We know we can draw on this resource. This is where transformation occurs. We don’t just know we’re doing something good. We feel it.

100

6

Resilience

It is inevitable that we will have challenges in our lives. By cultivating particular states of mind, we can cushion ourselves from inevitable adversity. As Helen Keller is believed to have said, ‘although the world is full of suffering, it is also full of the overcoming of it’. In this chapter we will explore how we might develop a practice of gratitude to balance out the relentless negative messages we receive from social media and news stories. We will consider how we might drop in some random acts of kindness, to give ourselves and others a burst of happy hormones. We will look at how we might spark a sense of wonder in everyday life. This might be used to distract ourselves from anxiety, or to help us manage a situation we can’t get out of. We will evaluate when our phones are helpful and when they are a drain on our time. There are practical tips for a digital detox. We will explore ‘flow states’. These are the times when we are in the zone, focused on a task we find interesting and challenging. We are able to orchestrate our body and mind, to make best use of our unique skills and talents. We look at how we might use these flow states more mindfully, to re-energise ourselves, so that we have resilience for tough times. We will address self-talk. We will confront our inner critic, and find out where our critical voices come from. By bringing awareness to these voices, we can start to rewrite the unhelpful messages. We can start to translate the voice into a more encouraging, supportive one; one that a mentor might use. We will consider how we talk to our body and our mind, and how we might change the tone of the conversation. DOI: 10.4324/9781003165125-8

101

Our emotional wellbeing

We will learn how to become more aware of our thoughts and feelings, spending time on them so that they don’t inadvertently affect our behaviour when we least expect it. We will allow for our own vulnerability, and how this might show up in our role as an AHP. We can practice self-compassion and turn our vulnerability into a strength. We end the chapter with a moment of rebellion. AHPs tend to be such goody-two-shoes. It can be thrilling to be bad. Disclaimer: be bad on your days off. Resilience is the ability to bounce back from the inevitable challenges our everyday lives will throw at us. By cultivating one or two of these practices, we are making ourselves more elastic, so that we can spring back.

Gratitude practice Research shows that people who practice gratitude experience wideranging physical, emotional and social benefits. They feel better about their lives as a whole, experience more positive emotions, feel more alert and alive, and experience more joy and pleasure.1 They sleep better, have lower blood pressure, are less bothered by aches and pains and have better immune responses. 2 They are less lonely, more forgiving and more compassionate, offer more support to others, and feel more connected with other people and their community and environment.3 Practising gratitude is one of the simplest practices in this book. Think of three things that you are grateful for today. Try to do this every day. Have a set time: driving home from work, or before bed. You can write them down, if you like. These can be really small things. In fact, the smaller the better. That way we tune into how little things make a huge difference. Our day-to-day wellbeing is not so much dependent upon whether we are in a relationship, drive an expensive car, have an impressive house, perfect children or a high-status job. Our day-to-day wellbeing depends upon little acts of kindness (both giving and receiving), little moments of wonder, little 102

Resilience

interactions with people we don’t know. And, yes, a brownie and a shot of coffee can be the thing that makes all the difference in getting through the day. Here are some other examples: ––

A shared look or smile from a stranger.

––

A funny phrase or word you heard.

––

Sunlight through the trees reflected onto the wall of your office.

––

The scent of shampoo or soap in the shower.

––

The feel of a comfortable shirt that we have had for years.

––

A flower leaning over our fence from a neighbour’s garden.

––

The snatch of a song playing on the radio.

––

The sound of birds singing.

––

A train arriving on time.

––

A person holding the door open for you.

––

A favourite mug.

When we focus on these small things, it helps us to appreciate that our lives are rich and full. There are dozens of things happening every day which we may have been taking for granted. Social media and news feeds tend to focus on the negative. It is easy to conclude that people are not kind or helpful, that we have limited resources, that no one works together for the common good, that the world is spiralling into depravity and that the planet is doomed. Practising gratitude helps us to notice all the instances of kindness and cooperation in our daily lives. People do things for free all the time, without thinking. Practising gratitude helps us to notice our wealth. We have an abundance of clothes, food, utensils, furniture. We have even greater richness surrounding us in the natural world, with an abundance of plants and animals, and ever-changing interest of seasons and weather. These natural and universal riches are perhaps the most profound and lasting of all. They are not dependent upon our status. They can be accessed by us throughout our lifetime, when things are going well for us, and when things are not going well. 103

Our emotional wellbeing

Figure 6.1  Gratitude practice

Practising gratitude provides us with a daily antidote to the stresses and strains in our lives. The stresses and strains are still there, but they are balanced out by the good things. This practice will ultimately build our resilience.

Tune in How does it feel in your body and your mind when you think of three things you are grateful for? How hard was it to think of three things? Did you feel even more appreciation for them because you consciously brought them to mind? Are you feeling a sense of gratitude more often? Does this practice make you more mindful of what you choose to buy? Does it make you take more care of your possessions? Does this practice make you interact with people differently? Might you be more open to little positive interactions with strangers?

Go deeper Keep a gratitude journal, listing your three things each day for a year. 104

Resilience

Every now and again you might want to share one of your three things with the person who made you feel grateful. You might even write them a card to list the ways in which they have made you feel grateful. Gratitude is contagious. Share your gratitude with those around you. Verbalise your gratitude when you feel it. It is a gift of positivity that you can give to others.

Random acts of kindness Kindness is contagious. If we behave kindly towards another person, they are 278 percent more likely to behave kindly towards another person.4 Being kind to another person has as many wellbeing effects on the giver as the receiver. We feel good about ourselves when we are kind. Informal acts of kindness (those we are not obliged to carry out through our professional role) have the most impact upon our own wellbeing.5 An act of kindness leads to the release of ‘happy hormones’ such as serotonin and oxytocin. Serotonin regulates anxiety and increases focus. Oxytocin promotes a feeling of connection and bonding with other people. Even witnessing an act of kindness can promote these biochemical changes. Just one little act of kindness can ripple outwards, so that one act of kindness can generate many more. Try out any of these random acts of kindness: ––

Smile at a stranger on your way to work.

––

Say hello to someone you pass in the corridor.

––

Hold the door open for someone.

––

Help a parent with a pushchair up the stairs on the underground.

––

Start a conversation with someone you would not usually talk to.

––

Send a thank you message to someone you work with.

––

Sing the praises of a colleague in front of their manager.

––

Pick up litter.

––

Leave a tip.

––

Let someone go in front of you in a queue. 105

Our emotional wellbeing

––

Buy food for a homeless person.

––

Make a donation to a food bank.

––

Sacrifice a birthday present for a charity donation.

––

Take good quality clothes to a charity shop.

––

Feed the birds.

––

Rescue an insect.

––

Give up your seat on the bus or train.

––

Scratch a dog behind their ears.

Tune in How did it feel? Were the effects surprising? How does it feel now that you think about it again? Are you likely to repeat this act of kindness? Did you notice the reaction of others? How did this feel?

Go deeper Your acts of kindness could spread to your consumer activities, so that these are in line with your kind intentions. This might include: ––

Setting up a regular subscription to a charity that means a lot to you.

––

Spending your money on companies that can demonstrate high ethical and environmental standards.

––

Switching to a local or organic supplier of fruit and vegetables, or other produce.

––

Only buying fair-trade or cruelty-free products, and spending time to research this.

––

Switching to a renewable energy supplier for home electricity.

––

Buying less for you and your family, and passing on what you no longer use.

Cultivate a sense of wonder Ravi Ravindra, spiritual teacher and writer, has said, ‘wonder cannot co-exist with anxiety’. Nor can it exist with any other negative 106

Resilience

Figure 6.2  Cultivate a sense of wonder

emotion, thought or mind-set. This strategy can be utilised at any time in any place, as a relief from anxiety, worry, annoyance or boredom. Take your focus to a small object like a leaf, flower, stone or shell. You might be able to look out of the window and see a bird or insect. If you don’t have these available, focus on an everyday object, like a pencil or pen, the fabric of your clothes, or even your own fingertips. ––

What colours can you see? Are there very subtle variations of colour?

––

What patterns can you see? Do they remind you of anything else in nature?

––

What does this object feel like? If you close your eyes, do you feel more? 107

Our emotional wellbeing

––

What is this made of? Are there fibres or threads that you didn’t notice before?

––

What is the history of this object? Was it always in this form, or has it changed?

You can use the following practice whenever you are in a frustrating situation which is winding you up. For instance, when you are waiting in traffic or in a queue. Take your attention to something in the distance or something that is easily overlooked. It might be a tree or patch of weeds. It might be a manhole cover or street lighting. Ask yourself: ––

I wonder what it is used for?

––

I wonder how it got there?

––

I wonder what changes it has seen?

––

I wonder if anyone else has stared at it and asked these questions?

A sense of wonder is also useful for boring and repetitive tasks. Come to the task as if you are a child or an alien-being who has never experienced this task before. The next time you are washing dishes, bring your whole attention to the task. Approach it as a child would, with a sense of wonder and playfulness. ––

Notice the bubbles. Notice their colours, texture, and the sound they make.

––

Notice the flow of the water from the tap, and as it overflows.

––

Feel the weight and shape of each dish or utensil. Think about how they were made.

––

Use all of your senses. Sight, sound, touch, smell.

––

Appreciate how the parts of your body are coordinating to carry out these movements.

Tune in What does it feel like to experience wonder in mundane situations? Did your thoughts become more interesting or creative? Did you feel younger, 108

Resilience

more curious, more vibrant? Did this practice instil gratitude as well as wonder? Do you feel more connected to the present? Do you feel more connected to your environment?

Go deeper This practice might spark a new interest or hobby. For example, observing trees might make you curious about what species grow in your environment. You might be more curious about your local history. You might want to experiment with taking photographs, or exploring the visual arts.

Digital detox How far away from you is your phone right now? If you wanted to, could you reach for it without needing to get up? In the last few years, smartphones have become extensions of our bodies. For good reason. They help us to organise our lives. Our phones are our calendars, our address books, our sat navs, our news feeds, our weather-checkers, our post-it notes, our shopping lists, our wallets, our cameras, our music, our podcasts, our connection to loved ones, our social profile in the world. It is no wonder we value our phones. Our phones are also our biggest waste of time. Without checking your screen time on your phone, write down your estimates for the following questions. ––

How long, in total, do you think you spent on your phone in the last seven days?

––

How many times did you pick up your phone per day on average in the last seven days?

––

What are the five most common reasons for phone pick-ups?

––

What are the five applications you use most on your phone?

Now you can check your phone to see how accurate your estimates are. You will find ‘screen time’ or ‘digital wellbeing’ in your phone settings. How accurate were you? 109

Our emotional wellbeing

Were there any surprises? I realised about a year ago that my attention was really suffering from having my phone nearby all the time. For most of my life I have loved reading novels. I realised that I had only read about five books all year, and I just wasn’t getting absorbed in the story like I used to. The culprit was my phone. I would read a page or two of my book, and then something would come up that I would want to check out on my phone: a historical detail, for instance. This was stopping me from getting into the flow of the novel. When I thought about it, this over-checking my phone also interrupted my attention when I was watching TV. It might even have been getting in the way of conversations. If someone is looking at their phone when you enter the room, are you more or less likely to start a conversation with them? How does it feel if someone picks up their phone halfway through a conversation? We are addicted to our phones because the software is designed to be addictive. We get the same hit of dopamine from having someone reply to a text or getting likes on social media that we see in drug addiction. We don’t get a reward every time we pick up our phone. Sometimes we are disappointed to find that nothing has changed: no one has messaged us or liked our post. Sometimes we get a moderate reward, and sometimes we get a huge reward. This ‘intermittent reinforcement’ is most addictive of all. Once we understand this mechanism, we can start to take control of our phone use. Put some of these ideas into action. ––

Don’t sleep with your phone in your room. Buy an alarm clock.

––

Wait for ten minutes before picking up your phone in the morning. Then extend this to 20, 30, 60 minutes.

––

Switch off your phone and put it on to charge 30 minutes before bed. Then extend this to 60 or 90 minutes.

––

Review your notifications. Which ones are essential? Which ones are distractions? Aim to reduce your notifications each week until you are down to only a couple of types of notification.

110

Resilience

––

Review your apps. Do you use them all? If you haven’t used them in the last three months, move them into a sub-folder away from your home screen. Delete them in three months if you still haven’t used them.

––

Only have the most useful apps on your home screen. Reduce this as much as possible.

––

Use ‘screen time’ to set limits for overall phone use, and to set limits for particular apps.

––

You might use features such as turning your screen black and white after a set time each evening. This will reduce the sensory reward of using your phone.

––

Review your social media. Aim to reduce the number of accounts you follow by 10 percent, then 20 percent, then 50 percent. Only follow accounts if they regularly lift your spirits. Mute those you are not sure about, but delete them in a week if you didn’t miss them. Unfollow the accounts which make you self-critical or bring you down.

––

Think about what times of the day you want to use your phone, and for what purpose. There will be some essential purposes. There will be some that are for fun.

––

Build in end-points for the apps you find most alluring. Set a timer for them so that you don’t endlessly scroll. Remember that apps are designed to have no end-point, so you have to build them in.

––

Allow yourself the occasional slippage. We will never be perfect. Anticipate days when your willpower is weak. This is not ‘all-ornothing’. You are aiming for sustainable change.

––

Have a place where you keep your phone when you are at home. Don’t automatically take your phone with you when you move from one room to another. Don’t automatically take your phone when you go out for a walk.

––

Consider talking to your friends and family about your intentions. Prepare yourself for some cynicism, and don’t try to persuade them to do the same. Let them see the effect it has on you, and then they might be intrigued.

––

Check your phone usage each week. You can see whether screen time has gone up or down, how many pick-ups there have been, and which 111

Our emotional wellbeing

apps you have used the most. This will help you set realistic goals and stay on track in the long-term. ––

If someone else picks up their phone in the middle of a conversation with you, ask ‘is everything OK?’ This is generally all the social cueing they need to put it down again.

You may find yourself surprised and disappointed at how difficult this is at first. Don’t give up. Take small steps first, and I promise you that it will get easier. You will start to see the reward of not being within arm’s length of your phone. The rewards of not being at the mercy of our phones include: ––

Increased focus on tasks that need our attention.

––

Increased pleasure in activities away from our phone.

––

Increased interaction with our family and friends who are in the room with us.

––

Insight into what gives us most pleasure or purpose on our phones.

––

Insight into the mechanisms of addiction so that we have compassion for others.

––

Improved sleep quality, if we were previously using screens late at night.

––

Time for self-care activities.

Tune in How does it feel to review your screen time? If you were shocked or disappointed, don’t berate yourself. Use this as motivation to set realistic goals. How does it feel to set goals? How does it feel to reduce your screen time by just a little bit?

Go deeper You might try an occasional or a regular ‘phone sabbath’ where your phone stays switched off all day. This can be easier to try if you are on holiday or out for the day, because you will be out of your normal routine and there won’t be the context cues pulling you back to your phone. How does this feel at the end of the day? 112

Resilience

Finding flow When we are in a state of flow, we are fully absorbed in an activity. Our attention is entirely taken up with the activity. We feel relaxed, but alert. We are energised and alive.6 We have no capacity for worry or anxiety, because our whole focus is upon this activity. To achieve a flow state, the activity has to have a certain amount of challenge. We need to bring our full attention to it. We need to coordinate our body and our mind. There is a certain amount of thinking and creativity, as well as a physical challenge. Children achieve a flow state easily and naturally. They explore the world around them with an attitude of wonderment. They go with the flow. They let one thought lead into another, or one action lead to another. There might be a fun challenge, but this arose as part of playing. It has its own intrinsic reward because the process is fun. You might be able to remember finding a state of flow as a child. It might have been during water or sand play, pouring from one container into another, or mixing and moulding gloop. It might have been through building with Lego. You were carried away by an idea that evolved as you played. Maybe it was sorting shells or buttons, or other small objects you found delight in. It might have been climbing trees, skateboarding, skipping, riding your bike, hula-hooping, performing acrobatics … Your whole mind and body coordinated their efforts, and you were ‘in the zone’. When we find flow, we get a break from our worries. We are right here, right now, absorbed in this activity. Our minds and bodies are working as one, in perfect harmony. As adults we can find a flow state again. You might already have found it through a hobby. It might be making bread, gardening, decorating cakes, fishing, paper-craft, woodwork, sewing, playing a musical instrument. We might find flow during a physical activity. It might be walking, running, cycling, swimming, dancing, practising yoga or a martial art, playing sport. Sometimes we find flow in rituals or preparations for a celebration or religious occasion. We might find flow whilst making decorations for a party, laying tables, wrapping gifts. We might even find flow when we are tidying up. 113

Our emotional wellbeing

Figure 6.3  Finding flow

We can even find flow through household tasks. It might be mopping the floor. It might be tidying a cupboard. The task has to have a certain amount of challenge to it, so if you have neglected the task for a while you are more likely to find flow. The task will have intrinsic reward as you see the difference you are making. The more we become aware of our flow states, the more we seek them out and appreciate them. We might make different choices about how we spend our time. This activity is not ‘just’ a hobby. It is a vital part of our self-care. It allows us to feel competent and confident. It is rejuvenating and re-energising.

Tune in What activities bring about flow states for you? 114

Resilience

How does it feel in your body after five minutes of being in a flow state? Did you feel a sense of harmony between body and mind? Do you feel energised?

Go deeper You might remember having had hobbies from earlier in your life which you have let go of. Think about when you enjoyed art or craft activities at school. It might be colouring, calligraphy or making cards. It might be a DIY task. It might be painting or decorating, or restoring an item of furniture. It might be a sporting activity. It might be dance or drama or singing. Can you explore this activity again? Ask your friends and colleagues what hobbies and activities they enjoy. Do any of them appeal to you? Could you ask them to teach you a little more? Don’t let perfectionism inhibit your learning. You will not be competent straight away. Catch yourself when you are being self-critical and change the script to one you would use with a child who is learning a new skill. Once we have persisted and learnt the basic skills, we are likely to then be able to bring our own unique thinking and creativity to it. Then we are likely to find flow.

Self-talk We all have voices in our heads which constantly comment on what we are doing and thinking. These voices were established early in our lives. They might be the voices of our parents and carers, our siblings, our friends and peers or our teachers. Often these voices are critical. Unfortunately, because we are a highly socialised species, we remember what we have been criticised for. We don’t want to repeat a rejection. We are less good at remembering or even noticing when we have gained approval and respect from others. Perhaps they don’t get voiced: if everything is going well, there is no need to comment. It is helpful to know that there is a natural negative bias to our selftalk. Once we know this, we can start to counteract it with conscious positive self-talk. This is important for our self-esteem. 115

Our emotional wellbeing

Self-esteem will ultimately benefit those around us. We will be our best selves for more of the time. We will be less insecure and demanding, and more self-assured, confident, resilient and brave. We will allow ourselves to shine and encourage others to shine along with us. It may be useful to identify our fears about ourselves. This can be painful, and so you will need to meet these messages with compassion and scepticism. You might like to take five minutes to answer these questions. ––

Write down five negative personality traits that you think you have.

––

Where did this message come from? Can you remember someone labelling you with this trait?

––

What were their motivations or fears when they said this about you? Could it have been more about them than about you?

––

With your current life experience, do you think that this labelling was fair or accurate?

––

When was the last time you exhibited this trait?

––

Can you think of someone who you love who exhibits this trait?

––

Do you forgive that person if they exhibit this trait?

We are allowed to have a collection of negative personality traits. If we were perfect we would be without interest. Moreover, supposedly negative personality traits can have a positive side. For example, if you are a ‘show-off’, you also exhibit enthusiasm and charisma. If you are a ‘wallflower’ you are also a good observer and you allow others to express themselves. The next time you find yourself talking to yourself critically, tune into this. ––

Whose voice are you hearing?

––

Can you replace that voice with your most encouraging mentor?

––

What would this person say to encourage you?

––

Would they recognise that you are doing your best with your current level of experience?

It might be useful to have some set phrases that you can draw on in the moment when you find yourself slipping into negative self-talk. 116

Resilience

These are a few of my favourites: ––

I am enough.

––

I am a work in progress.

––

This too will pass.

––

Mistakes are proof that I am trying.

––

I learn from my mistakes.

––

We can do hard things.

Tune in How does it feel to hear a compassionate, loving voice? Did you recognise that some of the critical voices are out of date, or were just wrong in the first place? Is there freedom in this?

Go deeper You might want to journal about this. What are the beliefs that you have held about yourself that might be out of date, or might have been wrong in the first place? Do you notice that sometimes you have been criticised for seemingly opposite traits? For example, perfectionism and sloppiness? What does that say about critical voices? If you feel that you do have that personality trait, can you accept that this is a part of you? Has there ever been a time in your life when that trait was helpful? Does it serve you now? Can it be used in a positive way?

Make friends with your body We all have bodies. We have a long history with our bodies. We go back a long way. This relationship with our body is complex. We will have received messages about our body at various stages in our life. The negative messages might as well be seared into our flesh; we don’t forget them, and they are intensely painful. The positive messages are gratifying but 117

Our emotional wellbeing

are ultimately toxic. They might give us a false sense of pride which will ultimately become a pressure. The perfect body is a cultural creation. It differs from culture to culture and it changes through time. A tiny percentage of the population will fit the ideal, and they will likely be terrified of losing what they have as they get older. Not having the perfect body from the outset gives you the opportunity to come to terms with imperfection earlier in life. Some bodies are ignored. The vast majority of bodies we see in the media, be it advertising, in soap operas or TV dramas, presenting the news or on social media, have very predictable proportions within a very narrow size range. Until very recently the skin tone was set to a default white. We rarely see disabled bodies, but if we do, the story is around their disability. We rarely see incidental disabled bodies. This doesn’t bear any resemblance to the population norms. It is incredibly damaging to see this narrow range of bodies. If we are in the majority, we don’t even notice it. We assume that people are fairly represented. It is especially damaging if we have one of the body types which is ignored. We might experience disappointment with our skin, our hair, our body shape, our muscle strength, our flexibility, our cardiovascular fitness. Our hormones are probably going to cause us distress for a substantial part of our lives. Many of us do not feel comfortable with the strict gender stereotypes our society imposes. Then there is age. From our late 30s or early 40s we are constantly reminded that we are not what we were. We are offered skin creams, hair dyes, teeth-whitening products, support garments. It is not just the aesthetics of our body that challenge us. Very few, if any, bodies enjoy perfect health. Sooner or later, we pick up injuries and illnesses that mean our bodies are not functioning perfectly. We feel frustration with that part of our body, particularly if it is slow to heal or if it is changed forever. We are not stuck in this troubled relationship. Like all relationships, we can bring compassion and gratitude to the situation to make things a little better. Take some time to think about your body.

118

Resilience

Figure 6.4  Make friends with your body

––

How long have you had your body?

––

How has it changed?

––

What parts of your body do you have a troubling relationship with?

––

Where did the negative messages come from?

Once you have identified a part of your body that you have had a troubled relationship with, make a commitment now that you will no longer address it with scorn and ridicule. Think of a term of endearment that you would use for a hurt child or animal. It might be ‘sweetheart’ or ‘precious one’. Address it warmly with this word. ––

Address that part of your body now, talking to it in a gentle way.

––

You might say ‘Sweetheart. I am sorry. I have treated you unkindly when you were doing your best’.

––

You might ask ‘Can we start again? Can I do anything to help you?’

It might be that you have a long-term condition, like asthma, eczema, arthritis, diabetes, high-blood pressure, irritable bowel syndrome. You 119

Our emotional wellbeing

might have muscle aches, migraine, premenstrual syndrome or endometriosis. You might have depression or anxiety. You will have been frustrated with this condition. You will have wished it away. Can you make friends with that part of your body now, and understand that it has been trying to do its best for you, but is struggling? Maybe you can make a commitment that you will check in with what that part of your body needs. You might be able to tweak your overall wellbeing, through getting more sleep, breathing well, moving more, eating a little better, starting a meditation practice. You might not get total relief from the condition, but you will get to know what helps and what doesn’t help. You will feel that you have agency. You are in partnership with your body, rather battling with it. It may be that you can slowly change your emotional response to your health condition. You might be able to come to a place of compassion. You might be able to allow yourself to rest and recuperate in response to a flare-up. You might be able to anticipate a period of stress and put in place more self-care to counterbalance the demands on your body. You might be able to focus on all the aspects of your body’s functioning that are going incredibly well. When we consider how much is happening in our bodies, it is amazing that most parts of our body are functioning well most of the time. For instance: ––

We have 100 trillion cells in our body. Each is programmed to carry out a specific function.

––

We make 200 billion red blood cells, 10 billion white blood cells and 400 billion platelets per day.

––

We have 100,000 miles of blood vessels throughout our body.

––

We have 100,000 trillion microorganisms in our gut microbiome. They produce the vital metabolites we need in our body.

––

We have over 100 different neurotransmitters in the brain and over 50 different hormones to regulate the body. There are likely to be more.

––

There are 25,000 phytochemicals that have multiple health benefits for our bodies, acting on many different body systems concurrently.

––

We have 37 thousand billion billion chemical reactions taking place in our bodies per second.

120

Resilience

––

In case you missed that, we have 37 thousand billion billion chemical reactions taking place in our bodies per second.7

Tune in How does it feel to address the part of your body as ‘sweetheart’ or ‘precious one’? How does it feel to offer it compassion and gratitude? Is it surprising to learn how complex a human body is? Does this foster a sense of awe and wonder?

Go deeper You might want to carefully curate the types of bodies that you are exposed to in your social media feed. Tune in to when you find yourself feeling ‘less than’ in response to a picture or video on social media. Your version of this will be unique to you. It might be around body size, shape, fitness, flexibility, hair, skin, clothing, cosmetics … You might want to stop following accounts that regularly make you feel ‘less than’. Or you might want to send them a polite message to say how their posts are triggering a particular response in you, and how you would value diversity in the representations that they show. It is really important that all of us give this feedback. Companies, charities and organisations want our business or our attention. We hold the power to influence the images that they put out there.

Riding the wave of emotion We would probably all like to feel positive emotions all the time. Failing that, we might like to feel calm and relaxed. This is unrealistic. To enjoy a full human experience in relationship with other human beings, it is inevitable that we will soon be subject to negative emotions. This includes sadness, loneliness, disappointment, frustration, resentment, anger, fear, shame and anxiety. Our social nature means that we are primed to love other human beings. We need love and esteem. But we are also primed to be on the look-out for

121

Our emotional wellbeing

anything which threatens our emotional security or our place in the group. As human beings we have a highly sensitive limbic system that is primed to always be on the look-out for threats. Our brains do not distinguish between real, concrete threats to our safety, and threats that are only in our thoughts. They all result in a stress response. Because we, unlike other mammals, can have abstract ‘thought stresses’ we are more vulnerable to over-activation of our stress response. Our limbic systems are also primed to seek out pleasure. This can be in the form of money, clothes, food, possessions, love, sex, social status, power. When we meet a desire we get a burst of dopamine and our reward system experiences the pleasure of satiation. Dopamine helps our brain to remember how we got this reward so that we can seek it out again and replicate the pleasure. This addictive patterning can be self-destructive, and this can cause pain to others we love. Most of us feel uncomfortable with negative emotions such as anger, sadness, regret, shame and fear. They make us feel out of control, vulnerable, lonely or unlovable. There is a tendency to suppress such feelings; to not show them, and even to not feel them. We probably received messages as a child which told us not to display our inconvenient emotions. If the adults around us were not comfortable with their negative emotions, they were unlikely to allow us to display ours. We might have been told not to make a fuss, to pull ourselves together, or not to upset the people around us. Most of us are taught to keep negative emotions to ourselves and to be afraid of them. When we don’t allow ourselves to feel negative emotions, it is likely that one of two things happens. 1. We might avoid feeling that emotion. If we were born a girl, we are more likely to hide our anger. If we were born a boy, we are more likely to hide our sadness or fear. Repressed emotions are linked with depression, anxiety and chronic stress. Stress is linked with all the most common chronic health conditions that are treated in general practice.8 2. We might divert our attention away from our emotions. We might learn to activate our reward system instead, by indulging in behaviours such as over-eating, drinking alcohol, taking drugs, having sex, shopping or over-working. 122

Resilience

There is a third way. If we allow ourselves to feel the negative emotions, we learn that they do not last for long, and that they do not threaten our safety in the world. If we can sit with ourselves and allow ourselves to feel the emotion and offer ourselves compassion in this moment, we can activate the parasympathetic response and self-soothe. With practice, we can even override addictive behaviours. We can meet our emotional need for comfort. We will no longer need to repress or divert our attention away from these negative emotions. We can sit with our feelings, feel them, offer ourselves compassion and let the emotions move on. The next time you find yourself feeling intense anger, sadness or fear, try this practice. ––

Allow the feeling to exist.

––

Don’t get caught up in story-telling about the situation (the ‘he said, she said’ details). Stay with the feeling. What are you feeling?

––

Where do you feel this emotion in your body? Is it in your throat, chest, stomach?

––

What does it feel like? Is it heavy, hard, oppressive, restrictive, burning, freezing, prickling?

––

Does it have a shape or a colour?

––

Put your hand on your chest or throat. Touch stimulates the release of oxytocin, which calms and comforts us.

––

Say to yourself ‘I am allowed to feel this. It is difficult, but it is ok to feel it’.

––

Monitor what is happening in your body. Allow the feeling to take up space in your body.

––

As soon as your mind starts to wander and indulge in story-telling, come back to the feeling in the body. Let the emotion take up space, grow, shrink, change.

––

Repeat ‘I am allowed to feel this’.

––

Take as long as you want to allow the emotion to exist. Ride the wave, and it will pass.

123

Our emotional wellbeing

Tune in How did it feel to allow the emotion to take up space? Was it challenging to not get caught up in story-telling about another person and what they have done wrong? Was it challenging not to get caught up in self-recrimination? Did it feel safe to feel this emotion in this way? Did you feel out of control or was it manageable? Did you feel a sense of support or empathy or compassion?

Go deeper Given that there is a link between repressed emotions and stress, and that there is a link between chronic stress and chronic health conditions, you may also be interested in the following practice. Repeat the following phrase regularly to yourself. You may want to say it first thing in the morning or last thing at night. I give my body permission to feel emotion. Once I have felt it, I give my body permission to let go of it. I give my body permission to let go of anything that is not needed for my body’s perfect functioning.

Observing thoughts Our limbic system does not distinguish between a real physical threat and a ‘thought threat’. A ‘thought threat’ could be anything. It might be replaying an argument you had with your partner. It might be worrying about your children. It might be worrying about finances, work, illness, the future. Most of our thoughts are repetitive. We have thought them before, or someone else has thought them before and passed them on to us. Our media recycles negative thoughts about politics, crime, national security, scarcity of resources or money, the selfishness of human beings. We are unfortunately neurologically primed to focus more on 124

Resilience

threat than feel-good stories. We remember and repeat and recycle the negative stories, but forget to repeat the positive stories. We can counteract the negative bias by cultivating gratitude, kindness and wonder. We can also reveal to ourselves that we are not our thoughts. We can separate ourselves from our negative thoughts. We can let them go, and move on with our day. We can put our creative energies into something more fulfilling instead. The next time you find yourself worrying about something, try this: ––

Observe yourself thinking the thought.

––

You can provide a commentary, as if you are the subject of a documentary.

––

For example ‘Ali is worrying that she has made a mistake at work. She has this thought a lot. It is a bit of a theme with her’.

––

As soon as you observe yourself, you have taken yourself out of the repetitive cycle.

––

Imagine the thought as a cloud, or a bubble or a wave on a shore.

––

Thoughts come and thoughts go. They are repetitive and transient.

––

We are not our thoughts.

By taking ourselves out of our heads and into a position of observer, we can see that it is just a thought. We might even be amused or entertained by ourselves working ourselves up over this familiar worry. You might spot a pattern to your thoughts. You might observe how often you worry about something that might not ever happen. You might obsess over something from your distant past. You might observe that you worry about everything, from major disasters to tiny little slights that might not even have happened. You might observe that you tell yourself a lot of stories. You might be the hero or the villain. These stories get better in the telling. They keep you stuck and take up a lot of your energy. Awareness is the agent of change. Once you recognise what you are doing, you take the power away from your thoughts. They have no reality in the present: they are either dealing with past events or possible future events. 125

Our emotional wellbeing

Once you realise that you are not your thoughts, you release yourself from their power. The vast majority are just repeated, recycled thoughts that have been thought by you before and will probably be thought again. When you do have an original, interesting thought, you can celebrate it. If you release yourself from repetitive thoughts, you are likely to have more energy for creativity and innovation, and to be able to solve the problems that you do have right now. All you ever have to deal with is the problem you have right now. Do you have a problem right now? You only have to do the calm, compassionate thing for the next five minutes. That is all you will ever have to do. If you can do this for most of the time, you will probably be OK.

Tune in How does it feel to be the observer of your thoughts? Does it diminish their power over you? Do you have to stop yourself from slipping back into telling a story? Is it hard to pull yourself out of the story and come back to being the observer? Does it help to use your name when you describe yourself thinking the thought? Does it help to commentate as if you are the subject of a documentary? Do you feel less caught up in repetitive thoughts?

Go deeper You might be interested in reading Ekhart Tolle’s ‘The Power of Now’.9 This repays regular reading and re-reading. We can identify when we are getting caught up in telling stories, or obsessing about the past and future. It is a challenging but ultimately enlightening read. 126

Resilience

Our vulnerability We have a professional code of conduct which sets out the standards of behaviour required from an AHP. We also have our own personal ethics about how we behave at work. We are still human. There will be some situations at work which trigger an emotional reaction in us. Sometimes we will be immediately aware of it. We will feel a strong connection or sense of responsibility towards a particular service-user, their parent, carer or a colleague. We are aware that we want to do our absolute best for this person, perhaps above and beyond what is required. Occasionally someone might trigger us into a very negative association. This is perhaps more disturbing as a health professional. Sometimes it might only occur to us later that a certain situation at work is getting to us. A particular service-user might be in our thoughts long after their appointment. We might be worried about their onward journey into other services. Sometimes we just get a sense that something in us is off-centre, off-balance and we are on the edge of sadness or anger. We are very good at putting these feelings to one side whilst we are at work. The danger is that if we don’t attend to it at all, it will rumble on in our subconscious. It is likely to rear its head when we least expect it, affecting our behaviour, mood or even our health at a later stage. It is helpful therefore to be aware of our emotional vulnerabilities, or triggers, as a professional. This will help us to tune in when something arises, to pay attention to it and to process it. What triggers us will be very personal, dependent on what has happened to us in our lives. Some examples of potential triggers include: –– –– –– ––

A patient has the same diagnosis as us, or someone we love. A patient reminds us strongly of someone we love, or someone who has hurt us. A patient is struggling with life circumstances similar to our own. There is a safeguarding issue which has resonances in our personal life. 127

Our emotional wellbeing

–– ––

There is a bereavement similar to one that we have suffered. A patient has been let down by an agency that let down someone we love.

I used the word ‘patient’, but it could be anyone at work: a parent, carer, relative, colleague or someone who you manage. When we become aware of the trigger will determine how we respond. If we are in the middle of an appointment with a patient, we will likely maintain a professional manner, but express our empathy for this person. If we are still going through the experience, it is probably not helpful to share our experience with the patient. We are there to offer our calm presence. However, if we have come through a tough situation and can offer hope, then this might be appropriate. When we have completed our work with the patient, we can take time to attend to our thoughts and feelings. If we have a supportive colleague at work, we might let them know that we found a situation challenging. Our self-care is important at this stage. We might tune into what will be most helpful at this time. It might be a walk at lunchtime; it might be a breathing practice. If we don’t attend to our feelings, we are likely to find the care of this patient more stressful. Once we are in a safe space, probably at home at the end of the day, we might allow the emotion (see ‘Riding the wave of emotion’ on p.121). We might sit with the thoughts that have come up (see ‘Observing thoughts’ on p.124). We might even journal about them (see ‘Writing therapy’ on p.254). This process will help us to separate our thoughts and feelings from the clinical situation. It will guard against us over-identifying with a particular patient and imposing our own narrative onto the situation. If we impose our narrative, then we are not present for that person, and we might not give them the best or fairest care. It might be helpful to take this situation to our professional supervision, if we feel safe talking to our supervisor about this issue. We can learn a lot from these situations, personally and professionally. They can help us with our professional boundaries. We may also need a discussion with our line manager if there is a conflict of interests or if 128

Resilience

patient care might be compromised. We can make these decisions once we have processed our thoughts and feelings. All AHPs have vulnerabilities. It is helpful to be aware of them, either ahead of time or once they come up in our clinical work. To dismiss them, or to be unaware of them, risks our wellbeing, and possibly the wellbeing of patients, carers, colleagues or people we manage.

Tune in Do you have a sense of what your vulnerabilities might be? Have you had an experience of identifying very strongly with a patient or carer? How did this affect your stress? Did it make the management of the case more complicated? Would you do anything differently in retrospect?

Go deeper We may feel that we experienced a difficult situation a long time ago and that we should be over it by now. We often need to process trauma again and again. This doesn’t make us weak or unprofessional. It is an opportunity for self-compassion. Our vulnerability can be a strength. We have unique insight into this situation. We can use this. If we feel safe, we might share our insights with our colleagues. This can refocus our team on compassionate, holistic care. See also ‘Practising non-judgement’ on p.212. This is helpful if we are feeling strong negative feelings towards a service-user, carer, colleague or manager.

CBA. Can’t Be Arsed We all need the option of occasional rebellion. There are definitely days when you will want to stick two fingers up. We need to experience the full range of emotions to be a rounded human being, and this includes resistance, rebellion, and even occasional rudeness. 129

Our emotional wellbeing

Figure 6.5  Software update

Just make sure this happens at home, and not at work. A disciplinary will not do much for your wellbeing. Here are a few suggestions for your rebellious days, when you are not at work. ––

Take off your fitness tracker if it is annoying you. You are the boss of your fitness tracker, and not the other way round. If you want to walk 500 steps today because you are exhausted, then you are allowed to make that call.

––

Eat ice-cream for breakfast. Or cold pizza. Or just a double espresso.

––

Reject your worthy pile of books to read, and turn to Netflix instead. Binge on a box-set in your pyjamas.

––

Make a den and hide in it. Be a child again. You can use blankets and chairs to enclose yourself. Bring into your den everything you might need for your survival today. This might include your emergency self-care kit (see p.261). 130

Resilience

––

Call a friend. Have a rant. Have a laugh. Swear a bit. Cry if you need to.

––

Signal to those who live with you that you are having a CBA sort of a day. You could write a sign to hang around your neck. It might say ‘out of order’, ‘software update’, ‘buffering’, or simply ‘CBA’.

––

Be a dog for a day. Dogs find a patch of sunlight and they lie in it. They get up, have a good stretch and yawn luxuriously. This allows them to recharge, and be the most loving creatures on Earth. Learn from them.

––

Or be any other animal you fancy for the day. Or even a plant. Plants are zen.

You might like to think of a few more, just for yourself. Being occasionally rebellious is delightful and joyous. We should never lose touch with our inner child, our inner animal, our creative self. Don’t bother about what others might think. Everyone has their chaotic corner, dirty drawer, crazy voices, wicked streak. This moment of rebelliousness might allow you to stay on track for the rest of the week.

Tune in How does it feel to be subversive? What is the impact of this brief moment in the overall trajectory of your life?

Go deeper If you are experiencing feelings of guilt, shame or regret, try the ‘R iding the wave of emotion’ or ‘Observe your thoughts’ strategies in Chapter 9. Examine your ‘Self-talk’ on p.115 or practice ‘Forgiveness’ on p.268.

Apply this at work ––

Orthotists and Prosthetists: the nature of your work deals with loss. Whilst this offers more opportunity for gratitude, kindness and appreciation of our body, it also presents more 131

Our emotional wellbeing

––

––

––

challenges for emotions and thoughts. Do any of these practices feel like they are appropriate to share with your patients? Is this a discussion to have with your team? Art Therapists, Drama Therapists and Music Therapists: you are familiar with helping service-users process their thoughts and feelings. Do you have ways of processing your own thoughts and feelings at the end of the day? Can you find flow for yourself at the weekend in order to restore your energy for the next working week? Paramedics and Operating Department Practitioners: can you manage your adrenaline and cortisol by having a digital detox when you are not at work? Can you cultivate a sense of wonder or find flow in order to replenish yourself when you are not at work? Are you aware of your own vulnerabilities? Radiographers and Orthoptists: you have unique insight into the human body. Does this heighten your appreciation of it? Can you convey this to vulnerable patients when medical treatment might make them feel that their bodies are letting them down?

Notes 1 Emmons R A, McCullough ME. ‘Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life’ Journal of Personality and Social Psychology 2003 Feb;84(2):377–389. 2 Boggiss AL, Consedine NS, Brenton-Peters NM, Hofman PL, Serlachius A. ‘A systematic review of gratitude interventions: Effects on physical health and health behaviors’ Journal of Psychosomatic Research 2020 Aug. 135:110165. 3 Emmons R A, McCullough ME. ‘Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life’ Journal of Personality and Social Psychology 2003;84(2):377–389. 4 Chancellor J, Margolis S, Jacobs Bao K, Lyubomirsky S. ‘Everyday prosociality in the workplace: The reinforcing benefits of giving, getting, and glimpsing’ Emotion 2018 Jun;18(4):507–517. 5 Hui BPH, Ng JCK, Berzaghi E, Cunningham-Amos LA, Kogan A. ‘Rewards of kindness? A meta-analysis of the link between prosociality and well-being’ Psychological Bulletin 2020 Dec;146(12):1084–1116. 132

Resilience 6 Csikszentmihályi M. Finding Flow: The Psychology of Optimal Experience Harper Collins 2009. 7 A response on quora​.c​om in response to the question “On average, how many chemical reactions happen in the body in one second?” 8 Schneiderman N, Ironson G, Siegel SD. ‘Stress and health: Psychological, behavioral, and biological determinants’ Annual Review of Clinical Psychology 2005;1:607–628. 9 Tolle, E. The Power of Now: A Guide to Spiritual Enlightenment Yellow Kite 2020.

133

7

Meditation

There is a perception that meditation is hard work and takes years of practice. Meditation is simply sitting with ourselves. And breathing. We have already started to explore this, so if you have tried any of the breathing practices in Chapter 2, you have probably already experienced a calm, meditative state. For a full meditation practice, you can continue to focus on the breath, and it is as simple as that. If you find that you need something else to anchor your thoughts, then add any of these practices in. You probably don’t feel you have ten minutes in the day when you can sit and do nothing. But think about other activities that take this length of time. Scrolling Instagram comes to mind, for me! Whilst it might be uncomfortable to simply sit with ourselves, it is invaluable to have a space each day where there are no demands on you. You just need to be here now. You don’t need to ‘empty your mind’. This is impossible and not desirable. The focus is to observe. Be a health professional. Observe what comes up, and try not to pass judgement. Don’t we do this all the time at work? In this chapter there are a few different ideas for meditation. Pick one to start with, probably the one that appeals the most, and see what happens. If the thought of sitting still for ten minutes horrifies you, start with five minutes. You don’t have to sit in a cross-legged position to meditate. If you do want to sit in this position, you can make it more comfortable by raising 134

DOI: 10.4324/9781003165125-9

Meditation

your sitting bones up on a cushion or folded blanket. This will raise your hips above your knees, which is more comfortable for most people. Or you could sit in a chair, with your back supported. Or you can lie down. Putting a pillow under your head, and maybe one under your knees can increase your comfort. A warm, heavy blanket can also make you feel grounded and contained. The benefits of meditation are wide-ranging and profound. Meditation induces a state of ‘relaxed alertness’ by increasing alpha and theta waves in our brain.1 This is conducive to a generalised state of wellbeing, and is likely to benefit our whole bodies because it initiates a parasympathetic response. So far, research has shown that meditation can –– –– –– –– –– –– –– ––

Reduce blood pressure2 and the associated risks of cardiovascular disease.3 Reduce our general risk of mortality, including heart disease and stroke.4 Improve our sleep and our ability to manage stress.5 Improve our visual-spatial reasoning, working memory and executive function.6 Reduce our risk of depression and reduce the severity of depression symptoms.7 Help with managing pain and chronic health conditions such as arthritis.8 Reduce ruminative thinking and increase empathy and self-compassion.9 Reduce stress and increase job satisfaction for health professionals.10

If there was a drug that could do all of this, we would all be clamouring to get our hands on it. The best way of exploring the possible benefits is to try meditation yourself. The benefits can be immediate, but are enhanced by regular practice. Try to set aside a regular time when you will settle down to meditate. Meditating in the morning can give you a sense of preparation and calm focus before the day starts. Meditating in the middle of the 135

Our emotional wellbeing

day can be an oasis of calm in the middle of whatever the day throws at you. Meditating in the evening can help you to de-stress after your day, and leads to more restful sleep. Don’t worry if you miss a day. Just come back to the practice the next day. Falling off the wagon is really important, because it teaches us that we can just get back on the wagon. It is better to meditate once per week than not at all, but a daily practice will provide an anchor-point that helps you maintain your equanimity through life’s challenges. You will find a length of time that works for you. Five minutes is very doable every day. After ten minutes I notice that my thoughts have calmed, and I feel peaceful and connected if I go beyond that. You will get to know what you need. As the mindfulness professor Jon Kabat-Zinn has observed, ‘it is indeed a radical act of love just to sit down and be quiet for a time by yourself’. It is time to get quiet.

Mindful meditation As zen master Thich Nhat Han has said, ‘To meditate with mindful breathing is to bring body and mind back to the present moment so that you do not miss your appointment with life’. This practice invites us to tune into our body, tune into our mind and tune into our relationship with the world around us. Rather than checking out, we are checking in. With practice, the calm presence we find within this practice will become available to us in our daily lives, allowing us to be responsive rather than reactive. ––

––

136

Sit in a comfortable upright position. This might be cross-legged or kneeling on the floor. Or you can sit in a chair with your back supported. Be comfortable. If you are sitting cross-legged, it can be helpful to sit with a cushion under your sitting bones, so that your knees are lower than your hips. You can wiggle at any point. Rock your head from side to side or roll it to free up tension your head and neck. Wiggle your hips, wiggle your knees. Wiggle anything else you need to.

Meditation

––

––

––

––

––

––

Start to focus on your breath. Breathe slowly in and out through the nose. Focus on the breath as it enters the nostrils and take it deep into the lungs. Breathe how you need to breathe in this moment. It can be a big deep breath followed by a sigh to let go of tension. You might then feel ready to take slow, quiet, steady breaths. You mind will wander. You will think about things that have happened yesterday and today and you will start to plan things coming up in the next day or two. This is normal. Gently bring your attention back you your breath. Each time you do this, you have succeeded; you are a successful meditator. When your mind wanders, observe the thought. Think to yourself ‘that’s interesting’. See it as a positive that you can observe where your mind led you to. This is in an insight and a gift. You can observe which people, events or thoughts come into your mind. Wish them well and let them go. You might imagine them as wandering clouds, or balloons that can be let go of. If there is a person that troubles you, put them in a safe place. They might be sealed in an imaginary bubble. Wish them well and let the bubble float away. Gently return your focus to the breath.

Tune in At the end of this practice, how do you feel? Were you able to bring your attention back to your breath? Did anything surprising come up?

Go deeper On the following pages are optional additions to your meditation. I try to tune into what I need on any given day. If at any point in your day you feel stressed or overwhelmed, try a mini meditation where you focus on the breath. Every time you feel your thoughts spinning, bring your attention back to the breath. The more you are able to do this, the more in control you will feel. Most of our ruminating 137

Our emotional wellbeing

thoughts are just repetitions of what we have thought before. Don’t waste your brain’s bandwidth with these thoughts.

Body scan A body scan is a good way to check in with yourself. You may not be aware that you are carrying tension somewhere in your body. It might be a stiff shoulder or clenched jaw. If it helps, tighten and clench it further before letting go. You can do this body scan in a seated position, when you are standing or when you are lying down. As you move through your body scan, spend a second or two on each part of the body. Feel the ‘aliveness’ of each part of the body. If this sounds a bit weird, then try this. Shut your eyes, if you feel comfortable to do so. Hold out your hand in front of you. Can you feel a tingle of ‘aliveness’? We can tune into this ‘aliveness’ at any time we need to. It can be a brilliant emergency stress relief. It can also help to tap into the essential joy of being alive. Record yourself speaking this sequence if it helps. You are working your way up from your right foot, up the right side of the body, to your head and then down the left side of your body. Feel the energy in each part of the body and then move on. Take your attention to each of these places in turn: –– –– –– –– –– –– –– ––

138

Right sole of the foot, big toe, second toe, third toe, fourth toe, little toe, top of the foot. Right ankle, shin, calf, knee-cap, back of the knee, thigh. Right buttock, hip, lower back, mid-back. Right shoulder-blade, upper arm, elbow, forearm, wrist, back of the hand. Right thumb, forefinger, middle finger, ring finger, little finger, palm, wrist. Right forearm, inside elbow, upper arm, shoulder, shoulder-blade. Back of the neck, back of the head, top of the head, forehead, eyes, cheeks, nose, lips, jaw, chin. Left shoulder-blade, upper arm, elbow, forearm, wrist, back of the hand.

Meditation

–– –– –– –– –– ––

Left thumb, forefinger, middle finger, ring finger, little finger, palm, wrist. Left forearm, inside elbow, upper arm, shoulder, shoulder-blade. Throat, heart, right lung, left lung, diaphragm, abdomen. Left mid-back, lower-back, hip, buttock. Left thigh, back of the knee, knee-cap, calf, shin, ankle. Left top of the foot, little toe, fourth toe, third toe, second toe, big toe, sole of the foot.

Once you have performed the whole body scan, feel the whole of the body. Breathe through the whole body, feeling that energy is entering the lungs and radiating outwards to fill every part of the body. You might imagine this as a warm light. Feel the light travelling to every part of the body.

Tune in Did you manage to stay present? If your mind wandered, did you bring it back to the body when you became aware of this? How did it feel to be able to bring back the attention to the body? If your body could talk, what would it say to you after you have given it this attention?

Go deeper For a longer version of this practice, see the ‘yoga nidra’ on p.47. Like meditation and this body scan, Yoga nidra has been shown to promote a shift of the autonomic nervous system into the parasympathetic response,11 which has a host of health benefits. So far research has shown that yoga nidra can improve cardiovascular health,12 improve blood sugar control,13 improve hormonal health,14 and aid recovery after trauma.15,16

Breathe in the whole of creation This meditation promotes a sense of wonder at the world we live in. This sense of wonder is always available to us, regardless of what is 139

Our emotional wellbeing

going on in our day-to-day lives. It is especially helpful if we are feeling lonely or disconnected. Again, you might record yourself so that you can be guided through the sequence. After a few times, you might just do this in your head. –– –– –– –– –– –– –– ––

Imagine breathing in the whole of creation. Breathe in the air, sea, earth. Breathe in the mountains, plains, rainforests, coral reefs. Breathe in the plants, trees, insects, fish, birds, mammals. Imagine them all in their myriad colours, patterns, shapes. Imagine this creative force entering you with each breath and spreading throughout the body. Feel the energy that connects us with everything on this planet. Feel part of the creative force. Imagine all the people who are meditating with you, right now, around the world. 

Tune in How does it feel to focus on the natural world? Were you surprised by the images that came to mind? Were you affected by the abundance of landscapes and species? Does this make you feel more connected to your environment?

Go deeper Environmental meditations and appreciation of the natural world can help us to make better choices in our lives. We are more likely to reduce our consumption, switch to a renewable energy supplier or reduce our carbon footprint with the choices we make as a consumer. If you want to enhance the richness of your visualisations, follow Instagram accounts which post photos of nature. The Woodland Trust, RSPB, WWF and National Geographic all publish amazing images. We might back up our appreciation with donations or membership of environmental organisations. 140

Meditation

Figure 7.1  Breathe in the whole of creation

We might encourage changes at work to reduce the environmental impact of our organisation. For example, reducing our use of plastic and reducing food waste. This is one of the benefits of meditation: it can support us live a more ethical, thoughtful and connected life.

Feel a sense of wonder for your body This is a variation of the body scan practice, but allows us to go deeper, and visualise the internal landscape. We have privilege as AHPs in that we know how wondrous the human body is. This meditation allows us to tap into this awareness. You don’t have to visit every part of your body every time you do this meditation. You might choose to focus on one part of your body. Approach it as a novice, as if you are seeing all this for the first time. 141

Our emotional wellbeing

–– ––

–– –– –– –– –– –– –– –– ––

Imagine that you are inside your body and can take a look around. Start in your mouth and move up to your nostrils. Take a good look around. See the air spiralling up through your nostrils and entering the throat. Move up to the skull. Imagine that you can see your brain and all the amazing neuronal connections that are firing there. Travel down your throat to your lungs and explore the alveoli and the exchange of oxygen into the red blood cells. Move to your heart and feel the power of your heart beat. Follow the blood all around your body, to your hands and feet and back again to the lungs. Imagine the digestive organs, and the coordination of stomach, liver, gall bladder, intestines. Imagine all the helpful gut bacteria helping you break down your food, and the myriad chemical reactions going on all of the time. Imagine your bones making new blood cells, and the lymph system clearing out all the toxins and waste products. Imagine your nerves transmitting signals between body and brain to keep you safe. Appreciate the wonder that is your human body. No one is orchestrating this; it is all working in harmony without our conscious control. We can let go of our awareness and it will continue.

Tune In How often do you feel appreciation for these parts of your body, or for your body’s functioning? Do you feel more compassion for your body after this meditation? Does this meditation underline your commitment to breathing, sleeping, moving and eating well?

Go deeper If you feel you need a refresher, or if you want to be able to visualise these body systems more easily, check out animations on YouTube. ‘Pebbles Kids Learning’ produce animations for children, but they work for adults too! 142

Meditation

We are all made of stars Everything inside us came from the cosmos and will return to the cosmos.17 The star dust that resides temporarily in us has been recycled through plants and organisms and rocks over millennia, and will continue to recycle through after we have passed. This meditation is grounding, and at the same time energising. It helps us feel that we are connected to the universe, and that the universe has our back. Once we have felt this, it is an awareness that we can draw on whenever we need to. ––

Imagine that you have an invisible line of energy from the base of your spine to the centre of the earth. –– With each inhale you are taking in energy from the core of the earth and it is rising up through your spine. –– With each exhale the energy is moving through your body. –– With each inhale the energy comes up your spine, and with each exhale the energy radiates upwards and outwards. –– Feel the energy like a wondrous vapour cloud moving around your body. –– You control the movement of this energy with your breath. –– Feel the energy rise from the base of your spine, down and out through your hips, legs and feet. –– Feel the energy circulate all around your abdomen, and up into your chest and throat. –– Feel the energy spreading down each arm and into your fingers. –– Feel the energy rise up through your shoulders and neck and into your head. –– Feel the energy rise up to the crown of your head. –– Imagine it as a line of energy shooting out of the top of your head up to the stars. –– Feel the energy come back down from the stars through the crown of your head, down your spine and back down to the core of the earth. – – Feel yourself anchored to the earth with this grounding energy. –– You have always been and will always be connected to this energy.  143

Our emotional wellbeing

Tune in How does this feel in your body? How easy is it for you to visualise or feel this energy? Don’t get too caught up in what the ‘energy’ is. This practice is about finding space and comfort in the body. What we are thinking or visualising in our mind can profoundly influence how we are feeling in our body. You don’t have to believe in prana or chi to get a benefit from this practice.

Go deeper If you feel drawn to this practice, you might want to explore Kundalini yoga and meditation. This tradition focuses on the rising energy of the spine, and associated points, called chakras, along this central channel.

Figure 7.2  We are all made of stars 144

Meditation

Loving kindness meditation We would all like to be positive beings full of love and light for ourselves and the rest of humanity. But we all have days where we are not. This meditation is for those days. Practising loving kindness is as good for us as it is good for those who surround us. Loving kindness is a ripple that spreads outwards. If you offer a warm smile or kind words to a stranger, they are much more likely to do the same with the next person they meet. It is like a positive infection that radiates outwards. This meditation is like a ‘thought version’ of a warm smile or kind words. I find it particularly useful when I am thinking about someone who is going through a hard time. At the time of writing we are in the middle of a pandemic and we cannot physically reach out to those we love and care about. At the same time, everyone we care about is going through a hard time. A few are suffering bereavement, loss of their livelihood or acute anxiety about the future. This meditation is for times like this. In this meditation, you will repeat four phrases. At first you might want to record or read them. Eventually you will memorise them.

Start with yourself. We cannot offer loving kindness to others if we are not loving and kind towards ourselves. –– –– –– ––

May I be filled with loving kindness. May I be safe and protected. May I be healthy and strong. May I live at peace in this world.

Move on to a person who you find it easy to love. This might be a friend, family member or even a pet. It might be someone who is having a hard time at the moment and is in your thoughts a lot. Repeat the phrases, this time addressing them to the person you have chosen. If another person drifts into your mind, you can switch the offering to them. 145

Our emotional wellbeing

–– –– –– ––

May you be filled with loving kindness. May you be safe and protected. May you be healthy and strong. May you live at peace in this world.

Move on to a person who you have a more complicated relationship with. It might be someone who you have disagreed with. It might be someone whose behaviour is causing you pain. It might be a stranger who was rude to you. Repeat the phrases for this person. –– –– –– ––

May you be filled with loving kindness. May you be safe and protected. May you be healthy and strong. May you live at peace in this world.

Tune in How does it feel in your body to wish loving kindness upon yourself and other beings? Did the practice make you feel more compassion towards the complicated person in your life? How might this affect your relationship with them, going forward?

Go deeper The next time you find yourself getting annoyed with someone, note it. Later on offer them this ‘loving kindness meditation’. Still later, you might be able to summon spontaneous feelings of loving kindness, recognising that people who are rude or negative are probably struggling with something. You might also use this meditation to forgive someone in your life who has hurt you. It does not mean that you excuse their behaviour, but that you are able to find the peace within yourself to move on. You don’t ever need to see them again or tell them that you have forgiven them, but you no longer have to carry the burden of resentment towards them. 146

Meditation

Apply this at work ––

––

––

––

––

––

Paramedics, Radiographers and Operating Department Practitioners: meditation can be a very effective way to ground yourself after a stressful or distressing day. We can acknowledge our thoughts and emotions, and allow them to pass through, without feeling overwhelmed by them. Drama Therapists, Music Therapists and Art Therapists: meditation might offer you the time to ground yourself before or after work. If you find yourself worried for a particular person, you might focus on them in the ‘loving kindness meditation’. AHPs working in multi-disciplinary teams: there can be conflict within teams. Meditation can help us to depersonalise situations. It can help us to tap into our wise voice, so that we can come back tomorrow and find compromise. All AHPs: meditation brings a sense of stability and calm. Once we have felt that, we can use it at other times in the day. For example, if we are about to give a diagnosis or a difficult message to a patient. With regular practice, this ‘centredness’ is always available to us. Managers: it can be hard carrying the personal stories of those staff we manage. We care deeply about our colleagues, and do not leave them at work at the end of the day. The ‘loving kindness meditation’ can be a way of honouring our colleagues. When patients die. Meditation can help us connect with something larger than ourselves. We might experience this as God, universal consciousness, the infinite. Meditation can heighten our sense of an ever-present connection.

Notes 1 Lomas T, Ivtzan I, Fu CH. ‘A systematic review of the neurophysiology of mindfulness on EEG oscillations’ Neuroscience and Biobehavioural Reviews 2015 Oct;57:401–410. 2 Anderson JW, Liu C, Kryscio RJ. ‘Blood pressure response to transcendental meditation: A meta-analysis’ American Journal of Hypertension 2008;21:310–316. 147

Our emotional wellbeing 3 Levine GN, Lange R A, Bairey-Merz CN, Davidson RJ, Jamerson K, Mehta PK, Michos ED, Norris K, Ray IB, Saban KL, Shah T, Stein R, Smith SC. ‘Meditation and cardiovascular risk reduction: A scientific statement from the American Heart Association’ Journal of the American Heart Association 2017 Sep 28;6(10):e002218. 4 Schneider R, Nidich S, Kotchen JM, Kotchen T, Grim C, Rainforth M, King C, Salerno J. ‘Effects of stress reduction on clinical events in African Americans with coronary heart disease: A randomized controlled study’ presented at American Heart Association Scientific Sessions 2009, Orlando, FL, November 14–18, 2009. 5 Klatt MD, Buckworth J, Malarkey WB. ‘Effects of low-dose mindfulnessbased stress reduction (MBSR-ld) on working adults’ Health Education and Behaviour 2009 Jun;36(3):601–614. 6 Zeidan F, Johnson SK, Diamond BJ, David Z, Goolkasian P. ‘Mindfulness meditation improves cognition: evidence of brief mental training’ Conscious Cognition 2010 Jun;19(2):597–605. 7 Dimidjian S, Beck A, Felder JN, Boggs JM, Gallop R, Segal ZV. ‘Webbased mindfulness-based cognitive therapy for reducing residual depressive symptoms: An open trial and quasi-experimental comparison to propensity score matched controls’ Behaviour Research and Therapy 2014;63:83–89. 8 Rosenzweig S, Greeson JM, Reibel DK, Green JS, Jasser SA, Beasley D. ‘Mindfulness-based stress reduction for chronic pain conditions: Variation in treatment outcomes and role of home meditation practice’ Journal of Psychosomatic Research 2010 Jan;68(1):29–36. 9 Chiesa A, Serretti A. ‘Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis’ Journal of Alternative and Complementary Medicine 2009 15(5):593–600. 10 Shapiro SL, Astin JA, Bishop SR, Cordova M. ‘Mindfulness-based stress reduction for health care professionals: Results from a randomized trial’ International Journal of Stress Management 2005;12(2):164–176. 11 Markil N, Whitehurst M, Jacobs P, Zoeller RF. ‘Yoga nidra relaxation increases heart rate variability and is unaffected by a prior bout of hatha yoga’ The Journal of Alternative and Complementary Medicine 2012;18(10):953–958. 12 Monika, Singh U, Ghildiyal A, Kala S, Srivastava N. ‘Effect of yoga nidra on physiological variables in patients of menstrual disturbances of reproductive age group’ Indian Journal of Physiology and Pharmacology 2012 Apr-Jun;56(2):161–167. 13 Amita S, Prabhakar S, Manoj I, Harminder S, Pavan T. ‘Effect of yoganidra on blood glucose level in diabetic patients’ Indian Journal of Physiology and Pharmacology 2009 Jan-Mar;53(1):97–101. 14 Monika, Singh U, Ghildiyal A, Kala S, Srivastava N. ‘Effect of yoga nidra on physiological variables in patients of menstrual disturbances of reproductive age group’ Indian Journal of Physiology and Pharmacology 2012 Apr-Jun;56(2):161–167. 148

Meditation 15 Stankovic L. ‘Transforming trauma: A qualitative feasibility study of integrative restoration (iRest) yoga nidra on combat-related post-traumatic stress disorder’ International Journal of Yoga Therapy 2011;(21):23–37. 16 Pence PG, Katz LS, Huffman C, Cojucar G. ‘Delivering integrative restoration-yoga nidra meditation (iRest®) to women with sexual trauma at a Veteran’s Medical Center: A pilot study’ International Journal of Yoga Therapy 2014;24:53–62. 17 Shrijver K. and Shrijver I. Living with the Stars: How the Human Body is Connected to the Life Cycles of the Earth, the Planets, and the Stars Oxford University Press 2015.

149

SECTION 3 Bringing it into the workplace The first two sections of this book have focused on our needs. This chapter adds in the demands of work. We look at how to reconcile those two competing demands. When we are not faced with the pressures of work, we can take time out for ourselves. We might experience this when we have a period of annual leave. We sleep better, breathe better, move better, eat better. We take a step back and experience gratitude and wonder. We find flow in our hobbies and interests. We feel connected with the natural world. And then we go back to work. We spend about a third of our lives at work. As Allied Health Professionals, we are at an advantage because our work has intrinsic reward. We find our work stimulating, invigorating and meaningful. Work provides us with a clear sense of purpose. Ask any AHP to say why their discipline is important, and they will be able to give a clear answer. Because it tends to be a vocation rather than just a job, we invest a lot of time and effort into work. When things are going well and we feel energised by work, then this enhances our wellbeing. If things are not going so well, if the team ethos is of overwork, if your ideas for innovation are not heard or if there is conflict at work, then we can end up feeling drained by work. This section invites us to examine what is going well at work, and how we might be empowered to make changes. Some of these changes start with us. Other changes might spread to our colleagues and affect the work culture of our team. Other changes are systemic. They require DOI: 10.4324/9781003165125-10

Bringing it into the workplace

us to be courageous and start a dialogue with our colleagues, our managers, our organisation. This is where self-actualisation happens. We feel empowered to use what we have learnt and put it to use with our communities. Work is our community. We can make a big difference, to ourselves, our colleagues and the people we serve.

152

8

Antidotes to stress

If we don’t manage our stress, we spread it. This chapter is all about recognising our stress and stopping it before it spreads. Stress has always been with us and will always be with us. For most of our evolutionary history, we had to manage very real threats to our lives. It might have been that we had to deal with an attack from an animal predator or from another tribe. Cold or stormy weather might have damaged our shelter. We might have felt the threat of starvation, and had to respond to this by hunting or gathering or growing our own food. Our stress response would have been helpful in these situations, because it would have given us a burst of adrenaline or sustained cortisol to keep us focused on the task in hand. Our stress response still helps us in this way. If we are faced with a real danger, like a vehicle coming towards us at speed or a friend choking, we can spring into action and respond. We need some stress in our lives. Our bodies work best when they are able to modulate between sympathetic and parasympathetic responses. Ideally, we want a short burst of stress, followed by longer periods of calm parasympathetic activity. Examples of useful short bursts of stress are: going for run, giving a diagnosis to a patient or presenting a paper at a conference. The adrenaline in these stressful situations will help us think quickly and perform our best. In between these stressful events, we want prolonged periods of calm, focused activity, where we can breathe well and think clearly. Adrenaline is the short-acting stress hormone, and cortisol is the continuing stress hormone. We have a predictable ‘cortisol curve’ each day. Levels are highest in the morning, helping us to wake up and DOI: 10.4324/9781003165125-11

153

Bringing it into the workplace

get going. They gradually tail off during the day. By the evening, our cortisol levels are low enough to allow us to relax, and become sleepy at bedtime. Our brains do not differentiate between a real physical threat, and imagined ‘thought’ threats. Examples of ‘thought’ stresses are: ––

Finding out that a clinic has been over-booked and you have too many patients to see in the time available.

––

Opening your email inbox in the morning and being asked to do a complex task with unclear instructions.

––

Attending a meeting where there is conflict between two professional groups, with each blaming the other group for problems in the system.

––

Being conflicted about whether you should stay late at work to catch up on admin, or go home to your family.

Many of us live with raised levels of cortisol as a response to these ‘thought’ stresses throughout our day. Stress is here to stay. We can only learn how to manage it. The first step is to recognise when we are stressed. Most of us are permanently so stressed that we don’t even recognise it. Have you ever taken a holiday and felt that for the first time in months you have actually been able to leave work behind? You have become acclimatised to a constant low-level stress, so that you are no longer able to identify the triggers. You will get better at identifying your stress triggers, and you will get better at employing strategies to deal with them. On the following pages, you will find a selection of strategies to try when you find yourself in the moment of stress.

Set an intention for your day Our mental attitude can shape how a whole day unfolds. If there is a meeting, clinic or event that we are dreading, it can affect how we behave and how we feel well ahead of the actual event. We might be more irritable or more anxious all week. This is a waste of our energy. An alternative approach is to set an intention at the start of each day. This can prime us to feel more positive. This is likely to affect the 154

Antidotes to stress

interactions we have with our family before work, and with our colleagues and patients when we get to work. Your intention describes an attitude towards life. It is a quality that you want to cultivate. This practice only takes a minute or two of your time. You can do it before you get out of bed, before you leave the house, or before you walk into your workplace. It is best to set your intention early in the day, before you begin your work. You can change the adjectives so that they are meaningful for you.

–– –– –– ––

Feel your whole body. Say to yourself ‘Joyful, energetic body’. How do those words feel in your body? Focus on the centre of your chest. Say to yourself ‘Open, compassionate heart’. How does this feel? Focus on the space between your eyes. Say to yourself ‘Alert, responsive mind’. How does this feel? And finally, spread your awareness outwards from your body to the space around you. Say to yourself ‘Lightness of being’. How does this feel? 

We can’t control how our day unfolds. We can’t anticipate the curveballs that may be thrown at us. We can control how we respond. This practice brings us back to our calm, consistent presence. It reminds us of our best self. It focuses our attention on what is important. By setting an intention, we make it less likely that we will be destabilised during the day. We are primed for joy, energy, compassion. We remind ourselves of our higher purpose in life, beyond transient stresses and strains of this particular day. We might have some sort of reminder to come back to our intention throughout the day. We might write it down or type it into our calendar. Our overall intention might be repeated internally before an important meeting, clinic or event. When we feel stressed, we can repeat our intention to ourselves. We might have a consistent intention for a week or month and then review it. If an intention is no longer resonating, it is time to set a new intention. 155

Bringing it into the workplace

Figure 8.1  Set an intention for your day

Tune in Did you choose the right intention? How did it feel in your body? Did it affect your state of mind? How did it feel to repeat it during the day?

Go deeper You might want to journal about your intention and its effects. You might have different intentions for different sorts of days, for example a week-day intention and a weekend intention. If you change roles or take on new responsibilities, you may want to change your intention to help you manage uncertainty and new learning. 156

Antidotes to stress

Shift your perspective This exercise gives you a sense of perspective. It is useful if you have got caught up in the detail of a complex task, and can no longer see the wood for the trees. We often get into this state when we are working alone on a project, but it can also happen when we are working in a group, trying to produce an end product. It might be a complex report, a process or policy, or trying to work out a solution to an embedded problem. Have you had the experience of struggling to find a word that you know is on the tip of your tongue? As soon as you start thinking of something else, the word just comes to you, effortlessly. Or when you have been grappling with a difficult problem all day. You are driving home, or you are at home chopping vegetables, and suddenly an idea pops into your head, which is the perfect solution. If you have got stuck on a task, it might be more productive to step away for a while. Can you get a change of scenery by going for a walk? If you are working in a small group, you might all get up and go for a walk. You might move to different positions when you get back. You will return to the task feeling refreshed, and having rebooted your brain. You will be surprised by how much more creative and innovative you can be for having had this shift in perspective. If you feel yourself becoming overwhelmed by the complexity, take a step back. –– –– –– –– –– –– ––

If you can, go to the window. First, focus your gaze on your hand. Look at the lines on your skin, wrinkles, veins, tendons, knuckles, fingernails. Focus for a few breaths. Shift your gaze onto something that is far away. Focus on distant buildings or distant trees: as far as your eyes can see. Focus for a few breaths. Where are you at now?

157

Bringing it into the workplace

Tune in How do you feel now? Has it helped you to step away for a few rounds of breath? Was it helpful to shift your focus from near to far? Do you feel more able to approach the task in hand?

Go deeper You might also use a breathing practice to shift your perspective inwards and then outwards. First focus on the journey of the breath in through the nostrils, deep into the lungs and then out again. After a few rounds of focusing on the journey of the breath in and out of the lungs, imagine the breath travelling throughout your body, bringing energy to every part of your body. You might then imagine this energy spreading outwards from you, radiating into the space around you and then as far out as you can imagine.

Small treats In her novel ‘The Sea, The Sea’, Iris Murdoch wrote ‘One of the secrets if a happy life is continuous small treats, and if some of these can be inexpensive and quickly procured so much the better’. We can offset the stresses of the day by scheduling short periods of deliberate enjoyment. This way we can cycle between sympathetic and parasympathetic activation. The periods of stress or, to use a more positive term, engagement, are balanced out, by periods of conscious indulgence, enjoyment and relaxation. Small treats remind us that we have agency. We can help influence how our day unfolds. There is a lot that might be out of our control, but there is a lot that is within our control. These small treats can be really simple. They often involve activities or tasks that we are already doing. We can make them more pleasurable by bringing our attention to them. Experience this moment with all your senses. For example, brushing our teeth can be made more pleasurable by walking to the window and looking out. Chopping vegetables for 158

Antidotes to stress

Figure 8.2  Small treats

dinner can be made more pleasurable by noticing the patterns when we slice them in half. Even emptying the dishwasher can be made more pleasurable by feeling the weight of the cups in our hands, and thinking about how they serve us every day. What works for you will be personal, and you can refine this list, but here a few ideas: ––

––

Looking at natural shapes. It can be any tree or plant. Look at the patterning of roots and branches; the way leaves spread out to share the light; the veins in leaves; the intricate structure of flowers. Looking at the sky. Look for cloud formations; the way the sun might be colouring the clouds; the different colours in the sky at sunrise and sunset or on a cloudy day. 159

Bringing it into the workplace

––

––

––

––

–– ––

––

––

––

––

––

––

160

Noticing sunlight. Notice how it changes everything: how it transforms colours; how it provides definition; the shadows and highlights; how magical anything can look if it is backlit. Sitting or standing in a patch of sunlight. Feel the warmth on your skin. This is especially enjoyable in the colder months. Close your eyes and notice the vibrant colours that you see. Watching birds. Notice their darting movements; their tiny beaks, eyes, feathers; the way they interact with one another; their flight. Cutting a flower or sprig of something growing in the garden to appreciate close up. It might even have a scent. Once you start looking, you find that there is something in flower year-round. Listening to natural sounds. Tune into the sound of birds; the rustling of leaves in the breeze; the sound of rain. Cradling a warm mug of tea. Experiment with different sorts of tea. Ginger, turmeric, lemon balm and chamomile are calming. Brew your tea in a teapot for an added sense of ritual. A lovingly made coffee. If you have the equipment to grind your beans, brew your coffee and steam your milk, then make this a mindful moment. Scooping a spoon into the bottom of the peanut butter jar and eating it neat. Make sure no one else is around. For enthusiasts, there is also almond butter, cashew butter and chocolate-andhazelnut butter. Enjoying food and engaging in mindful eating (see p.74). This can be during every mealtime, and can definitely include an indulgent treat. Make an occasion of it and savour every mouthful. Noticing the incredible patterns and colours that surround us. For instance, when chopping fruit or veg, notice that each slice is a work of art. Think about the patterns in cauliflower, onion, a pepper, an orange, an apple. Inhaling a favourite scent. Try essential oils like patchouli, lavender, rose or rosemary. You can keep them in your bag for when you need a dab. Enlivening your drinking water with a slice of lemon, a sprig of mint or a slice of root ginger. This can be surprisingly refreshing.

Antidotes to stress

––

––

–– ––

––

––

––

––

––

–– ––

Laying your hands on your body wherever you feel stress. This might be your tummy, chest or head. This reminds us of the calming touch of our caregiver. Gently pressing both hands down on the top of the head whilst resisting the pressure by gently pushing upwards with the head and spine is calming. Placing a weighted blanket or a bean bag heated pad on your neck, shoulders or lap. This makes us feel held and calm. Spending a few moments with your breath. Breathe through your nose. Extend your exhale. You might notice the gap between inhale and exhale. This brings a sense of space and clarity. Grounding your feet on the floor, or your sitting bones into the chair. This makes us feel stable and safe. There will be an additional benefit: as we ground down our feet or sitting bones, we simultaneously raise our torso and head so that there is more space in our spine and lungs. Having a good stretch. Focus completely on the sensation in your body. Try stretching upwards, outwards, forwards, backwards, to the sides or in a twisting motion. Experiment with pressing down different parts of your foot and notice how it affects your hips or shoulders. Bouncing lightly on your feet with knees bent, as if you were trotting on a pony. Shake out your arms. Move in a way that feels natural to you. Move your pelvis by tilting it or rotating it. Jiggle or sway to match your mood. Swaying your body as though you are seaweed in a rock pool. Sway to your own pace and rhythm. You can make any shape you like. Shake it out. Put on your restorative playlist (see p.243). Shake out your arms and legs, feet and hands. This is very effective for letting go of stress, and making yourself smile. Spending a moment to appreciate your body. We are here now. We have been allowed to exist. This is incredible. Saying these intentions as you focus on your body, heart and mind: ‘Joyful, energetic body. Open, compassionate heart. Alert, responsive mind. Lightness of being’. 161

Bringing it into the workplace

––

––

––

A hug from a family member or a pet. Relax into this oxytocin moment and make the most of it. This is a gift you are giving to one another. Fluffy dogs and cats are perfect for resting a tired head. Having a photo or a memento which reminds you of someone you cannot hug at the moment. Sit with their presence and feel what they have brought to your life. Enjoying a song of the day, a poem of the day, photograph of the day or artwork of the day. We can feel appreciation for the insight of others. 

Tune in Are there other small treats that you can think of which work for you? What colours, patterns, shapes, sounds, textures, shapes, scents, stretches, movements and sensations are calming to you? How can you make them into a small treat? Can you make a mindful moment out of something that you do every day? Be as creative or crazy as you like.

Go deeper Spread the joy by talking about these things. Other people will be intrigued and inspired. If one or two people think you’re a little strange, does it matter?

Stop blaming When we are stressed, it is easy to slip into blaming others. We don’t like the situation we find ourselves in, and we feel out of control. We want an easy solution and so we blame someone else. We might feel that we don’t have time to carry out a task, or that we don’t have time to do it well. We might feel that the task is not a priority. We might feel that it does not play to our strengths. It might highlight our weaknesses, as we see them. It might remind us of our 162

Antidotes to stress

lack of some quality we feel is important in this situation. This might be organisation skills, focus, the ability to multi-task, to work in a shared office space, to work in less-than-ideal conditions, to work at speed with many patients. When we are this uncomfortable, we tend to project this discomfort outwards. We don’t want to feel it, so we blame it on someone else. Common people to blame include: ––

Admin: they didn’t send a letter or a report at the right time; they booked the wrong patient.

––

Management: they don’t understand your day-to-day work; they are too busy to know what is happening on the ground.

––

The executive team: they are obsessed with performance and meeting targets. These things have no relevance to you.

––

Our colleagues: they are disorganised, untidy, loud. They have a different understanding of the caseload. They interpret protocols differently.

––

Our patients: they don’t want to help themselves. They don’t listen. They don’t follow our advice. They don’t turn up.

––

The IT team: they don’t pick up the phone. You can’t report your problem if you have no Wi-Fi connection. They don’t realise how this has an impact on you.

When we put all the blame on someone else, we know that we are not being fair. It generates more negative feelings, which we might try to suppress. We add these feelings to the thoughts about our own inadequacy. We have generated more stress and resistance to the present moment. When you become aware that you are blaming someone for your current stress, congratulate yourself. You have just stopped the flow of a negative spiral. You can take this one stage further by remembering any of the following things about the person or team you are blaming: –– –– ––

They are human, just like me. They make mistakes, just like me. They have their own demands and priorities, just like me. 163

Bringing it into the workplace

–– ––

They have strengths and weaknesses, just like me. They will learn from mistakes if they are given compassionate feedback, just like me.

If we don’t stop the negative spiral, we are likely to behave badly. We might be sarcastic, tetchy or uncommunicative. We might transmit our annoyance through our non-verbal communication like facial expression, body language, lack of eye-contact or tone of voice. This will be loud and clear for others, and will affect their day. We will also be aware we have done this, and this will make us feel bad. If we bring our awareness to what we are doing, we will halt this negative spiral. We will wait until we are calm, and then we will give compassionate feedback, which takes into account the possible pressures and priorities of the other person. We are all human. We are all doing our best with our current resources. Compassion makes us feel good. It is an antidote to stress. Stress is the mismatch between perceived demands and perceived abilities to meet that demand. Compassion is the recognition that we cannot meet all demands all of the time, and that this is OK.

Tune in The next time you find yourself blaming someone for something that has stressed you out, tune in. Is this fair? Even if they do bear responsibility, do you also bear some responsibility? How does this feel? You are doing your best. Can you offer yourself compassion? Can you offer the other person compassion?

Go deeper We can relate this to any area of our lives. If we are quick to judge, we don’t allow the possibility of learning. We can never have a 360-degree perspective of a situation. There will be all sorts of nuances and complications from the other person’s perspective. We can only build our learning and our resources by opening ourselves to the possibility that we do not have all the answers. There is freedom in this. 164

Antidotes to stress

We are all allowed to make mistakes Understandably, we worry that our mistakes will diminish us. It might result in other people thinking that we are ‘less than’. We might worry that we will be seen as less qualified, less knowledgeable, less organised, less aware, less able. We might worry that we will not recover from a temporary blip in our self-confidence. If we put this to the test, by owning a mistake, we can find that this blip to our self-confidence is very temporary indeed. It doesn’t diminish us at all. Try this the next time someone says something to you which feels like a criticism. You will get a strong urge to defend yourself. You might get the urge to mount a counter-attack with a criticism of them. Sit with this feeling for a moment. You will note that not reacting feels OK. In fact, you get a feeling of calmness when you don’t react. You get space to think. ––

––

––

–– ––

Imagine that someone at work complains that no one ever empties the dishwasher but them. You might want to immediately point out the last time that you did it, or that you do other tasks to help clear up. Instead, allow what they have said. Process what they have said. Don’t offer any defence. Show them that you have listened by not instantly reacting. Acknowledge what they have said, and reflect upon how this might affect them. You might offer appreciation for what this person does. Does this response diminish you? What is the impact? Does your response damage your reputation in the eyes of the other person? How might they see you differently? What is the impact on the other person?

The teeny tiny dent to our ego is soon mended. We realise that we are not diminished by acknowledging our own mistakes. This ends up being a positive thing. It helps us to see ourselves as fallible. Other people see us recognising our own fallibility, and are likely to have more respect for us, and more trust in our judgement. 165

Bringing it into the workplace

We do not have to be perfect, to ourselves or to others. This means that other people are more comfortable in taking responsibility for their mistakes, because they do not fear harsh judgement. A lot of conflict is generated when we pretend that we don’t make mistakes. We can avoid this altogether if we sit with the situation and reflect on our part. We can allow for the possibility that we may have made a mistake. We don’t have to take full responsibility if we feel that other people have also made mistakes. We just have to take responsibility for our part. We don’t have to confess to things we didn’t do. We don’t have to gush with apology or self-reproach. Often, just a simple acknowledgement of what the person has said and how they might feel is enough. Allow yourself some time and space to reflect. You don’t have to offer any solutions immediately. You can indicate that you will think about it more. This shows that it is important to you. You are being responsive, and not reactive. This is an optimal state when working with others.

Tune in Is it easier or harder to take responsibility for mistakes with your partner, children or other relatives? How about your friends? And how about colleagues, your manager, admin or so on? What are you afraid of? What would be the impact if you took responsibility for your part? Would it diminish you? How would the other person view you? How would you view yourself?

Go deeper You might choose to write about a mistake you have made. Write about how you realised you had made a mistake. Maybe someone else brought it to your attention? What was your immediate reaction and response? What thoughts and feelings came up? Were you able to suppress the urge to deny the mistake or to defend yourself? Did you take time to process the information? Were you able to admit your responsibility? To yourself or to others? What was the effect? What did you learn? What did you learn about yourself? What did others learn? 166

9

Our work environment

The Dalai Lama has said ‘When you think everything is someone else’s fault, you will suffer a lot. When you realise that everything springs only from yourself, you will learn both peace and joy’. We have agency; we can influence how things work around here. We might work in shared clinic rooms in hospitals or health centres. We might work in patients’ homes or residential homes. We might visit schools and colleges. We might work some of our time in openplan offices with hot-desking, or we might work some of our time at home. Wherever we work, there is legislation to ensure our health and safety at work. Employment law requires that reasonable adjustments are made for those with disabilities. If you work for a large organisation like an NHS Trust or Local Authority, there will be an occupational health service that you can consult if you experience pain or discomfort at work. They will make recommendations such as changing your seating and workstation setup, and trialling equipment like alternative mice or keyboards. Many NHS Trusts now provide a fast-track physiotherapy service, meaning that you can be seen quickly before a minor niggle becomes a long-term condition. It is important that we take responsibility for our own health and wellbeing at work, and report any issues we may be having. If you feel that your workplace can be improved to support the team’s health and wellbeing, then take this to your manager. Employees are an organisation’s most valuable asset. If the workplace is contributing to poor health and wellbeing, your employer has a strong incentive to make changes. DOI: 10.4324/9781003165125-12

167

Bringing it into the workplace

In this chapter we will look at how we might set up our workstation to avoid musculoskeletal problems. We will consider how to build in movement breaks for better physical and mental health. There is a ten-minute yoga routine to do at your desk. We look at how we change the food environment at work in order to support healthy food choices. Many more health professionals started working from home more in 2020 due to the Covid pandemic. All of the same considerations apply to home working. There are also some extra considerations, including how we ensure that we leave work on time and create healthy boundaries between work and home.

A workstation that works for you There are basic guidelines for creating a good workstation when we are using computer equipment. –– –– ––

–– –– ––

–– ––

––

168

A desk that is stable and clear of clutter, with space for equipment or documents. A desk which allows comfortable leg space beneath it, or can be height adjusted to allow you to stand and work safely. A computer screen that is at the right height so that the top of the screen is level with your eyes. Adjustable stands may be used. A screen that can swivel or tilt so that there is not reflected glare from lighting or windows. A screen where the brightness and contrast can be adjusted, so that the image is clear. A keyboard that is parallel to the edge of the desk, with space for the wrists to be supported and arms to rest on the desk between typing tasks. A mouse that also allows the wrist to rest on the desk. A headset might be provided if you are required to carry out virtual appointments or meetings. This ensures privacy, and prevents voice-strain from talking too loudly. A chair that is stable and can be adjusted for height so that your feet rest comfortably on the floor.

Our work environment

––

–– –– –– –– –– ––

A chair that has a back rest that can be adjusted (unless you are more comfortable with alternative seating, like an ergonomic chair or a wobble stool, or if you have a standing desk). Cables and electronic equipment have been tested for electrical safety. Cables are stowed neatly and there are not any slip-or-trip hazards. The space is adequately lit, ideally with lighting that is close to natural lighting. The space is adequately ventilated, with a comfortable temperature. The space has appropriate noise levels to allow normal conversation. The space allows for you to get up and move around regularly for 5–10 minutes per hour.

The most important of all of these considerations is to take regular movement breaks. The worst thing we can do when we are working at a desk is to sit without moving. This is a risk for cardiovascular and metabolic disease1 and depression, 2 as well as musculoskeletal problems.3 Standing is better than sitting,4 and sitting but moving position regularly is better than sitting still.5 This is why standing desks, wobble stools or even a chair with castors are preferable to static seating. If in doubt, wiggle. Some office environments might allow for additional measures that work for you. If you have your own workstation, or if you work from home, you might personalise the area with items you find calming, such as a photo or a plant. You don’t want too much clutter, though, as this could be distracting. If you work in a very noisy office environment, you might like to wear headphones with recordings of white noise or natural sounds.

Tune in Try a number of different workstation solutions, and note how you feel after working in this way. How much does this solution allow you to move? Do you feel any discomfort or pain? Are you taking regular movement breaks? Are you varying your movement? 169

Bringing it into the workplace

Go deeper Talk to your team about how you all might move more. You might have standing or walking meetings, if there are only two or three people. Supervision lends itself to a walking meeting, as walking can help ideas to flow. Movement is contagious: if you get up and stretch, it will remind your colleagues to get up and stretch. Announce when you are going for a walk. Create a culture where movement is valued.

Movement throughout the day Research into the places in the world where people live the longest, the so called ‘blue zones’ of Okinawa, Nicoya, Icaria, Sardinia and Loma Linda,6 shows that in all of these communities, movement is built into their day. These people are not training for marathons, lifting weights or doing boot-camp. Their environment is set up so that every day they have to move in a variety of different ways. They are digging in the garden. They are crouching down and stretching to pick fruit and vegetables. They are pushing wheelbarrows and carrying buckets. They knead bread. They sweep the floor. They perform their daily chores without handy gadgets. We might not live in a ‘blue zone’, but we can still incorporate some of these principles. A few ideas for your home and working environment are: –– –– –– –– –– –– –– –– 170

Cycle or walk part of the way to work if you can. Park furthest away from the entrance to your clinic base. Take the stairs, not the lift. Set a reminder every hour or half-hour to get up and get up and move around. Sit on a wobble stool or a gym ball for some of your day. Have a standing desk, and regularly bend, stretch, stand on one leg, stand on tip-toes. Stand up and move around when you are on the phone. March or jog on the spot when you are waiting for the kettle to boil.

Our work environment

–– ––

––

––

–– –– ––

Volunteer to walk to the shop for lunch. Between seeing patients in a clinic, carry out one minute of high-intensity activity, e.g. sprinting on the spot, star-jumps, lunges, squats or push-ups against a wall. Get up and greet patients in the waiting room, and walk through to your treatment room with them. Do the same at the end of the session. Keep a collection of fitness toys near your desk. This might be a resistance band, weighted ankle or wrist cuffs, or a massage roller to push around with your feet. Bounce on your feet and shake out your arms and legs if you have a minute to spare. Sway from side to side, or circle your hips. Experiment with walking meetings or walking supervision sessions. Before dinner each night, dance to one song from your music collection.

You only need to increase your activity a little bit to make a difference for your cardiovascular health. If you want to be especially efficient, try a minute of high-intensity exercise like star-jumps or sprinting on the spot, mixed with less intense movement for ten minutes. Just three of these sessions per week have been shown to be as effective as 150 minutes of moderate exercise per week.7

Tune in How does it feel at the end of the day if you have walked a little further than usual? How does it feel if you find an opportunity for five minutes of movement? Did it have an effect on your brain as well as your body?

Go deeper You might have a movement buddy at work to help keep you on track. You could set goals together and be accountable to each other. Make your goal realistic and build in some wiggle room for days when things go wrong. 171

Bringing it into the workplace

Fitness apps or trackers can be useful in monitoring your progress. Some devices vibrate at the end of each hour to prompt you to take a movement break.

Desk yoga The sequence below can be done in two, five or ten minutes, depending on how long you explore each posture. These movements will help to keep your spine flexible, stretch your back muscles and bring fresh blood supply to your vital organs. You have connective tissue, called fascia, surrounding all of your organs, muscles and muscle groups. The fascia weaves in and out around organs, muscles and joints, keeping them in place. The fascia is a whole organ. It wraps the whole body, like cling film. It is this sense of connection that yoga postures tap into. Releasing the fascia in the shoulder might bring relief to the fascia in the hip, knee or ankle. The more we tune into this, the better we get at stretching for our body’s needs. Yoga movements work deeply inside your body: they support digestion,8 hormonal health and the immune system.9

Figure 9.1  Seated cat and cow 172

Our work environment

Breathe through your nose if possible. This will extend the breath, and you will be able to feel more space in your body in each movement. 1. Seated cat and cow This will wake up your spine and move all the big muscles in your back.  Sit or stand up straight. Imagine someone gently pushing between your shoulder-blades to bring your chest forward of your shoulders. Feel a sense of space in your chest and lungs. You can stretch your arms out to the side to broaden the chest. As you get used to this movement pattern, do this whole movement on an inhalation. On an exhalation, curl your tail-bone under you, as if you are a dog curling its tail between its legs. Your tummy will move towards your spine. Your mid-back will push backwards. You will hunch your shoulders forward and tuck your chin into your chest.

Figure 9.2  Seated side stretch 173

Bringing it into the workplace

Do this whole movement on an exhalation. Make it slow. Savour the movement and the breath. Pause between breaths. Let the breath initiate the movement. Inhalation: chest forward; exhalation: tail-bone curls under. 2. Seated side stretch This stretch will wake up the sides of the body, and allow you to take breath deep into your lungs.  Sit up straight, or stand up. Raise the right arm over your head. Your arm is straight. Spread the fingers. Feel the energy all down the arm as you firm up your tummy. Tip your arm to the left. Breathe deeply. You can go as far as feels right for you. Keep your hip firmly planted so that it doesn’t move. This will create space at the side

Figure 9.3  Seated twist 174

Our work environment

of your waist. You will feel a stretch down the whole of your right side-body, from hip to hand. Breathe in and out of your right lung. Repeat on the other side. 3. Seated twist Twisting the body will wake up nerves and muscles along your spine. The movement will squeeze then release the internal organs, bringing a fresh supply of blood to them. Twists are energising and refreshing.  Sit up straight, or stand up. Raise both hands over your head, with straight arms. Take the right hand over to the left hip, and the left arm back behind you, as if you are trying to reach for a wall behind you. You will feel a stretch across the left shoulder and chest. As you breathe, you will also feel a stretch across your tummy and hips. Breathe into these spaces. As you breath in, lengthen the spine upwards, and as you breath out, twist a little more. Repeat on the other side.

Figure 9.4  Push away tension 175

Bringing it into the workplace

4. Push away tension This is really useful for easing any sort of back or neck tension. It can also help in easing a headache.  Stand near a wall, or sit on a chair near a desk. Reach your hands out to the wall or desk. Push away the desk or wall. Experiment with pushing from your index finger and thumb, or from the little finger outside-edge of your hand. Imagine unscrewing a jam jar with your hands. This will activate the muscles of the wrist, forearm, upper arm and into the shoulders and back. Experiment with the pelvic tilt movement described above, where you alternately curl your tailbone under, and then push your chest forward. Breathe into the tight spots. Bend or straighten each arm. Wiggle your hips. Customise these movements. Move like you.

Tune in In each posture, breathe slowly and deeply. Imagine where the breath is going. You might feel that this posture has opened up one lung more than the other. Imagine the breath spreading through the body. How does opening out the shoulder affect the hip? How does breathing into the lower-back affect the abdomen? Get to know your tight spots and breath into them. Wiggle your pelvis a lot. Nod or shake your head, and turn it side to side. Move instinctively. You will get to know what works for you. Customise these movements, and move like you.

Go deeper Yoga is a ‘slow burn’ activity. It takes time. But the more we tune in, the more we tune in. Our body and breath are a constant source of energy, space and wonder. You might want to find a local yoga class, or use a yoga app. Find a teacher who allows you to move like you, and who respects where you are at. I highly recommend the ‘Yoga Anytime’ app, as it has teachers who use sensitive language and empower their students to find the yoga movements that work for them. 176

Our work environment

Support healthy food choices What do we buy for the team when we want to say thank you? What do service-users buy? Typically it is chocolate, sweets, biscuits or cakes. We can’t make a cup of tea at work without being tempted by them. It is important to remember that if we are tempted, it is not our fault. We are not greedy. It is not that we have no self-control. We are hard-wired to find these foods almost impossible to resist, because we have evolved over thousands of years in an environment of limited food. So how do we adapt to cope with this food environment? Everyone is in the same situation, so it may be worth raising it as a staff group at work and maybe agree some shared strategies. These might include: –– ––

––

––

Put the unhealthy snacks away in a cupboard so that we don’t see them every time we make a cup of tea. Have healthier snacks on display, like fresh or dried fruit, popcorn or packs of nuts and seeds (providing no one has a nut allergy). If you are going to have a sweet treat, then make an occasion of it. Have a set time when the team will get together. If someone has brought in a home-baked cake, you know that it has been made with love and care. Savour every mouthful. Keep a tempting range of herbal teas. These might satisfy your need for a flavour burst. The rainbow colours of selection boxes of tea-bags can give you a sensory lift, just like a selection of sweets would.

Tune in Because we get a dopamine hit from eating sugary fatty foods, we might reach for crisps, biscuits or chocolates when our other needs are not being met. 177

Bringing it into the workplace

Might you be thirsty? Might you need to move around to wake yourself up? Are you upset? What else could you do to meet your basic needs? What could you do to soothe yourself? If you are used to eating lots of snacks between meals, it will take a couple of weeks to get used to not snacking. Make sure your meals are nourishing and satisfying. Fibre-filled wholegrains10 and pulses11 and healthy fats12 will keep you feeling full for longer.

Go deeper We need healthy fats to balance our blood sugar13 and our hormones.14 Our hormones help regulate our appetite and help our body to metabolise vitamins, including vitamin D. They are important for our immune system and mood. Nuts, seeds and olive oil are excellent sources of healthy fats. Hummus or nut butters on crackers, or as dips for vegetables, or whole nuts and seeds are really good snack choices. Try roasting nuts and seeds for eight minutes in the oven with aromatic herbs or spices and a sprinkle of salt or tamari. Rosemary, thyme or cumin seeds all work well.

Leave work on time Think about when you were at school. Did school ever over-run? Did you ever find yourself, as a schoolchild, unable to tear yourself away from your school desk, or unable to prioritise going home to your family? What cues helped you decided when it was time to leave? The ‘ending cues’ might have included: ––

Some sort of bell or alarm to remind you of the time.

––

The people around you responding to the time by packing up their bags and putting on their coats.

––

The teacher understanding that it is time to wrap up, and allowing you to leave.

––

A school timetable that defines the start and end of each lesson and the school day.

––

An awareness that other people need to use the room, for example the school cleaner. 178

Our work environment

––

The fear of social disapproval if you do not leave on time.

––

A parent or carer waiting at the school gate.

Leaving work on time is important because: ––

In order to give our best, we need time to rest. We can only be energised by work if we have a long enough period of rest.

––

We need to be honest with ourselves and others about what can be achieved in the time available.

––

We will be setting unrealistic expectations of ourselves and others if we work longer hours than we are paid for.

––

We make best use of the time if we know time is limited. We work efficiently and keep to task, rather than allowing ourselves to be distracted.

––

We show that we value the time of others. We are not the only person to be impacted if we over-run. Other people have commitments, and they rely on us to keep to time.

––

Not many things are so urgent they cannot wait the 12 hours until we are back in work. If we work shifts, there should be a structure for handing over.

––

We need to recognise our fallibility. If we over-work, we are more likely to make mistakes. If we are tired, we are less likely to realise we have made a mistake.

––

In order to thrive and flourish, we need balance in our lives. We need time for self-care if we are going to lead long and fulfilling careers.

––

There is an impact on others. They may feel pressure to do the same.

Can we create an ‘ending cue’ to help us leave work on time? Can we enlist the support of others to make sure that we take notice of the ending cues? Ending cues might include: ––

Start and ending times at work, agreed with our manager and known by our colleagues.

179

Bringing it into the workplace

–– –– –– –– ––

––

The use of a calendar which defines the length of appointments in our day. The use of a rota or timetable for the sharing of rooms and resources. Some sort of timer or clock so that we know when we are at risk of over-running. Some phrases we can use to indicate to patients that their session is coming to an end. A backup cue from our colleagues if the initial ending cues have not worked, for example them appearing at the door to remind us. Shared understanding within our team that it is a good thing to leave on time.

We might find that no one is asking us to stay at work beyond our official ending time. The person keeping us at work is ourselves. ––

What is the impact if we leave on time?

––

What is the impact if we stay at work?

––

What will others think of us if we leave on time?

––

What will others think of us if we stay at work?

––

Do we need to address a problem in our workload?

––

Do we need to raise a concern about the team workload?

––

Do we need to talk about our team culture?

––

If we are saying yes to this, what are we saying no to?

––

Do we have an unmet need?

These questions should be asked compassionately. If we are consistently working too late, there is a perfectly reasonable explanation. We are working because there is a problem somewhere. We may be part of the problem, and other people may be part of the problem. There is an opportunity here to explore the problem. Awareness is the primary mechanism of change.

180

Our work environment

If you work from home, you will need to be even more conscious of start and finish times. You will need some very robust ending cues. For instance: ––

––

–– ––

––

––

Adjust the screen-time settings on your devices and laptop so that notifications are turned off, and you cannot access particular applications outside of work time. At the end of the day, put your work devices away so that you can’t see them. You could think of it as tucking up your laptop for bed, so that it gets enough rest in order to be replenished the following day. Have some sort of alarm so that you keep track of time during the day, including lunchbreaks and movement breaks. Your calendar should reflect your working hours. You might need to carry out a week’s audit of how you spend your time to see if you are keeping to defined hours. Keep to time if you have virtual appointments. If nothing else, do this for your patients and their carers, because their time is also precious. Have some sort of ritual to mark the end of the working day. It could be a proper cup of tea, made in a pot, which you sit down to drink near a window and look out at the world. This is the signal that you have left work. 

Tune in Are you in the habit of working more hours than you are paid to work? If work is meeting a need, be it for approval, validation, meaning or purpose, can you meet this need in a different way? How can you make your leisure time more tempting and appealing at the end of the day?

Go deeper You might want to raise this as an issue with your team. If you think that it is a problem, it is likely that others do too. How could you work together 181

Bringing it into the workplace

Figure 9.5  Leave work at work

to make sure that the work culture shifts? For as long as team members are putting in unpaid hours, you will not get more staffing. Can you all agree to support one another to leave on time? Can you also agree to take your lunch breaks? Remind yourselves that you are doing this for your colleagues as well as yourself. A burnt-out team is not an effective team, and will ultimately lead to sickness absence and people leaving the profession.

Notes 1 LaCroix AZ, Bellettiere J, Rillamas-Sun E. ‘Association of light physical activity measured by accelerometry and incidence of coronary heart disease and cardiovascular disease in older women’ Nutrition Obesity and Exercise 2019;2(3):e190419.

182

Our work environment 2 Zhai L, Zhang Y, Zhang D. ‘Sedentary behaviour and the risk of depression: A meta-analysis’ British Journal of Sports Medicine 2015 Jun;49(11):705–709. 3 De Kok J, Vroonhof P, Snijders J, Roullis G, Clark M, Peereboom K, Van Dorst P, Isusi I. ‘Work-related MSDs: Prevalence, costs and demographics in the EU’ European Agency for Safety and Health at Work 2019. 4 Jain P, Bellettiere J, Glass N, LaMonte MJ, Di C, Wild R A, Evenson KR, LaCroix AZ. ‘The relationship of accelerometer-assessed standing time with and without ambulation and mortality: The WHI OPACH study’ The Journals of Gerontology 2021;76(1):77–84. 5 Zemp R, Fliesser M, Wippert PM, Taylor WR, Lorenzetti S. ‘Occupational sitting behaviour and its relationship with back pain – A pilot study’ Applied Ergonomics 2016;56:84–91. 6 Buettner D, Skemp S. ‘Blue zones: Lessons from the world’s longest lived’ American Journal of Lifestyle Medicine 2016 Jul 7;10(5):318–321. 7 Gillen JB, Martin BJ, MacInnis MJ, Skelly LE, Tarnopolsky MA, Gibala MJ. ‘Twelve weeks of sprint interval training improves indices of cardiometabolic health similar to traditional endurance training despite a five-fold lower exercise volume and time commitment’ PLoS ONE 2016;11(4):e0154075. 8 Kavuri V, Raghuram N, Malamud A, Selvan SR. ‘Irritable bowel syndrome: Yoga as remedial therapy’ Evidence-Based Complementary and Alternative Medicine 2015;2015:398156. 9 Lim SA, Cheong KJ. ‘Regular yoga practice improves antioxidant status, immune function, and stress hormone releases in young healthy people: A randomized, double-blind, controlled pilot study’ Journal of Alternative and Complementary Medicine 2015 Sep;21(9):530–538. 10 Cioffi I, Ibrugger S, Bache J, Thomassen MT, Contaldo F, Pasanisi F, Kristensen M. ‘Effects on satiation, satiety and food intake of wholegrain and refined grain pasta’ Appetite 2016 Dec 1;107:152–158. 11 McCrory MA, Hamaker BR, Lovejoy JC, Eichelsdoerfer PE. ‘Pulse consumption, satiety, and weight management’ Advances in Nutrition 2010 Nov;1(1):17–30. 12 Maljaars J, Romeyn EA, Haddeman E, Peters HPF, Masclee AM. ‘Effect of fat saturation on satiety, hormone release, and food intake’ The American Journal of Clinical Nutrition 2009 April;89(4):1019–1024. 13 Montserrat-de la Paz S, Lopez S, Bermudez B, Guerrero JM, Abia R, Muriana FJ. ‘Effects of immediate-release niacin and dietary fatty acids on acute insulin and lipid status in individuals with metabolic syndrome’ Journal of the Science of Food and Agriculture 2018 Apr;98(6):2194–2200. 14 Mumford SL, Chavarro JE, Zhang C, Perkins NJ, Sjaarda LA, Pollack AZ, Schliep KC, Michels K A, Zarek SM, Plowden TC, Radin RG, Messer LC, Frankel R A, Wactawski-Wende J. ‘Dietary fat intake and reproductive hormone concentrations and ovulation in regularly menstruating women’ American Journal of Clinical Nutrition 2016 Mar;103(3):868–877. 183

10

Team culture

As Allied Health Professionals, we don’t work in isolation. We are part of a team. This team might be part of a department or directorate, which is part of a larger organisation. There are likely to be other services we intersect with, in education, health or social care. We are a cog in a wheel, but we are an important cog. If we get jammed, the whole mechanism gets jammed. If someone else gets jammed, it will impact on us. In this chapter we will be looking at how we can be an empowered member of a team, and how we can work towards our whole team being empowered. The issues or activities in this chapter are teamfocused. If you feel these issues are relevant for your team, then maybe you could talk to a few colleagues to see how they feel about them. You might talk to your line manager. I expect that they will be pleased that you are being proactive in suggesting a topic for discussion at a team meeting or staff development day. The first activity in this chapter is to raise awareness of how teams work best. All other activities build on this. We will discuss time-management and how to distinguish between what is urgent and what is important. This ideally will be agreed as a team, but is powerful on a personal level. We will think about the benefits of setting service objectives as a team, so that professional and personal priorities align. On a practical note, we will consider how we might manage emails and meetings so that these are not a drain on us or others in our team. We will consider how to build positive relationships within the team. We have the opportunity to develop ourselves and develop our 184

DOI: 10.4324/9781003165125-13

Team culture

team at the same time. This is good for the effectiveness of our service, and for the effectiveness of Allied Health Professionals.

An empowered team This is an activity that could work as a self-reflection, or as a paired or group activity. The benefit of doing it as a group is that it may help inform later decisions or priorities for your team. You may decide to do it now individually, and then take it to your team for a group activity. Either write for two minutes or talk for two minutes to answer each of the two questions below. Write or talk without pausing for too much thought; just allow yourself the freedom to spurt ideas without the need to edit or refine them. Set a timer for each of the two-minute periods. –– ––

For your service, what does an empowered service-user look like? What does an empowered team member look like?

Teams of AHPs will have diverse service-users, demographics and service delivery models. Despite this diversity, there will be common threads. Below are some possible ideas that may have arisen from asking these questions about empowerment. There are no right answers, and the list below is by no means exhaustive.  Why is it helpful to think about empowerment? You might want to spend a few moments thinking about this. My thoughts are (but you might have equally valid and different thoughts): ––

We have finite time and resources. We might be able to use them creatively.

––

We are only going to be with this service-user for so long. After their appointment, it is up to them. So we want them to understand what their options are.

––

Empowered service-users can make informed choices.

––

Empowered service-users are more likely to take responsibility for their health and wellbeing. We can optimise our effectiveness if we work with them towards shared goals. 185

Bringing it into the workplace

––

Empowered service-users can help shape services. They feel able to tell us when we get it wrong.

––

We need to be clear about roles and responsibilities within the team, in order to avoid duplication or gaps in provision.

––

An empowered team can drive innovation and provide an excellent service.

––

An empowered team has high morale and good recruitment and retention.

Thinking about your own team now, are there aspects you would like to develop? You may want to discuss these issues in a team meeting or service development day.

Table 10.1 An empowered team What does an empowered service-user look like?

What does an empowered team member look like?

••

••

•• •• •• •• •• •• •• •• ••

They know why they have been referred to the service. They know what to expect from the service. They expect to be involved in their treatment planning. They are able to say if they do not understand. They know where they can access more information if they want it. They understand their options, and the pros and cons of each. They know what their role is in the management of their needs. They can say if there is a problem with following your advice. They can give honest feedback about the service. They feel valued for their unique insight and experiences.

186

•• •• •• •• •• •• •• •• ••

They know what the service is commissioned to provide. They know what resources are available. They know what their role is in the team, and the role of others. They know the referral criteria and the care pathways that are offered. They understand the prioritisation system. They know what is expected of them in their day-to-day work. They have some autonomy in decision-making which is appropriate to their experience and skills. They can give feedback about how the service is working. They are working to common goals in order to improve the service. They can contribute ideas to how the service might work better.

Team culture

If you identify gaps, or think you can do more to develop an empowered service-user or an empowered team, then you might build them into your service objectives. It may be that you need to make specific resources for the empowered service-user. You may want to reach out to local communities and find out what their priorities are. You may want to re-establish or renegotiate your commissioning arrangements. You may want to look at how you can make your treatment planning more inclusive. You may have resources within the team that you can make more use of.

Tune in How was this exercise? Did the two minutes work? Did it help to get ideas flowing? Did you feel safe to talk or write freely?

Go deeper What other ways could you capture team members’ best ideas? Do you have regular supervision? Do you have time to talk as a team and reflect upon what’s working and what’s not working? How might you build in this time for reflection? Does your organisation have any tools for service improvement that you could use? See also ‘Compassionate Communities’ on p.277.

What is urgent and what is important? The Eisenhower matrix is a tool first used by President Eisenhower and then popularised by Steve Covey in his book ‘The Seven Habits of Highly Effective People’.1 The Eisenhower matrix distinguishes between tasks which are urgent and tasks which are important. Some will be both, and some will be neither.  An urgent and important task needs action now. It is a clinical duty which cannot wait. This includes clinics running to time and writing up the notes today. It also includes unforeseen events which require immediate action. An example would be a carer breaking down and telling us they can’t cope any more. 187

Bringing it into the workplace

Figure 10.1  Eisenhower's matrix

An important but not urgent task is one that can be scheduled in your calendar ahead of time. An example would be attending and speaking at a case review, or re-designing our service website. We are fulfilling our professional role and working towards long-term goals. We are in responsive and reflective mode. We can give it careful and sustained attention. Urgent but not important tasks can be delegated to another member of the team. An inquiry might be made of us, but it relates to a colleague’s clinical specialism. It might be data collection that admin staff are best placed to collate. We often do these tasks to please others, but they don’t make the best use of our time, and they don’t really relate to our professional role or long-term goals. Not urgent and not important tasks are the ones that we know are just distractions. Examples include scrolling Instagram or constantly checking for news updates. These tasks are for our own time.  At first you might find it difficult to assign a task to a quadrant. It becomes easier with practice. You might trial this technique as a team, so that you can support one another with working in this way. We are looking to spend less time in the ‘urgent’ quadrants, because if we schedule tasks they won’t become urgent. The more 188

Team culture Table 10.2 Urgent and important Urgent and important Do these today.

Not urgent but important Schedule these in your calendar.

•• •• •• •• ••

••

•• •• ••

Today’s scheduled clinical work. Safeguarding actions. Reporting an incident or near-miss. Writing up today’s clinical records. Urgent referrals where to delay would present a risk to a service-user. Sharing urgent and important information with relevant people. Any emails that help prepare for the days ahead. Your basic physical needs.

•• •• •• •• •• •• •• •• ••

Non-urgent referrals to other teams. Planning assessments and interventions. Multi-disciplinary team meetings. Emails, reports and other admin. Developing and delivering training. Producing resources for the service. Project work to fulfil service objectives. Professional supervision. Continuing professional development. Self-care routines.

Urgent but not important Delegate these tasks.

Not urgent and not important Don’t do these.

••

••

•• ••

Anything that relates to another team member’s role or agreed objectives. Work that would be suited to a colleague’s expertise or development, as agreed within the team. Work you are not commissioned to do, and which another service or charitable organisation may be able to pick up.

•• ••

Checking your phone or emails constantly. Scrolling social media. Self-criticism.

‘urgent’ work we have, the more stressed we are likely to be, and the more at risk of burnout. Many AHPs are both perfectionists and people-pleasers, and tend to spend a lot of time in the ‘urgent but not important’ quadrant. We may think that we are the only person who can do this task, or that it would be unfair on a colleague to delegate it. We need to trust in our colleagues, and remember that they too need to feel useful and valued. Underpinning this time-management model is an empowered team. An empowered team know what they are commissioned to provide, what each team member’s role is, what the priorities and longterm goals and who to speak to if there is a problem. If you are in doubt, then you may need to address these issues before implementing this tool. 189

Bringing it into the workplace

Tune in How does it feel to read this? Did any of the activities sound familiar? Can you see how this might work for your service? Can you discuss it with colleagues or your line manager?

Go deeper You might recognise that you struggle with people-pleasing or being a perfectionist. Take a look at Glennon Doyle’s book ‘Untamed: Stop Pleasing, Start Living’.2

Set service objectives as a team An effective team works towards shared objectives. Team members know what the service objectives are because they have been involved in the setting of these objectives. They know their unique contribution and their colleagues’ unique contributions to meeting these objectives. If your team doesn’t set objectives together, you might raise it as a suggestion. The following is an outline of how to set service objectives as a team. When thinking about new service objectives, ask all staff the following questions: –– –– –– –– –– –– ––

190

What is going well? Why? What is not going well? Why? What do the service-users say? Are there populations that we are not getting to, or not meeting the needs of? Are there any clinical risks that keep recurring? Are there any clinical risks that are likely to become more of an issue in the next 12 months? Do we need to update any clinical pathways in light of new research evidence or recommendations from our professional body?

Team culture

–– ––

––

––

Can you see that there is a better way to deliver a clinical pathway? What would we need to do to trial this? Can we work more effectively with our service-users, their carers or another service or stakeholder to improve this clinical pathway? Can we make use of the patient engagement team, communications team or other team to help us improve this clinical pathway? What information or data do we need to collect in order to measure our effectiveness in this clinical pathway?

Staff might discuss these questions in small groups, then share their ideas with the whole team and then submit their responses. About four service objectives might be selected. The service objectives are shared with the team. Staff submit a first and second preference for which project they would like to work on. Each member of staff works on one project. Each member of staff will also have ongoing responsibilities outside of project work. They may be the lead for a particular clinical pathway, a training course, website development or patient engagement. If they pick up more than one new project, we run the risk of staff being overstretched. One person will lead on each project. This will depend on their capacity and development needs, and can be discussed with them individually. There might be scheduled project group sessions through the year. The group writes a project plan for the whole year, with staff assigned to particular tasks. One person’s name is assigned to each task (rather than multiple people), so that they take ownership of the task. There is a completion date for each task written into the plan. Project group members work on their tasks, either on a scheduled project day or as part of their normal work, as appropriate. They are accountable to the project lead, who is accountable to the head of service. This accountability is key, to avoid projects drifting and service objectives not being met. This work can be written into each person’s individual development plan as part of the yearly cycle of staff appraisal. The project plan can evolve, with tasks being added, so long as they contribute towards achieving the service objective. 191

192

Collate video SA examples for each of the ‘Top Tips’.

Review final version FS of eLearning module.

3

4

End Feb 2021

End Dec 2020

End Oct 2020

FS

Write draft eLearning module.

2

End Aug 2020

Completion Date:

CO

Consult with parent/carer forum on the content of eLearning module.

1

Who to lead?

Steps to achieving the outcome:

Final version.

10 Videos (1 per strategy).

Draft module.

Survey monkey results.

Say less; communicate more.

How to share video files safely. How to compress and edit video files.

We need more video examples.

We need information to be written in Plain English, with video examples to illustrate each strategy.

Evidence: What have we learnt? (insert hyperlink or file name)

Why? To support parents to enable their children to become better functional communicators.

Objective: to add an eLearning module to our portfolio of resources for parents

Table 10.3 Project plan

Go live with eLearning module.

Submit to eLearning platform.

Contact parents and arrange for video sessions. Use appropriate consent forms and procedure.

Draft ‘Top Tips’ for parents. Make sure they are written in Plain English. Collect video examples.

What do we do next?

Bringing it into the workplace

Team culture

At the end of each project day, the whole team can get together to find out the progress of each project group. This way each team member has awareness of other work being carried out, and the heads of service have oversight of progress.  At the end of the year’s cycle, the project plans are reviewed. What started out as a project is now likely to become part of normal working practice, and embedded within a clinical pathway. It is likely that the project lead will continue to take overall ownership of that pathway. This needs to be managed by the head of service, so that there is a fair distribution of responsibilities within the team.

Tune in Do you feel that this way of working might be helpful for your team? What would the benefits be? What are the potential obstacles? What do you need to do next to explore this further?

Go deeper What does it mean to you when you have a say over the direction your service takes? What does it mean when you have a forum in which to feed back to management what is working and what is not working? What are the challenges of agreeing service objectives between a multi-disciplinary team? What skills do you need to develop as a team so that you can work together on projects? What structures need to be in place to support this? For example, time set aside, support from management, scheduled appraisals and reviews.

Effective emails Emails can be a very effective way to communicate with one another, but they can also be incredibly inefficient. Picking up the phone, or getting up and going to speak to the person is likely to be quicker and kinder, and more efficient if: ––

You are sharing complex information. 193

Bringing it into the workplace

–– –– –– –– ––

You want an immediate response. You’ve got an exciting new idea. You are angry or upset. Someone else is angry or upset. You need to give feedback that is sensitive.

If an email is taking a long time to write, it is probably best dealt with as a face-to-face or phone conversation. You will be able to express your point more sensitively, respond to the other person’s contributions with more warmth and have a more creative conversation. Conversations help us to bounce ideas off one another. They take us into unexpected places so that we have new insight. Emails don’t. Emails are best for: ––

Sharing information with a group of people that they can read in their own time.

––

Requesting the same action from a number of people.

––

Requesting a straightforward action from one or more people. If email is the best way to communicate, stick to these rules: –– ––

––

––

194

Emails generate emails. Only send an email when you have to. Make the subject line clear and detailed so that the reader can quickly prioritise it. For example: –– Action for OTs: update the equipment spreadsheet. –– Action for admin: send LM assessment report by 10 Dec. –– For Information: MDT meeting cancelled tomorrow. Get to the point quickly so that the reader knows what you are asking them to do in the first two sentences. People tend to skimread emails and if you don’t get to the point quickly, there is potential for misunderstandings. Misunderstandings generate a lot more emails. Write in plain English. Write for the reader, not yourself. Use short sentences. Use everyday words. Avoid acronyms or jargon. Write short paragraphs, with line spacing between each paragraph. Use bullet points for easy reading. Read through your email to make sure it is clear.

Team culture

––

––

––

––

–– ––

––

Keep emails short. People will respond in the same manner. This will save time for both of you when you are sorting through emails for the key information. Use one subject per email. If you put two requests in one email, it is likely that only one of the requests will be responded to. It is more effective to send two emails with different subjects than to incorporate two subjects into one email. When answering an email, stick to the original subject. You can always send another email starting another topic if you need to. It is very hard to find emails afterwards if the content does not relate to the subject line. Send the email to the people who need to take action. Copy in those who just need to read it. For every person copied into an email, you have potential to receive a response. Only use ‘reply all’ if you really need everyone to see your response. Have a detailed signature line. Make sure that all of your contact information is in the signature line of every email you send. Avoid controversial or argumentative emailing. Pick up the phone or talk to the person face-to-face. Emotional issues should never be handled by email. Delete emails that you don’t need. File emails into folders and sub-folders. For example ‘caseload’, ‘training’, ‘students’. Review your inbox and sub-folders every week to get rid of unnecessary emails.

Tune in What are your email habits? Do you send a lot of emails? How long are they? Do they get to the point quickly? Does the subject line accurately describe the content? Does it say what the expectation is? You could carry out a quick audit of how many emails you send in a day, and how many you receive. How many are essential? How many, in retrospect, could have been dealt with more efficiently if you picked up the phone? If you re-read the emails you sent, can you see any ambiguity or lack of clarity? Are there any emails you wished you hadn’t sent? What would you do now? See also ‘Pick up the phone’ on p.215. 195

Bringing it into the workplace

Go deeper If you find yourself struggling over the wording of an email, pick up the phone. Review your conversation afterwards. How did it feel? Did it take you in an unexpected direction? Was the conversation more useful than a series of emails would have been? Will this make you more likely to pick up the phone next time?

Meetings with a purpose Meetings can be lively, creative spaces, where minds come together to bounce ideas off one another and experiment with innovative solutions. Meetings can also be lifeless, stale spaces, where people are wondering why they have to be there, and wishing they were getting on with something else more important. Do all of the meetings you attend in a month have a clear purpose? It is an interesting exercise as a team to check out what you all think the different meetings are for. This will help everyone to refocus us on the different purposes of different meetings. This makes it easier to set a clear agenda. Staff will be more confident about which items to add to which meeting agenda. The exercise will focus everyone on the need to keep meetings to time, keep on track with the agenda and, most importantly, set expectations about what a meeting might achieve. Below is a template to state the purpose of different meetings. This has been filled out as an example only. Your team will have different meetings with different purposes. 

Tune in How would it feel as a team member to fully understand the purpose of each meeting you attend? Would you feel more empowered to participate? To add items to the agenda? To challenge if the item seems like it’s on the wrong agenda? How would it feel as a manager or a chairperson if everyone in the meeting understood the purpose of the meeting? 196

Team culture Table 10.4 Meetings with a purpose Allocation Meeting (60 mins every 2 weeks)

•• •• •• •• •• ••

Supervision (60 mins every 4 weeks)

To process new referrals and assign •• them to a clinical pathway. To allocate new referrals to staff •• caseloads. To change any clinical pathways. •• To agree equipment requests from staff. •• To consider any training requests and allocate staff to these. To prioritise current work within the team.

To discuss and problem-solve complex cases. To explore cases that are causing you stress, or triggering a lot of emotion. To explore difficult dynamics within a team or situation. To use coaching skills when you are stuck with a project.

Team Brief (30 mins every week)

Team Meeting (90 mins every 6 weeks)

•• •• •• ••

•• •• ••

•• ••

To share any admin updates. To share any IT updates. To share any equipment issues. To cascade information from NHS Trust and Local Authority, e.g. mandatory training. Sharing of good practice and lessons learnt. Good news story.

•• ••

To share a staffing update. To share outcome data and survey info. To share info about progress with project groups. To share updates from NHSE, NICE, CQC. To share info from courses attended and clinical networks.

Go deeper You might carry out a staff survey about the different meetings in your team to gauge how people feel about them. This can be a real eye-opener, and might be the way change is initiated. Staff need to feel safe to express their views, and the management team need to be receptive to constructive criticism. Running meetings well is a whole set of skills, and we are all here to learn. The ultimate aim is to increase staff engagement and empowerment in a team.

Meeting etiquette It is helpful for a teams to agree the boundaries of acceptable behaviour in meetings. 197

Bringing it into the workplace

Ground rules are likely to include: –– –– –– –– –– –– ––

Be on time. Come prepared with the agenda. Give the meeting your full attention. Talk respectfully to colleagues. Take turns at talking. Contribute your ideas. Finish on time.

The organiser of a meeting needs to make further considerations, which include: ––

––

––

–– –– ––

––

––

198

Every meeting needs a purpose. If it is a regular meeting, then the purpose is reviewed periodically. What do you need to achieve by the end of the meeting? Only invite those people to a meeting if they have a contribution to make. They might not need to attend the whole of the meeting, but join for certain agenda items. Meetings should not be too long. Attendees are likely to lose attention after 60 minutes. If the meeting has to be longer, then build in movement and refreshment breaks. Set a start and end time and stick to these. If you start ten minutes late, people will start arriving ten minutes late. Send an agenda one or two days before the meeting. Sending it a week before will mean some people will lose it. The agenda should be specific. You might state on the agenda whether the item is ‘for information and questions’, ‘to share ideas’ or ‘to make a decision’. Experiment with designating different roles in a meeting. It is worth rotating roles so that each person gets to experience the challenges of each role. This will help to make them a better attendee. The ‘chairperson’ welcomes everyone to the meeting and allows for introductions. They review action points from the previous

Team culture

–– ––

––

––

––

––

meeting. They introduce each item, manage the discussion and bring discussions to a conclusion. The ‘note-taker’ notes down any decisions that are made, and any actions, including who needs to do them and by when. An ‘includer’ might prompt quieter attendees to give their thoughts. Quieter team members might need time to gather their thoughts, and a way of feeding these back after the meeting. If the meeting is online, the ‘chat’ function might be used. A ‘time-keeper’ supports the chairperson, by reminding everyone the time allocation for each item and that there are five minutes before the break or end of meeting. If the discussion has gone off track, the chairperson might need to remind everyone to come back to the agenda item. They may need to ask ‘can we pick this up outside of this meeting?’ ‘Any other business’ needs careful handling. By that stage in a meeting, most people want the meeting to end. The team might be encouraged to add items to the agenda ahead of the meeting. The chairperson can decide if it is appropriate to the meeting or if it should be picked up with that person individually. It is good to end on a positive item. You might have a regular ‘good news story’ or ‘this week’s learning’ slot. The people to provide these quick items might be scheduled in each week.

Tune in The next time you come out of a meeting, tune into how you feel. Do you feel energised and enthused? Do you feel drained and despondent? Think about why this might be. Was the meeting well run? Did it keep to time? Did the agenda keep everyone on track? Were all the voices heard? What would have improved the meeting just a little bit? Can you feed this back compassionately to the chairperson? Can you discuss these issues as a team?

199

Bringing it into the workplace

Go deeper AHPs have to attend a lot of meetings. We can learn from some of the resources that are used in the corporate world. Search ‘how to chair an effective meeting’, and read a few blog posts or watch a couple of TED talks. Think about how you can use the advice in your work setting.

Space to think Our day-to-day roles are busy. We manage complex caseloads. We make multiple clinical decisions in a single appointment with a service-user. We have ethical dilemmas involving mental capacity and safeguarding. We have projects to manage, and multi-disciplinary team-working to negotiate. We have various degrees of autonomy, but we are all held accountable. We all need professional supervision. This might take the form of a one-to-one with a more senior colleague, or it might be as part of a group of peers from the same or different discipline. When we are newly qualified we tend to want to be told what to do. As we grow in confidence, we might want to explore our own ideas, but we appreciate a sounding-board, or a forum in which our ideas can grow. We need a space in which to stop and think. One model of professional supervision is ‘Action Learning Sets’. Action Learning Sets are used widely across the NHS and other organisations. They typically consist of a group of individuals who do not work together, but work at a similar level. Each member of the group commits to a set number of sessions, perhaps eight sessions, meeting once every month. It is helpful to have an independent facilitator to take care of time-keeping within the session. Time will be spent agreeing the ground rules of the group, including confidentiality and respect. Each group member brings their own particular ‘problem’ to a session. They will have spent some time thinking about this ahead of the session. A session of two hours might provide time to consider two to three people’s ‘problems’. A key element of Action Learning Sets is the time to think. There are strict turn-taking rules, which are managed by the facilitator. 200

Team culture

A typical session might include: –– –– ––

––

––

–– –– ––

–– ––

––

–– ––

The speaker takes 10–15 minutes to present their problem. They speak uninterrupted. The listeners each write down one clarifying question and one open question, but they don’t ask it yet. Clarifying questions, if needed, are closed questions around the specific circumstances. They might begin with ‘who?’, ‘where?’ or ‘when?’ Open questions encourage reflection. They are intended to help the individual explore their own thoughts, feelings and experiences. They might allow the speaker to gain insight or perspective. An open question cannot be answered by a ‘yes’ or ‘no’, a single word or phrase. The question cannot be a suggestion in disguise, like ‘have you thought about doing X?’ Once the speaker has finished presenting their problem, the listeners can ask their clarifying question, if they have one. The listeners then ask their open question. Examples of open questions are: ‘what support do you need?’; ‘what would be a good outcome for you?’; or ‘what feelings are coming up for you?’ The speaker can choose not to answer a question if they do not want to. The speaker has uninterrupted time to answer each question. This space to think aloud is often where new insights and perspectives happen. The facilitator might invite the listeners to offer their own experiences of a similar situation, but this part is very brief. It is really to satisfy the listeners’ impulse to offer help! The speaker can share any new learning or ideas they have, and what they might do next. At the next group meeting, the facilitator will check in with the speakers from the previous group to find out how the situation has developed.

This style of professional supervision might be frustrating for a newly qualified AHP, who just wants to absorb the wisdom of more experienced practitioners. However, for AHPs with a few years of experience, 201

Bringing it into the workplace

this model offers more scope for personal and professional development. The learning is more active. Being told what to do can be quite restrictive. If we can’t imagine following someone’s advice, we won’t do it; we will just politely accept the advice and pretend we are going to do it. This type of ‘advice-less’ supervision is ultimately more empowering. We can explore our own knowledge of the situation, integrate our thoughts and feelings, make new links, widen our perspective and intuitively identify the approach that is most likely to work for us. It takes practice for an AHP to stop themselves from offering advice! At first we will be chewing on our hands, trying to stop ourselves from saying ‘have you tried … ?’ In this process of enforced listening, we might realise how often we jump in with an answer before we have properly listened to the problem. It is worth remembering that ‘we have one mouth, and two ears’. The benefit for the speaker is that they have time to think, time to make connections, and time to have an ‘ah-ha!’ moment. They can let a question land, take time to think and don’t have to jump in with an answer straight away. This spreads into the rest of our lives. We realise how often we interrupt another person’s train of thought. This might be a serviceuser, a carer or a colleague. Using this technique in a structured setting, in group supervision, allows us to practice our listening skills. It allows us to practice open questions. It allows us to say ‘I’m not sure. Can I have time to think about that?’ We learn that for the bigger problems in life, we don’t need to be reactive. We need to be responsive. The difference is the space to think. Often the answer is already within us, we just need to make the right connections.

Tune in Does this style of supervision appeal to you? Is your career at a stage where you would benefit from this approach? What do you think you would find challenging or helpful about this approach?

Go deeper 202

Team culture

You might benefit from ‘Coaching skills’ or ‘Appreciative Inquiry’ training to develop these skills further. This is likely to be especially useful if you work in a multi-disciplinary team, if you are trying to empower service-users or partner organisations, or if you manage a team.

A connected team Wellbeing is related to how connected we feel with those around us.3 The quality of our relationships and our connectedness has been shown to affect our physical health,4 our mental health,5 our cognitive health,6 our health behaviour7 and even our mortality risk.8 Given how much time we spend at work, it makes sense that we will be happier if we have good relationships with our colleagues.9 Research even suggests that there is a ‘ripple effect’ of happiness, whereby if we surround ourselves with happy people, we are likely to be happier ourselves.10 AHPs often count colleagues as their some of their closest friends. We might go through life-changing times, and colleagues are the ones who support us every day. Work can be an escape from difficult home situations, and helps us to retain our sense of competence and confidence. It can take time to bond with colleagues. With some colleagues we instantly find a connection, but for others it is a slow-burn. We might need to work together on a project, or even go through a tough learning experience in order to appreciate one another. Often a bond is stronger for having come through a challenge. Social connection with colleagues is even more important if we work from home or carry out home visits alone. We may need to schedule in a remote daily or weekly team social meeting through video conferencing. Without this direct connection with colleagues, we miss out on the incidental conversations which support our wellbeing, as well as supporting our professional practice.  Below are some ideas for games you might play with your team during team meetings or scheduled socials. It is almost inevitable that you will have sceptical or shy team members. If you are introducing team games, initially you might want to make them short and simple. Think about how different activities might appeal to different team members. If you don’t know your team members well enough to make that call, many of the activities below 203

Bringing it into the workplace

Figure 10.2  A connected team

are designed to find out about people. The aim is to establish connection between different team members. We might realise that we have things in common that wouldn’t have come up in professional discussions. It might inspire team members to explore new hobbies and interests and support one another.11 Quick round questions: –– –– –– –– –– ––

What animal would you be and why? What film or TV character are you most like? What colour are you today? What is your personal weather today? What would you take to a desert island? What would be the best holiday ever?

Longer activities: ––

––

204

Make a team music playlist: every team member chooses a song which inspires them or cheers them up. You might play a song at the start of each team meeting. Hobby bingo: the group is divided into two teams. The caller has a list of hobbies or skills. For example fishing, rock-climbing, making bread, wild swimming, crocheting, growing vegetables, running. The team can put a counter on their bingo card if a person in their team has ever tried this hobby.

Team culture

––

Hobby masterclass: once you know the team members’ various hobbies and skills, you might see if anyone wants to run a fun masterclass. For example, one team member might lead a baking or craft activity. –– Pictionary or charades: there is a pre-prepared list of objects, actions, characters, books, songs or stories. One person has to draw or mime in order for their teammates to guess what it is. –– Show and tell: each person shows an item that they treasure, and explains why. Alternatively, they could show a special photo or play a piece of music. –– Two truths and a lie: each person gives two true facts about themselves and one lie. The rest of the team tries to identify the lie. –– Would you rather? Prepare options ahead of time, and make them politically neutral. You could focus on activities and experiences, e.g. water-ski or sky-dive? If your team is well established and team members trust one another, you might incorporate activities which are more personal, or which might inform team working. Work-focused questions include: –– –– –– –– ––

My perfect day at work would be … My vision of a positive team is … My proudest moment at work was … My biggest learning experience at work was … My favourite thing about working in this team is …

Tune in Think about the most effective team you have ever worked in. What made the team effective? What structures were in place to keep the team 205

Bringing it into the workplace

together? How much did you know about your teammates outside of work? Were there rituals or events which helped this bonding occur? What were the benefits when people were going through tough times?

Go deeper You may want to look into team-building games and activities to use at a staff meeting. You only need to carry out a five-minute activity to find out more about your teammates. Managers are always looking for ways to make a meeting more engaging for the team, and are likely to welcome an offer of help. The benefits for the team are wide-ranging. Staff will be more energised by the change to a regular team meeting; there will be an injection of fun into a working day; people will see that you care about getting to know their whole selves, not just what they offer as a professional. We all want to feel we can bring our whole self to work, and to be valued for who we are.

Notes 1 Covey S. The 7 Habits of Highly Effective People Simon and Shuster 2004. 2 Doyle D. Untamed: Stop Pleasing, Start Living Vermillion 2020. 3 Heinrich, L, Gullone E. ‘The clinical significance of loneliness: A literature review’ Clinical Psychology Review 2006;26:695–718. 4 Yiengprugsawan V, Welsh J, Kendig H. ‘Social capital dynamics and health in mid to later life: Findings from Australia’ Quality of Life Research 2018 May;27(5):1277–1282. 5 Landstedt E, Almquist YB, Eriksson M, Hammarström A. ‘Disentangling the directions of associations between structural social capital and mental health: Longitudinal analyses of gender, civic engagement and depressive symptoms’ Social Science and Medicine 2016 Aug;163:135–143. 6 Bowling A, Pikhartova J, Dodgeon B. ‘Is mid-life social participation associated with cognitive function at age 50? Results from the British National Child Development Study (NCDS)’ BMC Psychology 2016 Dec 2;4(1):58. 7 Umberson D, Crosnoe R, Reczek C. ‘Social relationships and health behavior across life course’ Annual Review of Sociology 2010 Aug 1; 51 36:139–157. 8 House JS, Landis KR, Umberson D. ‘Social relationships and health’ Science 29 Jul 1988;540–545. 9 Umberson D, Montez JK. ‘Social relationships and health: A flashpoint for health policy’ Journal of Health and Social Behaviour 2010;51 Suppl:S54–66. 206

Team culture 10 Fowler JH, Christakis NA. ‘Dynamic spread of happiness in a large social network: Longitudinal analysis over 20 years in the Framingham Heart Study’ British Medical Journal 2008 Dec 4;337:a2338. 11 Central YMCA. ‘Eudaimonia: How do humans flourish? A research report into the impact of lifestyle factors on people’s wellbeing’ Autumn 2016.

207

11

Conflict at work

Occasional conflict is inevitable. It is part of every healthy relationship. If you never disagree with a person, it is likely that there is a power dynamic that is preventing one of you from speaking your mind. This is not healthy. Allied Health Professionals may struggle with conflict. We generally see ourselves as ‘nice’ people. We are here to help; to make things better. When there is conflict, we may avoid it. This can lead to resentment in the long-run, and our resentment may come out in unexpected ways. We may complain to another colleague; we may be passive in a meeting; we may not put our full creativity into a piece of work; we may keep our brilliant ideas to ourselves. This is all a loss for our team, and for our personal and professional development. Conflict is energy. It can charge us up. We can put this energy into doing something different. That might be re-writing our own inner story; it might be having a sparky conversation with a colleague and both having a lightbulb moment; it might lead to creative collaboration and brave thinking. Moaning has its place, but it is ultimately disempowering. If we habitually moan about the same topic, we do not feel enabled to change it. The moaning might be internal. If you find yourself, in your head, constantly moaning about a particular person, situation, team, manager or aspect of your work, you need to take note. This is an opportunity for change. This is an opportunity for personal and professional growth. Everyone has intrinsic worth. Even the patient you can never please. Even the colleague who always argues against you. Even the managers who make obscure demands upon your time. This is the 208

DOI: 10.4324/9781003165125-14

Conflict at work

core belief that underpins compassionate communication. Regularly reminding ourselves of the intrinsic worth of all human beings will reduce conflict within our lives. This will lead into practising non-judgement. If we tune into how often we are making judgements, we can start to challenge these. Patients who are treated compassionately have the best clinical outcomes. If we are judging others harshly, we probably judge ourselves harshly. This can be a barrier to self-care. We will consider the benefits of picking up the phone rather than emailing. It is easy to forget this simple strategy for connection with another human being. We can often resolve a problem within a conversation in which we truly listen to one another. We gain a new understanding of a situation from another person’s perspective. We will examine our own story-telling if we have a disagreement with someone at work. We may be stuck in an old narrative which casts us as the victim and another person as a villain. Such simplistic, blackand-white thinking is not helpful for working relationships. This informs another important skill: how to de-personalise a situation and re-professionalise it. People who challenge us the most can be our greatest teachers. We could keep making the same mistake over and over and be stuck in an unhelpful dynamic. Or we could bring our awareness to the situation and change what we do. We consider personal boundaries, and how we can use these to foster self-care at work. This is the ultimate conflict at work: the conflict within ourselves between what is good for our professional self and what is good for our personal self. Defining our boundaries in preparation for inevitable conflict will help us deal with it effectively. We don’t have to compromise our self-care for the sake of our career. Thinking about personal boundaries will help us have constructive and empowered conversations with our manager and colleagues. Finally, we practice compassionate communication. We might think that we practice this every day, but we can always fine-tune our skills. Compassionate communication starts with knowing what is going on for us. We need to recognise our own thoughts, feelings and possible unmet needs, and how this is influencing a situation. We are then more able to communicate this in a constructive, compassionate way. We have control over how conflict plays out in our working life. Just like every chapter so far, awareness is the mechanism of change. We start by tuning in. 209

Bringing it into the workplace

Everyone has intrinsic worth Working as an AHP brings us into contact with a wide demographic of people. We are interacting at a very human, emotional level with people with diverse backgrounds. The nature of what we do allows us to see the innate goodness of human beings. Popular culture would have us believe that humans are abhorrent. In books and films we see people murdering or abusing one another. In politics and on social media we see people insulting one another for having different views, and seemingly being unable to work together for the common good. These stories sell. They are click-bait. They do not reflect reality. Most people, most of the time, are doing the best they can. People generally want to work together to make things better. Paul Santagata, Head of Industry at Google, developed this ‘Just like me’ mantra for his staff to keep in mind during difficult negotiations. I think it works for us too. –– –– –– –– ––

This person has beliefs, perspectives, and opinions, just like me. This person has hopes, anxieties, and vulnerabilities, just like me. This person has friends, family, and perhaps children who love them, just like me. This person wants to feel respected, appreciated, and competent, just like me. This person wishes for peace, joy, and happiness, just like me.

Our work shows us this. We have the opportunity of working with professionals and patients who have different cultural backgrounds, education experiences, social status, family structures and world views. We may work with groups of people who have faced great unfairness and adversity, such as the prison population and homeless people. Our work offers us a more balanced world view than we might otherwise have exposure to. We know, through the work that we do, that those people who have the lowest social status often do the most valuable work. We 210

Conflict at work

witness cooperation between different groups of human beings: doctors, nurses, AHPs, patients, carers, charities, community groups. We see people uniting to support the most vulnerable people in society. As AHPs, we see the innate goodness of humanity. We see the capacity for love, trust, warmth, generosity, forgiveness, hope, humour, creativity. We often see people when they are at their lowest ebb. It might be a patient at the end of life, a struggling carer or a staff team managing a crisis. If we are able to sit with that person and listen to them, we recognise that they are doing their best with their available resources. We feel the innate value of human beings. Intrinsic worth lays beneath all outward indicators of status. Intrinsic worth is constant, despite fluctuating thoughts, feelings and behaviours. Once we become familiar with the concept, we can start to recognise the intrinsic worth of everyone we encounter. Their outward behaviour is transient; their intrinsic worth is constant.

Tune in If you focus for a moment on a person who is irritating you, or who you are quick to criticise, try out the ‘Just like me’ mantra shown above. Sit with this for a moment. How does it feel after imagining this person with their friends and family and hopes and dreams? Do you feel more able to acknowledge their intrinsic worth?

Go deeper Sometimes our inner light shines bright and true. It radiates out to all who interact with us. At other times, our inner light is dim and wavering. It might only feel like a very tiny glow at the centre of us, and others might struggle to see it. You might sense this with the patients and colleagues you encounter. No matter how bright their light is shining, see if you can greet them with this thought: The light and the love in me greets and honours the light and the love that is in you. (translation of ‘Namaste’) 211

Bringing it into the workplace

The person that you see today in your clinic is not the sum total of this human being. Human beings have rich and varied histories. We never see the whole person all at once. We cannot underestimate a person’s capacity for transformation and radiance. You might like to try the ‘Loving kindness meditation’ on p.145. This meditation is a practical application of this concept.

Practicing non-judgement If we find ourselves, as health professionals, becoming frustrated with a particular service-user, parent or carer, or a colleague, who is not behaving as we would, it might be helpful to remind ourselves that: If we had this person’s family experiences, school experiences, job opportunities; if we had the same losses and disadvantages; if we were exposed to the same ideas and opinions in our social circles or on our news feed or in our social media … then we would probably be behaving in exactly the same way. That’s not to say that we can’t call someone out when they are crossing the boundaries of acceptable behaviour. We have a duty to be antiracist, anti-sexist, anti-homophobic. We should never turn a blind eye to abusive behaviour. A more common scenario is that someone has said or done something that triggers you. It might not trigger a colleague. It has reminded you of a vulnerability you have. You might only be vaguely aware that this has happened, but you can become more aware. Awareness is the first step. If you find yourself judging someone, tune into it. ––

212

Does this person remind us of someone we have known elsewhere? For example, a family member, ex friend or partner, or previous colleague or boss we did not like?

Conflict at work

–– ––

–– –– ––

––

––

Is there anything about their physical appearance that we are judging? For example, their hair style, clothes, jewellery? Is there anything about their way of talking that we are judging? For example, a regional accent, or a way of talking associated with a particular social group? Are we making assumptions about their life experiences, education or work history? Are we making assumptions about their values or beliefs? Are our social rules different to theirs? For example, non-verbal communication like eye-contact. Is this influencing our judgement of them? Is it possible that they are coping with things today that we are not aware of? They might be experiencing a difficult living situation, financial issues, relationship breakdown … Are we assuming that they have hostile feelings towards us when there might be another explanation for their behaviour?

By practising this awareness, we can start to realise that we carry all sorts of assumptions about ‘types’ of people. The assumptions we have about particular types of people are likely to have arisen in childhood, from non-verbal or verbal messages we received from our family, friends or teachers. They may have been reinforced by the television, newspapers or social media we have been exposed to. Complex algorithms in our social media and news feeds mean that content is tailored to agree with our existing beliefs. We are not being fed a neutral message about the world, but one that is skewed to align with our current prejudices. If we haven’t mixed with people from a particular group, we are likely to have the most inaccurate assumptions about them. We will judge them for more harshly for behaving in a way that we would forgive our friends and family for. By bringing this into our awareness, we can start to challenge and override our judgements. Treating patients with compassion has been shown to improve clinical outcomes for the patient.1

213

Bringing it into the workplace

Treating someone with compassion encompasses: –– –– –– ––

––

Recognising and acknowledging the person’s thoughts and feelings, and adapting our approach accordingly. Understanding that the other person has a different perspective to us, and brings their own experiences and expertise. Adapting our approach in response to the person’s stated preferences or learning style. Providing the patient with relevant and accessible information, but respecting their right to make a different decision from the one we would make. We may disagree with a patient’s assertion about a particular treatment or therapy, but the patient has lived experience of their condition, and so their view has validity.

Research has shown that there are a range of health and wellbeing benefits for ourselves when we practice compassion. These include our cardiovascular health, our immune function, our neuropsychological pathways and even our gene expression.2 As the ancient sage Patanjali reminds us, ‘A clear and tranquil mind results from cultivating friendliness towards those who are happy, compassion towards those who suffer, joy towards the virtuous, and impartiality towards wrong-doers’.3 This is the privilege of being a health professional. Every working day we have an opportunity to connect with people. Every working day we have a choice about whether to offer judgement or compassion to complete strangers.

Tune in Have you managed to challenge your own assumptions about someone? Were you able to consider that you may have got them wrong? How did it feel to allow new possibilities?

Go deeper 214

Conflict at work

You could write a reflection about how you caught yourself judging or making assumptions about someone and how you rewrote these. See ‘Writing Therapy’ on p.254.

Pick up the phone! If we are struggling to write an email because the information is complex or because the content might be controversial or emotive, it is probably better to talk directly to the person, or to pick up the phone. Email is a very blunt instrument. It reduces our communication to words. If we start to read an email and it stresses us out, we stop even reading the words beyond the first couple of sentences. We might read what isn’t there, or not read what is there. How many times have you not understood a complicated email because you were overwhelmed by the amount of information in it? When we talk face-to-face, we enhance our verbal communication with our non-verbal communication. This encompasses our body language, facial expression, gesture, tone of voice, and which words we emphasise in a sentence. We might revert to gesture or facial expression if we are struggling to find the right word. We can modulate or adapt what we intended to say, depending on what the other person says. We can express so much human warmth in this way. We are highly social beings who have evolved to tune into minute changes in tone of voice, direction of eye-gaze, flickers of dismay or distress across a face. This is what helps us connect on an emotional level. We see that the other person is just like us. They too are managing a never-ending cascade of thoughts and emotions which they are trying to shape into coherent language! We naturally mirror the person we are speaking to. If they are quiet and hesitant, we will become more gentle. We read their non-verbal communication and we start to empathise. We modify our approach according to their responses. This is why face-to-face is the most compassionate option if there is anything emotional or complex or contentious to discuss. Phone is another option. We don’t have the visual information of body language, facial expression or gesture. But we can hear the tone of voice, and so can pick up on the mood. 215

Bringing it into the workplace

There may sometimes be an advantage of phone over face-to-face. There is a level of protection if either of you are feeling vulnerable. Pacing, or looking out of the window, can both help to move you into a ‘calm and alert’ parasympathetic response. Phone conversations allow us to: –– ––

––

–– –– –– ––

Ask how that person is today. You might get the standard ‘fine; busy’ call-and-response, but you have shown warmth by asking. Gently introduce the topic you need to discuss. You can check with the other person whether this is a good time to have this conversation. Use active listening: focusing on what the person is saying right now, rather than what you think they will say. Try not to interrupt, as this will just add stress to the conversation. Take turns, clarifying and repairing any misunderstandings as you go along. Ask for time to process and think about an issue. Agree the next steps between you. End gently, and with warmth. Express gratitude. This is the warmth of human connection that we crave and need.

If you are under-confident with phone conversations, practise. Practise with someone who you find easy to talk to. Practise with quick, functional phone-calls before you move on to complex, emotive phone-calls. Every time you find yourself avoiding a phone call, think about why you are avoiding it. It might be exactly the reason it should be a phone-call, and not an email. If it helps, write down the key-points you want to make. One to three key-points is probably enough. Congratulate yourself if you have been able to make these points in the phone-call. Congratulate yourself further if you feel that they were understood. The phone (rather than email) allows us to connect on a human level. This is what makes our working day worth it, ultimately. We will ultimately feel more fulfilled in our role if we connect with the other human beings we work with. 216

Conflict at work

Figure 11.1  Pick up the phone

Tune in How did it feel to pick up the phone? How did this compare with how it feels to write a long and complicated email? Do you feel that you were able to connect with the other person? Are you becoming clearer about which situations require an email and which situations require a phone-call?

Go deeper Write a reflection about the difference a phone conversation makes. This might be straight after a phone-call, or a day later, when you see the impact it has made. You might find that over time your phone conversations get better: more productive; more connected. 217

Bringing it into the workplace

There will be phone-calls that are challenging, but where you can express yourself more meaningfully than you would have been able to do in an email. Once you have experimented with this, you might want to raise it in your team, and share your observations. You might invite others to do the same.

Stop story-telling Human beings are complex. In any given moment, we are simultaneously experiencing the present, but also being reminded of the past, and possibly projecting into the future. We have our perception of what is happening now, but there is a constant replaying of habitual thought patterns and emotions that get overlaid onto the present moment. This is heightened when someone says something which ‘triggers’ an emotion for us. At the point from which we are triggered, our attention and listening skills are diverted away from the here-and-now. We are possibly paying more attention to what we think that person is saying than what they are actually saying. We have begun telling a story to ourselves. We all have well-worn stories. They make up our personal history. They begin with family stories about what our personality is, how we are different from our siblings or similar to other relatives. Our stories encompass life-changing events: bereavement, separations, deprivations, struggles, triumphs. Our stories explain why we think or act like we do, how we’re going to do things differently, what we feel comfortable with, who we feel challenged by, what situations we avoid, and so on. As human beings, we seek out patterns, because this is how we learn and remember and organise ourselves in a complex world. The downside of being good at patterning is that we find ourselves creating the same stories in our lives over and over again. It is like we are reading from a script and can’t deviate. A quotation commonly attributed to Albert Einstein is: ‘Insanity is doing the same thing over and over again and expecting different results’. The way to break this pattern is to try to do something different. Our well-worn stories are likely to affect our personal relationships and our professional relationships. Different people will have different stories. It is possible to have seemingly contradictory stories going on simultaneously. We’re complicated. 218

Conflict at work

Do you recognise any of these storylines? –– –– –– –– –– –– ––

Am I the only person around here who cares about this? People think I know what I’m doing, but one day I’m going to be found out. No matter how hard I try, it’s never good enough. No one ever asks me what I think. Why wasn’t I included? They think he’s a better therapist/radiographer/paramedic than me. She/he always does this!

There are more stories, and more variations on a theme.

The next time you find yourself getting upset with another human being, it might be worth asking yourself: –– –– ––

What is this reminding me of? Have I slipped back into a well-worn story? Can I change the script?

Most of the time, awareness is enough. As soon as we become aware, we step out of the story. We can become an observer, rather than the protagonist. As soon as we have stepped out of the story, we recognise that our version is not the full story. We allow for curiosity. It is unlikely that we are 100 percent right or 100 percent wrong. It is likely that there are different perspectives. We might talk to the other person to check back our interpretation of what they said. We might expand upon or modify what we said. We might own our thoughts and feelings and explain how we made assumptions. This will invite the other person to do the same. 219

Bringing it into the workplace

We may not even need to talk to anyone else. We may just need to talk to ourselves. Our awareness might allow us to respond to the situation in a different way. We might ask ourselves: –– –– –– ––

What is the wise way to respond? What is the professional way of dealing with this? What can I learn from this situation? What will I do differently when this happens again?

We will always tell ourselves stories. This is part of being a complicated human being. But being aware of when we are telling stories, and how this might be affecting the current situation, changes the dynamic completely.

Tune in What did it feel like when you stopped yourself from story-telling? How did it influence your next step? How did it feel in your body when you imagined the other person’s perspective? Did you feel differently towards them?

Go deeper You might be interested in reading ‘I’m OK You’re OK’ by Robert Harris4 or ‘The Stories we tell Ourselves’ by R. Scott Gornto.5 These books help us to recognise the patterning of human behaviour, and how we might become more aware of our own patterns and stories in order to change the way we relate to others.

Depersonalise, re-professionalise A healthy team will be able to manage differences of opinion. There will always be different clinical priorities between professional groups in a multi-disciplinary team. A physiotherapist will have 220

Conflict at work

their professional lens. An osteopath will have another. A key skill in a multi-disciplinary team is to be able to express your opinion, listen to a colleague’s opinion and come to some sort of agreement or resolution about how to proceed. Sometimes you might have to compromise. A healthy team will recognise when compromise is needed. There will be compromise on both sides, rather than the person with the strongest will always getting their way. You will occasionally come across a colleague who you seem to clash with. It may be that you have different clinical priorities or clinical interests. You may have been trained or mentored in different ways, or have a different style or approach. If we find ourselves preoccupied and replaying conversations in our head, it is likely that we have become caught up in story-telling. As soon as we become aware that we are story-telling, we can ask ourselves a few questions: –– –– ––

–– –– –– ––

Where am I at today? Are there other things going on in my life that are making me feel vulnerable? What might going on for the other person today? Might there be things going on in their life that I don’t know about? Is this a pattern of behaviour that I recognise? Is this situation reminding me of another one in my life? Is this colouring my judgement? How might I be coming across? Might my intentions be being misunderstood? Can I address this? Am I overly attached to one solution? Might there be a different way of resolving the problem? Can I tolerate that we have a difference of opinion? Does there have to be a person who is right and a person who is wrong? What can I do to make the situation a little bit better with the other person? What can I do to demonstrate my respect for them?

These questions are designed to help you de-personalise the situation, and re-professionalise it. 221

Bringing it into the workplace

By working through the questions above, you have probably brought yourself out of subjective story-telling and back into objective professionalism. Professionalism allows for occasional differences of opinion. We can still respect another professional and have these occasional differences of opinion. You might have realised that your story-telling was more about you than the other person. They haven’t done anything wrong, and you probably were taking things personally that didn’t need to be taken that way. Once you have this insight, you may feel that you don’t need to take it any further. If you feel that there is conflict which needs to be resolved, it is best to check in with the other person face-to-face. If that is not possible, the phone is the next best method (see ‘Pick up the phone’ on p.215). The difficult people in our lives are often our best teachers. They help us to identify our story-telling, our blind spots, our judgements and assumptions, and perhaps the parts of ourselves we don’t like. They challenge us to practice compassion. Because we have to spend more time negotiating these relationships, we bring our full attention to them. Attention is the mechanism of change.

Tune in Can you think of a person who has challenged you at work? Can you work through the questions above to reach new insight into what is going on for you?

Go deeper You might write about this situation (see ‘Writing Therapy’ on p.254). Writing about it will make the learning more powerful. By writing, we send ourselves the message that this is important. We need to process the information and do something different.

Set boundaries for healthy work relationships Our professional body, the Health and Care Professions Council (HCPC) set out standards of conduct, performance and ethics. 222

Conflict at work

Clear expectations are also written into our job description, contract, commissioning arrangements and policies in our organisation. These written guidelines ensure that we have a shared understanding with our colleagues, managers and service-users. They set out clear professional standards. We can also think about our personal boundaries. If we have given this some thought, it is easier to identify when a boundary is being challenged. A boundary is something we can say a clear ‘no’ to. If we don’t have clear boundaries, we are in danger of overextending ourselves or going beyond our professional role or competence. If we don’t have clear boundaries, we might be at risk of colluding with a service-user or family member, when it is not in their best interests. If we don’t have clear boundaries, we risk agreeing with a colleague rather than using our own professional judgement. If we don’t have clear personal boundaries, there can be consequences for job satisfaction, our professional confidence, our work–life balance and our wellbeing. Think about some of these questions: –– –– –– ––

–– –– ––

What are my official working hours? How flexible am I prepared to be? How early is early and how late is late? How long do I take for lunch? Why is it important that I get a lunch-break? What are the non-negotiable items in my calendar? These can be professional and personal. What are the benefits and risks of me taking on additional clinical responsibilities? Are the benefits of developing my professional skills worth the personal risks of over-extending myself? Which projects do I need to be part of? If I accept this piece of work, what work am I not able to do? If I say yes to a request, what am I saying no to? This might include our personal life. If I say yes to this, what will happen next time? If I say no to this, what will happen next time?

223

Bringing it into the workplace

There will be occasions at work when we need to say a clear ‘no’. We might not agree with a service-user, carer, colleague or manager. We need to say so, or we risk our professional or personal integrity. Most of us need to practise this skill. Health professionals tend to say ‘yes’ because we are kind and we want to help. We sometimes say ‘yes’ as a reflex. If you regularly find yourself saying ‘yes’ when you mean ‘no’, you might try this strategy. ––

Thank the person for asking you.

––

If you need time to think about it, then ask for a specified length of time. You might need to talk to another person, check your calendar or consult clinical guidelines.

––

If you say no, explain why. Don’t over-explain it; if you talk for a long time, this will communicate that you might be open to persuasion.

––

Say what you can offer instead. This might include redirecting them to another person or service, offering a reduced amount of your time or offering a resource to get the person started.

Practice makes perfect. Start with a little ‘no’, like when someone asks if you want a cup of tea but you’ve just had one. You can progress to saying a bigger ‘no’. If we start saying ‘no’ sometimes, people will take notice that we have boundaries, and they will start to respect these. We are likely to feel empowered, as we recognise that our voice is important and that we have agency. This can make all the difference to our job satisfaction, personal and professional confidence, work–life balance and wellbeing.

Tune in How does it feel to say a confident ‘no’? Did you keep your explanation short and simple? What was the other person’s reaction? Would you say it in the same way again? Did the other person learn something important about you?

Go deeper 224

Conflict at work

Think about the roles and responsibilities that you have in your personal life. Which ones are non-negotiable or fixed? Which ones are negotiable? What are the consequences of spreading yourself too thinly? Can you renegotiate any of your current roles and responsibilities?

Compassionate communication AHPs are comfortable with helping others. We may be less comfortable with asking for help ourselves. If we don’t ask for help when we need it, we risk slipping into indirect communication of our distress. This might include manipulative behaviours, like sulking or blaming others. If we do this in our personal life, we are likely to do it at work too. Compassionate communication is based on respect and compassion for ourselves and for others. It can be applied to any relationship, be it personal or professional. Compassionate communication encompasses: ––

––

––

––

Observing without judging. When there is a problem, we describe the actual, observable, concrete behaviours that we can see and hear. For example, ‘I noticed that you didn’t say anything’, rather than ‘you didn’t back me up’. It’s an observation, rather than an opinion. Recognising and expressing our feelings. We start the sentence with ‘I feel’. For example ‘I feel alone’. We don’t add the clause ‘because you … ‘ This slips into judgement. Identifying our unmet need. ‘I need to feel supported’. We are being honest with ourselves and others. We may need time to think about this. Making a reasonable request about how we would like them to behave next time. ‘I would like you to be engaged in the discussion’. Think about whether your request is reasonable. We can ask the other person whether this sounds reasonable.

It is equally important that we then listen to the other person, as they may have their own observations, feelings and needs. 225

Bringing it into the workplace

Compassionate communication requires practice. We might get one or two principles straight away, but need to work harder on the others. Compassionate communication requires that we tune into our own needs, thoughts and feelings. We approach the conversation with more honesty about our own motives. Sharing our vulnerability is likely to generate increased empathy and trust from others. Ultimately, it will help us to process our feelings and take responsibility for getting our needs met. This will benefit others, as they will understand what we need, rather than trying to guess.

Tune in Can you think of the last time you felt upset with someone? It can be at work or at home. Can you go through the principles of compassionate communication above and come up with a phrase for each bullet point? It may take time to do so. You may find yourself slipping into judgement phrases. When you do, just return to the actual observable behaviour. Imagine yourself saying these phrases to the other person. How does it feel? How easy is it for you to identify your needs and feelings? Can you imagine the response of the other person? Even if they did not respond in an ideal way, would it feel empowering to use these phrases?

Go deeper If you struggle to identify your thoughts and feelings or unmet needs, you might practice these skills through ‘Riding the wave of emotion’ on p.121, ‘Observing thoughts’ on p.124. and ‘Writing Therapy’ on p.254.

Notes 1 Strauss C, Lever Taylor B, Gu J, Kuyken W, Baer R, Jones F, Cavanagh K. ‘What is compassion and how can we measure it? A review of definitions and measures’ Clinical Psychology Review 2016 Jul;47:15–27. 226

Conflict at work 2 The Oxford Handbook of Compassion Science eds. Seppälä EM, SimonThomas E, Brown SL, Worline MC, Cameron D, Doty JR. Oxford Library of Psychology 2017. 3 Ravi Ravindra. The Wisdom of Patanjali’s Yoga Sutras: A New Translation and Guide Shaila Press 2015. 4 Harris TA. I’m Ok You’re Ok: A Practical Guide to Transactional Analysis Arrow 2012. 5 Scott Gornto R. The Stories We Tell Ourselves: Stop Jumping to Conclusions. Free Yourself from Anxiety. Transform Your Relationships Auxano 2014.

227

SECTION 4 Our place in the world So far we have focused on our physical wellbeing, our emotional wellbeing and our wellbeing at work. This final section focuses on our wellbeing in relation to our wider community, and the world at large. It is about the bigger picture: our place in the world. This chapter is, in a way, about our need for spiritual fulfilment. Human beings, from the start of time, have needed to have a world picture: a way of understanding our place in the world. The major world religions all emphasise service to others and service to the world at large. They all emphasise a personal responsibility to try to be our best selves. If we don’t have a religious belief, we may find our spirituality in nature. This is sometimes referred to as ‘horizontal spirituality’.1 Our faith spreads outwards to all beings and all things in the world, rather than upwards to a deity. We may feel awe-inspired by the abundance, exuberance and mind-boggling diversity that we find on this planet. We may be astounded by our existence in this universe. This is only enhanced by our scientific observations from the microscopic to the cosmic level. We might have a humanistic world view, and be astounded by human endeavour. It is incredible what humans can do when they put their minds to it. This is evident in our work as AHPs. Whether we have a religious, spiritual or secular world view, we all want to be our best selves. We want to be important to others. We want to look back on our lives with pride. We want to live our lives fully. DOI: 10.4324/9781003165125-15

Our place in the world

Being an Allied Health Professional is often woven into the fabric of who we are. This is more than a job. This also means that it can drain us. We can get burnt-out. We might question whether this work is still for us. This section will look at how we keep feeling inspired and energised and motivated by our work, and how we might sustain ourselves through tough times. It is through the tough times that we find ourselves. We realise our strength and stability, and our connection with this world. Our wellbeing is deeply connected to the wellbeing of those around us. This extends to people we don’t even know. It is impossible to thrive if we are surrounded by people who are suffering. An individual person cannot truly thrive if their community is not thriving. We have an opportunity in a post-Covid world to address health, education and social-care inequalities. As AHPs we have unique insight into this. We can use our knowledge, compassion and vision to drive social change. We can use our influence, via our work organisations and our professional bodies, to make a societal difference. We can look outwards for models of how to proceed. We can inspire others with our ideas. We are social beings. We know at a very deep level that we have a responsibility to one another, and to our whole planet. This section considers how we stay true to our higher purpose. This is self-transcendence. We can expand our self-care to bring it out into the world. This is the ultimate in wellbeing.

Note 1 Bloom W. The Power of Modern Spirituality: How to Live a Life of Compassion and Personal Fulfilment Piatkus Books 2011.

230

12

Purpose

Even if we are not religious or spiritual, it is helpful to tune into what we see as our purpose in life. This becomes our lodestar, our moral compass, our spiritual guide. We will begin this chapter with identifying our natural gifts and our learned behaviours, and how to tell the difference. This will help us manage our energy so that we are not depleted by using too many learned behaviours and not enough natural gifts. Our purpose is our offering to the world. If we live with purpose, we bring our best self to work, as well as in our personal lives. If our activities are aligned with our values, we feel we are living our best life. We are authentic, vital and free. There are two different activities in this chapter aimed at identifying our purpose. One is more cerebral; the other is more creative. Choose the one which appeals the most to you. Once we are clear about our natural gifts, our learned behaviours, our values and our purpose, we can use this information to guide our decision-making. It will also help us to spot opportunities in our lives where we can make best use of these resources. This will lead to a more fulfilling life. There will be times when we feel depleted. An instant fix might be to have a slideshow to remind us of our higher purpose, or a restorative playlist that we can listen to at the end of a tough day at work. We will consider different types of personal goals, distinguishing between intrinsic and extrinsic rewards. We can anticipate that we will have bad days, and adapt our goals for those days. Finally, we will imagine living as though life was weighted in our favour. This mind-set contributes to an overall trajectory of personal DOI: 10.4324/9781003165125-16

231

Our place in the world

growth. We make use of the resources available to us, and are more attuned to opportunities. This whole chapter is geared towards helping us make wise choices about our overall career trajectory. If we can clearly identify our natural talents, values and purpose, this will help us to weigh up the pros and cons of making a career move. This can include applying for a new position, engaging in further learning or research, offering or seeking mentoring or supervision, moving into management, moving into independent practice, flexible working, working from home, taking a career break and planning for retirement. The more we tune into our values and purpose, the more secure we are in our decision-making. Ultimately we will have more satisfying, energising, dynamic careers and fulfil our potential as AHPs.

Identify your natural gifts and learned behaviours Tension is who you think you should be. Relaxation is who you are. Chinese proverb We all have different abilities. Some things seem to come naturally to us, without much effort. Other qualities are hard-won through practising them over and over. A natural gift is something which comes easily. It is something which brings us energy. We feel vital and vibrant when we use this skill. A learned behaviour has not come naturally. It can drain us of energy. We have worked hard to acquire the skill, and we have to consciously cultivate it. We might be very good at this skill, and others might assume that it is a natural gift. Only we can judge whether it is an energising natural gift or whether it is a learnt behaviour. Look at the list of traits below. Put a tick next to the traits that come easily and naturally, and which energise you. If you think you have acquired the skill, but that it is a learned behaviour, mark it with a ‘L’.  We want to make use of our natural gifts as much as possible, because we will be energised by these. So long as we are making use of our natural gifts, we will generate enough energy to help us acquire some learned behaviours too. We should be proud of the work we have 232

Purpose Table 12.1 Natural gifts and learned behaviours Adaptable

Creative

Inspiring

Adventurous

Curious

Observant

Ambitious

Decisive

Organised

Appreciative

Diplomatic

Patient

Authentic

Empathic

Persistent

Calm

Engaging

Reflective

Collaborative

Fun

Resilient

Compassionate

Independent

Strategic

Courageous

Innovative

Systematic

put in to acquire the learned behaviours, but also acknowledge the effort that they require from us. Think about your current job. –– –– ––

How do you make use of your natural gifts? Are there opportunities to acquire learned behaviours? What is the balance between natural gifts and learned behaviours?

If we know what our natural gifts are, we can look for opportunities to use them. We will be optimising our energy when we use our natural gifts. If we rely mainly on learned behaviours, we risk depleting our energy. We might be pleasing other people and getting better at our job, but it may be at the expense of our own vitality. Ideally we want the use of natural gifts to outweigh the use of learned behaviours. Knowing what your natural gifts are will help you make decisions about career opportunities. There might be a research opportunity that allows you to use your natural gifts of being curious, systematic and reflective. You may need to learn organisational skills to help you complete the project, but that will seem quite manageable if the other key skills come naturally. There will be times in life when you have the capacity to acquire learned behaviours. These will be the times when you look for a new job or take on new responsibilities. You may be exhausted for the first few weeks in a new role if you are learning new behaviours. You might 233

Our place in the world

need to replenish your energy at the weekends by focusing on activities which use your natural gifts.

Tune in How does it feel to identify your natural gifts? Was it a surprise to find that some of the things you are good at are learned behaviours? Does the identification of learned behaviours explain why you find some tasks more exhausting, even though you are good at them? Can you offer yourself more compassion when you are carrying out tasks that require learned behaviours? Can you indulge in more activities which use natural gifts in your leisure time? Would it be helpful to communicate this knowledge to the people in your life?

Go deeper You might explore natural gifts and learned behaviours as a team. This can promote compassion within a team, as you learn that what you assumed was a natural gift for a colleague is a learned behaviour. This awareness might help you make the most of the talents within your team. It might be useful for service development work.

Align with your values Values provide a reference point for us in life. In a chaotic world, where there are multiple demands on our time and attention, having a clear sense of our values can help anchor us. We can gauge the rightness of our actions by how they align with our values. Your values may overlap with your natural talents or learned behaviours. It is also possible to have a value that is not a particular strength for you, but that you really appreciate in others. We will ideally share values with our life partner and close friends. We may measure others by how closely their values overlap with ours. We are likely to have more trust in our colleagues and managers if we feel that they share our values. 234

Purpose

It helps if there is close overlap between our values and those of the organisations we are involved with. In this way, we can feel proud to be associated with them. This will include our school or university, our previous and current employers, our regulatory body, our government. We will feel more at ease and have trust in these organisations if we feel that they share our values. If we have had associations with organisations that don’t share our values, we are likely to have dissociated ourselves from them. This may have strengthened our own values. Our values influence every aspect of our lives. They influence where we spend money and which businesses and charities we support. They influence where we choose to live and work, how we engage with our communities and where we go on holiday. If an organisation breaches our values, we withdraw our support. Below is a list of values. Which ones resonate with you? You might want to give them a star-rating. The higher the star-rating, the more important that value is for you. These could be considered your ‘core values’.  Knowing our values is helpful in many ways. Being clear about our values will help us to: ––

Make wise decisions about how we spend our time, how we spend our money, where we work, who we spend time with and what we are exposed to in the real world and the digital world.

––

Find purpose and meaning in life. If our professional role is aligned with our values, we will find it more fulfilling. Similarly, we will feel enriched by our leisure time if we have hobbies and interests that align with our values.

––

Make difficult decisions. We could do the easy thing, or we could remain true to our values and do the courageous thing. Reminding ourselves of our values will increase our resolve to do the courageous thing.

––

Clear out clutter that doesn’t energise us. We might be associated with people, places, organisations, businesses, social media and mailing lists that don’t mean anything to us. We make the best use of our energy if we dissociate from these things.

––

Feel satisfied with our lives. We gain intrinsic rewards from being true to ourselves. We are not reliant on extrinsic rewards like other people’s opinions of us, or social status or money, in order to be contented. 235

Our place in the world Table 12.2 Core values Accountability Adaptability Adventure Altruism Ambition Animal welfare Arts Authenticity Balance Belonging Caring Clear boundaries Collaboration Commitment Community Compassion Competence Confidence Connection Contentment Contribution Cooperation Courage Creativity Curiosity Dignity Diversity Efficiency Equality Ethical Excellence Fairness Faith Family Financial stability Forgiveness Freedom Friendship

236

Fun Future generations Generosity Giving back Grace Gratitude Growth Harmony Health Home Honesty Hope Humility Humour Inclusion Independence Initiative Integrity Intuition Job security Joy Justice Kindness Knowledge Leadership Learning Legacy Leisure Love Loyalty Making a difference Nature Openness Optimism Order Parenting Patience Peace

Perseverance Personal fulfilment Pride Public service Recognition Reliability Resilience Resourcefulness Respect Responsibility Risk-taking Safety Security Self-discipline Self-expression Self-respect Serenity Service Simplicity Spirituality Success Sustainability Teamwork Thrift Time Tradition Travel Trust Truth Understanding Uniqueness Usefulness Vision Vulnerability Wealth Wellbeing Wholeheartedness Wisdom

Purpose

Tune in How does it feel to clearly identify your values? When you read through your core values, how does it feel in your body? Where do you feel it? Can you use this energy when you are in a difficult situation in order to do the right thing, staying true to yourself? If you dissociate from organisations, companies, mailing lists and social media accounts which do not align with your values, how does this feel?

Go deeper You can use your core values to make big and small decisions in your life. For example, if sustainability is important to you, you might hold yourself accountable every time you make a financial decision. This might include choosing your energy supplier, your mode of transport, where you buy your food or clothes. If a core value is ‘giving back’, you might look for companies who operate on fair-trade principles, pay their workers a living wage, and have strong ethical standards. You will find that this reduces your impulse buying. Spending money has a different meaning: it is not simply handing over your money: you have a sense of purpose because you see how your spending choices impact upon the wider world. Pennies are power.

Find your purpose Your sense of purpose is how you want to show up in the world. It is how you intend to serve others, and how you intend to be your best self. Human beings have an innate desire to find their role. We are social beings, having evolved in social groups. We need to know where we fit into the whole. We need to feel that we have something to offer and it helps if we value this offering. It helps to have a clear sense of purpose. It helps with making decisions about what is right for you. Having an overarching sense of your purpose does not keep you tethered to a rigid plan. It allows you to weigh up whether this particular opportunity takes you in a surprising 237

Our place in the world

direction, but still aligns with your overall purpose. Once you know your purpose, you can develop in multiple directions, often developing many possibilities at the same time. Health professionals often have a head-start in knowing their purpose. They do not go into the profession for the money or status. They are generally motivated by the intrinsic rewards of the role, because something about it appeals to their innate sense of purpose. Take a moment to think about the following questions. Write down your answers so that you can refer to them later. –– –– –– –– –– –– ––

Why did you choose this profession? What other careers tempted you? Which of those would have suited you? How does this profession bring out the best in you? Which particular parts of the job give you the most satisfaction? Which social demographics or clinical populations do you feel drawn to? If you could tweak your role, what would you add? 

For personal development, it is helpful to have a more expansive sense of purpose. One that encompasses work, but also your home life. Your purpose informs choices about your activities within and outside of work.

Thinking about when you are not at work, answer the following questions. –– –– –– –– ––

238

What activities energise you when you are not at work? Which activities would you choose if you had no time constraints? If you won a million pounds and could not spend it on friends and family, which causes would you support? If it was compulsory to volunteer once a month, what role would appeal to you? What would you like to be written in your eulogy?

Purpose

Figure 12.1  Find your purpose

Read through all that you have written. Do you feel like this encompasses your sense of purpose? Can you condense this into just five ‘purpose statements’ that are the most important to you? It might look something like this: ––

Awareness.

––

Curiosity.

––

Life-long learning.

––

Connection with others.

––

Caring for our planet.

Each purpose statement in your list will be heartfelt. It will energise you and inspire you. Take some time to reduce your list down to five. You can even sleep on it.

239

Our place in the world

Once you are happy with your five purpose statements, display them somewhere or keep them in a notebook or on your phone, so that you can keep referring to them. See where you can put these purpose statements into practice. Each week you could review them and reflect on where they came up at work or at home. Where can you use more of them in work or at home? If you need a little more help to choose your five phrases, try the exercise on the following page, which is less of an intellectual exercise, and more instinctive. When you have settled on your five purpose statements, you can start to consider them when you are making decisions in your life. If an activity is aligned with your purpose, you are living an authentic life. If you are being offered a choice but it is at odds with your purpose, you will probably feel a sense of disconnect and you will be uneasy with this choice. We are more likely to feel satisfaction with our life if our actions are aligned with our purpose. We are also more likely to look out for opportunities to fulfil our purpose when we are clear about what we stand for. This will help us to make wise decisions about career opportunities. We will be able to identify when we need to make a small tweak or a big change. If our current job does not align with our purpose, we can do something about this. If we have multiple options, we can weigh each against our purpose. Our purpose does not end when we reach retirement. We can carry over our purpose into whatever we do next, be that community involvement, volunteering, pursuing interests and hobbies, or spending time with friends and family. Living with purpose is a life well-lived.

Tune in How does it feel when you read your five purpose statements? Do they inspire you? Do they energise you? How can you put these words into action in your life? How can you use them in work? How can you use them in your leisure time? Can you use them in your relationships? Can you use these words to guide your decisions about how you spend your time outside of work? Can they help your decision-making around your learning and career direction? 240

Purpose

Go deeper You might want to journal about each of your five purpose statements. Write about a different one each day. Write a page about how you put this into practice at work. You may initially think you don’t use that quality at work, but after thinking about it for a while, you realise that you do. This can increase job satisfaction. You might want to review your purpose every few months, or once a year. You are allowed to evolve, and change some of your purpose statements if they no longer resonate.

Your purpose in pictures If you are feeling creative, it can be a fun exercise to explore your purpose through visual media. If you want to do this in a low-tech way, then you will need to collect a few magazines. ‘The National Geographic’ is perfect, because the images are often striking and inspiring. Photography magazines and Sunday supplements are also good. If you prefer to do this in a high-tech way, you will have no shortage of images to choose from on the internet. Try search terms like ‘photograph of the day’ or ‘artwork of the day’. Flick through the images that you see. As soon as an image appeals to you, cut it out or save it. Don’t think for too long about it; make a snap decision. If it inspires you or sparks your interest, choose it. Once you have a collection of around ten images, arrange them on the page. An optional step is to show this collection of images to someone. Ask them what they see in these images. They might see completely different things to you. This might clarify or broaden your understanding of what the picture means to you. Now see if you can explain to the other person why each image appealed to you.

241

Our place in the world

If you need some cue questions, here are a few: –– –– ––

What is it about this particular image that appealed to you? What does it remind you of? Does it inspire you? Does it energise you? Why?

If there are people or animals in any of the images, –– –– ––

What are they saying to you? What do they make you feel? What thoughts do they inspire?

Having done this, can you choose five words or phrases that these images have inspired? These words can become your purpose statements. They express what you want to create, cultivate and develop. They are the words that mean that you are bringing your best self into the world. You might want to write or type your purpose statements onto the same page as your images. You might want to save these images on your phone so that you can look at them when you need a reminder of your purpose or your best intentions. They can help you make decisions about what is best for you and your role in the world.

Tune in How does it make you feel to look at these images? Does it help to look at these images when you are lacking in motivation or purpose? Is it helpful to look at your images before an important day? Is it helpful to consider your images and purpose statements when you are making a decision about work or your life in general?

Go deeper You might make a slideshow of your images and set them to a piece of music. When you need inspiration or a lift in mood, you can play your slideshow and music. 242

Purpose

You might try this as a group exercise. In your team, you could take it in turns to share your slideshow and piece of music at the start of a team meeting. Others are allowed to make appreciative comments, but you don’t have to explain the images or music unless you feel comfortable to do so.

Make a restorative playlist Music has a unique ability to resonate with us. It can bring out emotions that might have been below the surface of our awareness. We can feel profoundly moved by a piece of music. We can feel the most intense joy, longing, sadness, hope, connection. Music has the ability to go beyond words. This might be why it is so useful when we are exhausted after a hard day at work. Music helps us to feel our common humanity. It is a spiritual experience. We can feel connected to people who are no longer with us; those who have passed through our lives but retain their significance. We can also feel connected with people we don’t know. Somehow the musician is expressing something that you have felt yourself, and there is a connection between you. Have you ever had the experience of being at a music event and everyone is singing or dancing together? Aerial shots of concerts often capture this, with a mass of humans moving as if it is just one organism. Music reminds us that we are a small part of a much larger whole. Music can transport us in time and space. Through music, we are reminded that we are many people living one life. We have had different incarnations of ourselves. We are children, we are adolescents, we are young, we are old. We are all of these things simultaneously. Music lends an awareness to this abundance and potential. With this in mind, you might like to create a playlist of eight songs which you know will restore you on a difficult day. Eight songs means that you have to be very selective and only choose the songs which really mean a lot to you. Eight songs are enough to hold your attention. They can be played on your commute from work to home, so that by the time you get home you are soothed and re-energised. 243

Our place in the world

You might choose: ––

––

––

–– ––

A song from an earlier period in your life. Songs from our childhood and adolescence are often energising. They make us feel young and fresh and alive. They might come with funny or fond memories that remind you of who you were before you became a health professional. A song which makes you want to sing or dance. Moving to music can help us move emotions through our bodies. Animals typically flap their wings, shake their bodies or squawk to get rid of negative emotion after a distressing event. Humans can do the same with the help of music. A song to represent a positive and nurturing relationship in your life. Someone who was, or is, able to soothe you and make you feel safe. An angry song which you can belt out and release your pent up frustrations from the day. A song which connects you to your higher self. It might be a hugely ambitious piece of orchestral or choral music. It might be a piece of music which has cultural, spiritual or religious significance. It might be an inspired, improvised piece of jazz or hip-hop. Whatever works for you.

Name your playlist something meaningful for you. For example ‘We can do this’ or ‘shiny happy tuneys’. Try your playlist out. You will know if it hits the spot or not, and you can edit it as needed. 

Tune in How does this piece of music make you feel? Where does it take you? Does it help you release negative energy? Does it make you smile or laugh? Does it make you feel free? Does it inspire you? Does it soothe you? Does it restore your balance?

Go deeper 244

Purpose

Figure 12.2  A restorative playlist

You might want to write about each piece of music and what it means to you. Or you might play it to someone else. You could make this a group activity, with each person taking it in turns to play a piece, and giving a short explanation of why they chose it. You will need to set ground rules that comments should be appreciative. Because music is very evocative and very personal, it can be very upsetting if someone doesn’t like a piece that you have chosen. If this does happen, don’t take it personally. It doesn’t take anything away from your appreciation of this piece.

245

Our place in the world

Set personal goals which have intrinsic rewards We are very familiar with setting goals for our patients or service-users. We also set objectives for our appraisals each year. These will typically be focused on our professional development. There may also a benefit to setting ourselves personal goals. Goals can give us a sense of direction in life. Even if we don’t reach our goal, it might mean that we learn some useful skills along the way. We might learn something about ourselves and our priorities. We might learn that we need to reset our trajectory. The benefits of setting goals include: –– –– ––

We evaluate where we are now, and where we would like to go next. Goals can help us prioritise our time and help us make decisions about our activities We can tie goals into our overall purpose. Our purpose is the big picture. Our goals can provide the detail for how we stay true to our purpose.

As an AHP, you are probably familiar with SMART goals. SMART goals are: ––

Specific: to a situation in your life.

––

Measureable: you can easily say if you have achieved it.

––

Achievable: given your current skills.

––

Realistic: for your current life situation.

––

Time-limited: by a certain date you will have achieved this.

SMART goals can be a bit joyless and limiting. If one variable in your life changes, the whole SMART goal is scuppered. This is why I also like SCRUFFY goals.1 SCRUFFY goals are sometimes used in special education, and so I have adapted the words for an adult population. SCRUFFY goals are: ––

Self-chosen: with an intrinsic reward for you.

––

Creative: there is more than one way to achieve the goal. 246

Purpose

––

Relevant: they link to your overall purpose; you can say why you have this goal.

––

Unspecified: they can be adapted for when you are having a bad day.

––

Fun.

––

For.

––

You.

Only you can decide whether you want to set SMART or SCRUFFY goals, or whether you want to set goals in a different way that works for you. You might want to set long-term goals for the next 1–5 years, or you might want to set short-term goals for the next few weeks or months. It is helpful to think of the next small step you can make. For example, if you currently get 10 minutes of movement per day, you could aim to get 20. Next month you could aim to get 30. You can build up slowly. Small steps are likely to be more sustainable that huge changes all at once. You might want to set goals around your career, finances or relationships. For example, you might want to have the goals of moving into a particular clinical area, or buying a house. This type of goal is reliant on extrinsic reward. Goals that are overly reliant on an extrinsic reward are associated with reduced wellbeing and life satisfaction.2 They can end up making us feel that we have no agency, because we are subject to forces beyond our control. The Band 7 role you want may not become available. You may not be able to afford a house in the area you would like to live. For career, finance and relationship goals, it might be worth having a Plan B or Plan C in mind too. For example, you might consider different options for a Band 6 or 7 post, or you might move into the independent sector. You might consider part-ownership, buying a flat or looking at a cheaper area to live. You have choices, and choices are vital for your wellbeing. Another type of goal is one which brings intrinsic rewards. These goals are focused on the process, rather than the end-point. We tune in to how we feel, and what we are learning or gaining from the activity. We know that we are going on a journey. It will have twists and turns; we will make mistakes and we will lose motivation, but we can get back on track. 247

Our place in the world

Rather than visualising yourself at the end point, visualise yourself in the learning process. For example, if your goal is around exercise, don’t visualise yourself as a different size or shape. This is an extrinsic reward. Instead, visualise yourself carrying out the activities along the way. Adopt the growth mind-set of ‘what will I learn?’, ‘what will I gain?’ and ‘what will I feel?’ These are intrinsic rewards. We need to anticipate a time when our initial enthusiasm has worn off, or when we are going through a challenging time and there might be competition for our time and attention. What will you do on a bad day? Imagine that a loved-one is struggling and needs your time and attention. What will you do on this day? Below is a sample sheet for setting goals. This is just a suggestion. You might prefer to lay out your goals in a more visual way, like a mindmap. Or you might like a spreadsheet or reward chart.  You can fill out the column for ‘what have I learnt so far?’ as you go along. This column relates to all the ‘tune in’ prompts that you have seen in this book. It is for your own observations and reflections. It is helpful to regularly update this, because the learning will

Table 12.3  Setting goals What is my goal?

Is it linked What activities will What will I do with my values I carry out? on a bad day? or purpose?

What have I learnt so far?

Spend time on my breath awareness every day.

Yes: self-care, looking after my longterm health; showing myself compassion; being the best version of myself.

Breathe when I open my emails.

••

March or jog on the spot when I’m waiting for the kettle to boil. Desk yoga.

••

Meditate for 5–10 minutes before I get into bed.

••

30–60 minutes of movement per day.

Meditate for 10 minutes per day.

248

••

•• ••

••

Breath awareness as part of my yoga practice.

••

Morning yoga using my ‘Yoga Anytime’ app. Lunchtime walk.

••

Meditate for at least 15 minutes before I get into bed.

•• ••

•• ••

••

I feel more calm. I sleep better. I get fewer colds. I feel more joyful and energetic. My mood is improved.

I feel connected to something that is bigger than myself.

Purpose

be continuous. You might review it every month. This way you can see whether the goal has an intrinsic reward for you. If it doesn’t have an intrinsic reward, you might change the goal. Don’t panic when you break your winning streak! When we start a goal, we are highly motivated to carry out activities, and we probably stick to it really well. After a couple of weeks, our motivation will reduce. If we have a bad day, we might forget about our goal and not do any activities towards it. This is normal.

When you have missed your activity for the day (or week): –– –– –– –– –– ––

Offer yourself compassion, remind yourself that you are normal. See this as an opportunity. What else do you need to do for your self-care? Do you need to have a more realistic goal, or have more options for a bad day? Is the goal intrinsically rewarding? What have you learnt so far? Reassure yourself that you can get back to the goal tomorrow. Visualise yourself tomorrow getting back to the activity. Visualise yourself having a moment of hesitation, and then deciding to go ahead with the activity with the mind-set of ‘what will I find out about myself today?’

It is important to experience a bad day, because we learn how we can adapt the goal. We are not aiming for perfection, because perfection is unsustainable. We are aiming for balance and flexibility. Our lives will change and fluctuate. Our goals need to reflect this.

Tune in How does it feel to think about setting goals? Does it feel restrictive or stressful? If so, don’t set goals, or keep them very scruffy! Does it feel motivating or energising? If so, go ahead and set goals. 249

Our place in the world

Go deeper We are more likely to stick with goals if we are accountable in some way. One way to be accountable is to start a wellbeing group at work. You might share your goals with one another and report back each month. This way, you might also be inspired by one another, and learn more about selfcare and its diverse effects.

Live life as it if is weighted in your favour We can’t control what happens to us in life, but we can control how we view it. Life is tough. In any one person’s life, there will be great adversity. We will fail more times than we win. We will fail exams, driving tests, medical investigations, job interviews. We will have failed relationships. We will struggle with parenthood and caring responsibilities. We will have periods of poor mental or physical health, often both at once. We will have panic attacks or episodes of depression. We will see those we love suffer. We will lose them. And yet, we survive. We often emerge from the experience with a changed perspective. We have a new insight. We have wisdom. We have compassion. Have you ever noticed that Plan B has turned out to be better than Plan A? You didn’t get into that university but you found a lifelong friend at another. You didn’t get that job, but another opportunity came along six months later. From every challenge, we can emerge a slightly different person. We realise that we have resources. That might be in the form of supportive family, friends or colleagues. We might seek support from further afield: counselling or an online community. We might develop self-care practices where previously we had none. We have more empathy or compassion for others who have experienced adversity. We have more courage and resolve. We have a more nuanced understanding of the world. We are more open to change. You can cultivate a mind-set of living life as if it is weighted in your favour.

250

Purpose

Think of three life events that fundamentally changed you. –– –– ––

What did you learn? What did you change? Is there a lasting positive influence?

I expect that you have stories of how adversity at first confounded you, or even devastated you, but then galvanised you into action. You can also use this concept in the small events in life that seem to confound you. It might be a traffic jam, a train that doesn’t arrive on time, a patient or colleague who is rude, a room that is unsuitable, a near-miss incident, a system at work which could be improved. If the world is weighted in our favour, there must be some opportunity here. It might be the opportunity to change. Instead of being worn down by work, we can raise the issue with our manager and share our idea about how to improve things. Instead of being paralysed by shame after a near-miss incident, we can learn from our mistake and do things differently next time. It might be the opportunity to accept what we cannot change. We cannot influence traffic or public transport. We can take the opportunity to take calming breaths. We could practice gratitude for what is going well. We have a car. We have a coat. There will be other trains. By telling ourselves that life is weighted in our favour, we can provide immediate relief and reassurance that something better will be coming along soon. We are priming ourselves to look for opportunities. We are more likely to notice and to make use of the varied the resources we have available to us. We will see events as opportunities and will consider our various options. There might be circuitous and intriguing routes to explore, and there will be adventure and adversity on the way. That all makes for a life well-lived.

251

Our place in the world

Tune in When life presents a challenge, acknowledge it. You wouldn’t choose this, but can you accept that it is there? You don’t understand why you have been sent this challenge. The meaning of it may not emerge for several months, or even years. Can you see the challenge as an opportunity to learn more about yourself? What do you need to do to take care of yourself?

Go deeper A deeper spiritual question is to ask ‘why am I here?’ or ‘why was I chosen to exist?’ In your short lifetime, what can you learn and create and share with the world? You could have been an amoeba, a potato, a dung beetle or a sloth. Instead, you are a human being. How can you make best use of this opportunity?

Notes 1 Penny Lacey’s work can be found at The University of Birmingham’s website. Search for: Scruffy Targets, Meaningful Outcomes, Inspiring Legacy – Celebrating the life and work of Dr Penny Lacey. 2 Hart R. Positive Psychology: The Basics Routledge 2021, p. 110.

252

13

Adversity

We will have times when things are going well for us, but these will not go on forever. Good times will be balanced by bad times. There are periods in our life when the dice seem loaded against us, and we have one difficulty after another. Self-care practices are useful in the good times. They are essential in the bad times. It is helpful if we have already established a few practices when adversity strikes, but it is never too late. Experiencing adversity can be the trigger we need to implement self-care. We will probably need to adapt our self-care in the peak of a crisis. Not least because we will probably have less time. If we have already established a practice of ‘tuning in’, then we may be able to identify what we need to do right now, and how we might adapt our practices. Gentle, compassionate practices are likely to be more effective at this time. You may want to reduce the strictness or intensity of practices, so if you usually do a half-hour high-intensity workout, you might want to go for a walk instead. Self-care can be doing nothing. It can involve drinking tea, eating chocolate, and lounging on the sofa watching movies. If this is the gentle, compassionate thing to do, then do it. Ideally, you will continue to ‘tune in’. You might identify after a few days that this is no longer entirely working for you. You might bring in some very gentle additional self-care. It can be as simple as stepping outside for ten minutes, having a shower or telling someone how you feel. This chapter will consider writing therapy, post-traumatic growth and moral injury in the context of being an AHP. We will think about what we need in our emergency self-care kit for when we feel exhausted. DOI: 10.4324/9781003165125-17

253

Our place in the world

We will examine our tendencies towards distraction behaviours and how we might interrupt an unhelpful pattern. We might visualise a protective posse of friends and supporters when we really need them. Finally we will consider forgiveness. Forgiveness is one of the most powerful tools to help us move on from adversity. Carl Jung famously said ‘I am not what happened to me. I am what I choose to become’. We can’t protect ourselves from adversity, but we can have a handful of practices to help us cope when it strikes.

Writing therapy I hear and I forget, I see and I remember, I write and I understand. Chinese Proverb There is evidence that writing our thoughts down can be as effective as receiving a counselling session. In research, outcomes have included better physical health, improved immune system functioning and fewer days off due to illness’.1 Writing about a traumatic event has been shown to reduce the risk of post-traumatic stress disorder (PTSD). The process of writing is thought to help with constructing a story which makes sense. It helps with emotional and social regulation after a traumatic event.2 If you have had an upsetting day, try writing about it in the following way: –– –– ––

–– –– –– ––

254

Write either for 15 minutes or for 3 pages. Write about whatever is bothering you right now. You do not need to read it back, so don’t worry about your handwriting, spelling or grammar. If it makes you feel better, then you can tear up the writing afterwards. Write whatever comes into your head. Write down your deepest thoughts and feelings about the event. You can make links with other events in your life, or with personal relationships you have now or have had in the past. You can link to the person you were in the past, the person you are now and the person you would like to be in the future.

Adversity

–– –– –– ––

You can write about the same issue for several days, or a different issue each time. Keep on writing until the time is up, or until you have written three pages. You may feel extremely distressed whilst writing. It is OK to cry whilst you write. Dispose of your writing if you like.

Tune in How does it feel in your body after you have spent some time writing? Was it surprising what came up? Did you learn anything new about the situation? Might this awareness help with ‘Compassionate communication’ on p.225?

Go deeper If the same issue keeps cropping up, or if you have been through a hard time or a trauma, you may want to seek professional counselling. Many employers, including the NHS and local authorities, offer a free counselling service. Charities can also offer counselling about specific issues, for example ‘Cruse Bereavement and Rape Crisis’.

Post-traumatic growth Trauma is something that shocks us to our core. There has been a threat to our physical or psychological safety. If we have grown up in a predictable, safe environment, we expect the world to go on being predictable and safe. One day, there is a sudden and shocking change. We have to somehow process this. Post-traumatic stress might follow a bereavement, or a devastating diagnosis for ourselves or a close family member. It might be a 255

Our place in the world

relationship breakdown. Post-traumatic stress is likely to follow on from abuse or sexual assault. Post-traumatic stress can involve: ––

–– ––

––

Intrusive thoughts about the event, resulting in overwhelming fear or grief. It can feel like we are experiencing the trauma again. Avoidance of any situations that might trigger memories of the event. This might include locations, people or activities. Inability to feel the normal succession of positive and negative emotions as we go through our day-to-day activities. There may be intense guilt or blame, or persistent negative emotions. Increased irritability and agitation, which can manifest physical symptoms such as heart palpitations, rapid breathing and sweating. There may be bouts of rage. There may be hypervigilance and an inability to relax.

These symptoms are considered normal in the immediate aftermath of trauma. If we are able to process the event, by talking about it or writing about it, or expressing our thoughts and feelings through a creative outlet, the symptoms of post-traumatic stress are likely to lessen over time. In the NHS and local authorities, staff can be referred to counselling services. NHS Trusts also provide supervision or support sessions such as Schwartz rounds to help staff process work-related trauma. If symptoms persist and are not reducing, we may need to seek help for possible post-traumatic stress disorder (PTSD). PTSD is an anxiety disorder which follows a period of overwhelming stress or fear. PTSD is not inevitable following a trauma. We now know that there is also such a thing as ‘post-traumatic growth’. This occurs when trauma is processed. We go through predictable phases in post-traumatic growth: ––

256

Initial shock: we can’t believe that this has happened to us. We might attempt to carry on as normal, or keep busy making

Adversity

––

––

––

––

––

practical arrangements. This is a self-protective behaviour, and only becomes problematic if it continues for many weeks. Questioning: we ask questions about how and why the event happened. We might look for someone to blame. We might blame ourselves. We might question what could have been done differently. We typically go around in circles in this phase, because there are no answers to these questions. This phase can also go on for many weeks. Reflecting: in this stage, we start to pull together a coherent story about what happened to us. We start to be able to say how we managed to survive the immediate trauma. We can say how it has affected us. Feeling: we still feel intense feelings of loss, anger or fear, but they don’t consume every waking hour. We might feel a wave of intense grief, but then it subsides. We can then experience positive emotions at other times without feeling guilty. Triggers: key dates or events might take us back to the trauma, and we will never be free of it entirely, but it no longer dominates our thoughts. Transcendence: we are likely to be more attuned to the trauma of others, particularly if the nature of their experience overlaps with ours. We may put our energy into something that makes this trauma less likely for others. We will only have energy for this once we have processed our trauma, which can take several years.

Behaviours that may impede post-traumatic growth include: ––

Denial of what has happened. Carrying on as if nothing has happened, and refusing to acknowledge the impact of it.

––

Not wanting to talk about it, or not wanting to work on our recovery.

––

Using drugs, alcohol or excessive working as a deflection from our feelings.

––

Not allowing the negative feelings.

––

Avoiding situations or people that remind us of the event. 257

Our place in the world

Post-traumatic growth is a relatively recently coined term, and it is likely that we will find out more about it in the next few years. However, it makes intuitive sense, because we often talk about experiences which made us who we are today. We wouldn’t wish those experiences on anyone else, but we can acknowledge that we have gained something in the process of dealing with the trauma. Having survived a trauma, we learn that we can do hard things. We can use this in the future. We might experience any of the following: –– –– –– ––

––

A new appreciation for life. The transient nature of life, and how every moment is precious. Deeper connections with other people. Greater love, empathy and intimacy with others. Awareness of our strengths. Feelings of confidence and empowerment from having come through. New perspectives. We might feel more compassion and empathy for people who are struggling. We might see the world through a new lens. Spiritual awareness. We have experienced dark nights of the soul. Somehow we have been able to carry on. Something bigger than ourselves might have helped us through.

Tune in Have you experienced trauma or supported someone through trauma? Are you able to relate your experiences to the processes outlined above? Are you at a stage where you can tell a coherent story about what happened to you? What have you learnt? What is the lasting legacy of your trauma?

Go deeper If you think that you may be suffering from PTSD, it is important that you seek professional help. Cognitive Behavioural Therapy (CBT), Eye 258

Adversity

Movement Desensitisation and Reprocessing (EMDR) and MindfulnessBased Stress Reduction (MBSR) have been shown to be effective in treating PTSD. There is also research evidence to support yoga and meditation as alternative therapies for PTSD.3

Moral injury Moral injury is the damage done to a person when they witness or are involved in an event or a decision which is at odds with their personal ethics. This may be followed by overwhelming guilt, shame, mistrust or blaming of others. It may have been beyond their professional or personal power to influence the decision. They are still troubled by it in the months that follow. Moral injury will be very personal. It depends on the individual’s ethics, their perception of an event, what happened afterwards, and how they were or were not able to process and make sense of it afterwards. In 2020, we experienced a global pandemic. Clinical decisions were made at speed, in response to a rapidly changing situation. Many Allied Health Professionals were redeployed to frontline services. AHPs who had never before been in life-and-death situations had to quickly learn skills around treating patients who were extremely ill, and caring for patients as they died. This was made more challenging by the need to wear Personal Protective Equipment (PPE) and maintain strict infection prevention and control measures. It reduced the spontaneity of human connection and communication. AHPs who were not redeployed had to rapidly transform the way that they delivered services using video-conferencing. Some services were suspended, or had to change their prioritisation of caseloads. There was extreme uncertainty about how long the crisis would continue, and there were local differences in the way guidance was interpreted. AHPs may have been instructed to act on decisions that they personally disagreed with. Because AHPs were often working in new roles and contexts, they may not have been able to challenge decisions. They may have been too overwhelmed or exhausted to process information at the time, but experienced doubt later on. 259

Our place in the world

It is important for AHPs to have a safe space in which to talk about adverse incidents. Depending on the work context, this could be at the end of a shift, or in a scheduled supervision session. Whatever the forum, the speaker needs time to fully tell their story. This will help them to process what has happened. The listener should use ‘active listening skills’. These include: –– ––

–– ––

Listening without interrupting. The emphasis is upon the speaker being able to tell their story without the listener interjecting. Not offering any judgement whilst the person is telling their story. Not offering advice, making suggestions or coming to any conclusions. Once the speaker has told their story, the listener may reflect back what has been said, to check their understanding. The listener may ask gentle questions to explore the speaker’s thoughts and feelings. This should be through open questions. For example ‘what were your thoughts at the time?’ or ‘what feelings do you have about it now?’

There may be agreed actions, so that the issue can be followed up. It may be appropriate for their concerns to be acted upon to prevent a similar situation from recurring. It is possible that the same decision would be made again. The person may be holding on to the guilt of not having raised concerns, but having done so retrospectively, they might start to come to terms with the fact that this would not have changed the clinical decision. It may be appropriate to access counselling, or other therapies. The indicators for this would be similar to those for post-traumatic stress (see p.256).

Tune in Can you think of a time when you fundamentally disagreed with a clinical decision? It might have been a disagreement about a clinical pathway or referral criteria. Were you able to raise the issue? 260

Adversity

Can you imagine the difference between someone employing active listening and someone not employing active listening? Do you think you are able to use active listening if a colleague brings an issue to your attention? What gets in the way of using active listening skills?

Go deeper Is your service or team familiar with the concept of ‘moral injury’? Is there a forum for raising concerns? Do you have adequate clinical supervision for these issues to be explored?

An emergency self-care kit We will have times in our life when we just don’t know what to do with ourselves. It might be after a shocking or sad event. It might be when we are worn down by a series of events. It might be when we have been working too hard, or giving too much of ourselves to others. Think about yourself on a day when you just don’t know what to do with yourself. You lack all motivation. You might know that it would help to go for a walk, or to eat healthy food. But you don’t. Can you make yourself an emergency self-care kit for this sort of day? It might be an actual kit that is kept in a box for when you need it. Some of the items might be activities or things that are not practical to store in a box. Instead you might write a list of these things. You might want to fill your kit with things that you can just absorb passively with a minimum amount of effort. It can help to focus on sensory stimulation. Ideas include: –– –– ––

Favourite scents, in the form of an essential oil, hand-cream, a candle, bubble bath or even your favourite herbs or spices. Favourite clothes, like your softest pyjamas or jumper, a blanket and warm socks. Favourite comfort foods, that have associations with being cared for. It might be buttered toast and tea in your favourite mug. It can be a really simple thing. 261

Our place in the world

––

––

––

––

–– ––

Favourite songs on your restorative playlist (see p.243). It might even help to have an angry playlist or a sad playlist. They can help you let it all out in a safe space. Favourite TV shows or films. You can choose something from different stages in your life, in case you want to feel like a child, teenager or younger adult. A favourite book. This could be a children’s book, poetry, a novel, a book of photos, an art book, a book related to your hobbies or a self-help book. Something that makes you feel pampered. It might be a facemask, nail varnish, a luxury chocolate bar, a hot water bottle or a heated shoulder pad. A candle or set of fairy lights can bring a sense of companionship and support. A small light is a symbol of presence, and of hope. A person to think about. Someone who is on your side and has always wished the best for you. They don’t have to be alive any more. You can still feel their support. You might choose a memento for that person, like a photo or something which belonged to them. 

On days like this, it is important that you set low expectations of yourself. If you don’t do anything that is self-destructive, then you have done well. If you do do something self-destructive, don’t beat yourself up. We learn from our mistakes. We are a work in progress.

Tune in If you are exhausted, rest. You don’t need to do anything else. What is the most nourishing thing that you can do right now so that you feel safe and supported?

Go deeper Once you have got through today, you can review what worked well, and what might not have worked so well. If you did something which did not 262

Adversity

Figure 13.1  Emergency self-care kit

work so well, the next strategy, which focuses on distraction behaviours, may be worth a read.

Distraction behaviours We all have self-destructive behaviours. They might also be called distraction behaviours, because they arose from a need to distract ourselves from pain. They have arisen because of a situation that was beyond our control and we felt overwhelmed. We are not to blame for our self-destructive behaviours; we are doing our best. Once we become aware of our distraction behaviours, we can start to manage them. As Drew Barrymore says, ‘making bad decisions doesn’t make you a bad person. It is how you learn to make better choices’. Awareness is the primary mechanism of change. Self-destructive behaviours include: ––

Negative self-talk, self-criticism, replaying our own mistakes or humiliations. 263

Our place in the world

–– –– –– –– –– –– –– –– –– ––

Blaming others in our lives for our problems. Working too hard or obsessive focus on one activity. Self-harming, drinking too much, substance misuse. Bingeing, purging or limiting food. Impulsive shopping, particularly when we don’t need the things we are buying. Gambling or taking financial risks. Spending too much time on social media. Taking part in risky sexual behaviour. Engaging with people who are not good for us; who do not help us be our best selves. Arguing with or cutting out people who are good for us; who do help us be our best selves.

It is helpful to think about how we learnt these behaviours. They will have served a purpose when we were feeling vulnerable, unsafe, out of control, overwhelmed or not good enough. –– –– –– –– –– –– ––

Do you remember when you first tried out this behaviour? What was the situation you found yourself in? Who were you with? Where were you? What were you feeling? What problem were you trying to solve? What reward did you get? Does it still work for you?

Given that the urge for the behaviour arises from an unmet need, or feelings we don’t want to feel, can you tune in? –– ––

264

What is your unmet need? Is it love, comfort, reassurance? Is it the need for control? Is it a need for meaning or purpose? Is there a feeling that you are trying to distract yourself from feeling? Can you ‘Riding the wave of emotion?’ (see p.121)

Adversity

–– ––

How do you feel after you have engaged in this behaviour? Is it still meeting a need, or is it no longer effective? Can you replace the unhelpful distraction behaviour with a slightly healthier distraction behaviour?

Thinking about these questions will help you to develop an alternative plan. Having a contingency plan will make it less likely that you will opt for your self-destructive behaviour. Make sure that your alternative behaviour is one that you like doing. Restorative yoga might be more inviting than a run. Simple breathing might feel more manageable than meditation. Your replacement behaviour can be unhealthy if it is better than the alternative. Eating chocolate is probably better than drinking a bottle of wine. It is helpful if your alternative behaviour feels nurturing and selfindulgent. Spend money if you need to. Make your indulgence the best quality you can afford. It might be helpful if your replacement behaviour takes up a bit of time, because this will occupy your mind and rewire neural pathways that were previously reminding you to carry out your unhelpful behaviour. It might be the time to learn a new skill, like cooking or craft. It’s helpful if your new behaviour has an intrinsic reward, and makes you feel energised. Tune into this. It may be helpful to have a person you can call on when you are feeling pulled towards your self-destructive behaviour. They can remind you why you want to change this pattern, and what you might do instead. You might choose to reduce your unhelpful distraction behaviour, rather than eradicate it. Can you set yourself a goal to indulge in it for less time in a day or week? The success of this might depend on how compulsive the behaviour is, and whether you are able to stop once you have started. You are the best judge of this.

Tune in If your behaviour is very impulsive and compulsive, you might need to remove any environmental triggers that will remind you of the 265

Our place in the world

tempting behaviour. This might mean changing your routines, including who you spend time with, where you go, and what you surround yourself with.

Go deeper Seek help if you can’t do this on your own. It might be useful to have a supportive group of people around you who know what you are going through.

A protective posse At times in our life when we are really struggling, it can be helpful to visualise the people who are on our side. These people can be alive or dead, here with us or living far away. By the power of our imagination, we can conjure them up whenever we need them, visualising them walking behind us, wherever we go. They have our back. They are rooting for us. They are on our side. Try to think of four or five people who have been your champions in your life. Your protective posse might include a parent or grandparent, aunt or uncle, sibling or cousin. It might include a teacher or mentor. It might include a couple of close friends. It might include a supportive colleague or manager. Whoever in your life has given you support, who wishes you well and who would want to support you through a difficult time. It could even include a pet. Imagine these people like an entourage, at your back. They are always available for you to summon up with your imagination. They give you positive messages about yourself. If there is a particularly difficult situation that you have to get through, they will be there with you. They will be cheering you on. It might sound trite, but this is the power of love. When we have been loved and cared for, we can summon this up at times when we really need it. Think about the people you really love and care for. Wouldn’t you want them to be able to summon up the feeling of your love and support if they were going through a hard time? Wouldn’t you want them to feel it even after you have died? 266

Adversity

Can you imagine your protective posse agreeing with this now, nudging you and reminding you that you are loved? 

Tune in How does it feel to think of the people who have been on your side? What would they say to you right now if they were here? How would their presence make a difference to you?

Go deeper If visualisation works for you, it can be a really powerful tool when you are struggling. Imagine that you have a protective bubble around you. It is a really strong bubble. If you are in a situation where you feel you are going to be

Figure 13.2  A protective posse 267

Our place in the world

criticised, the bubble is there to protect you. It stops hurtful things from penetrating the bubble. The hurtful words just bounce off the bubble and don’t get through to you.

Forgiveness We are enriched by relationships. Relationships teach us about love, learning, connection. There is a flip-side. To be in relationship with other human beings means that at some point they will behave in a way that hurts us. It might be a minor slight, like forgetting our birthday. It might be an insensitive comment. Sooner or later, we are going to feel let down. This is OK. Human beings make mistakes all the time. This is where forgiveness comes in. If we don’t forgive, we continue to be drained by the event that upset us. It lingers in our subconscious, taking up energy that should be spent elsewhere. If you watch animals in company, let’s say dogs, you will notice that there is occasional conflict. Dogs might get into conflict over space, attention, toys, food or water. They might play-fight, but one dog gets too rough. One dog might make unwanted advances towards another. Dogs get upset. They express this by jumping around, and making noise. They get it out, then they move on. It is forgotten. Dogs don’t go through the rest of their day ruminating on the event. Human beings don’t always communicate clearly to the other person that they are hurt. We have a tendency to hold on to our hurt. We have been made to feel ‘less than’. Less able, less valued, less popular, less successful, less attractive. A natural reaction to this is to want to get back at the other person. We might want them to feel ‘less than’ instead of us. Most of the time, the other person just made a mistake. They didn’t mean to hurt us; they were just careless. They are like us. We make mistakes too. Every human being has the capacity to be selfish, insensitive, thoughtless, unkind or inconsistent. Every human being has the capacity to learn from their mistakes and do better next time. If we forgive others, we are likely to forgive ourselves. Forgiving ourselves for our mistakes is the key to wellbeing. 268

Adversity

Ask yourself the following questions: –– –– –– ––

Do you forgive a child or teenager their mistakes? Why do you forgive them? Are you the same person that you were 10 or 20 years ago? Do you make the same mistakes that you made then? Or have you grown?

We forgive children and teenagers because we recognise that they are still learning. Life is really complicated; there are lots of skills to learn; different relationships allow us different opportunities to learn. Hopefully we start to use the feedback we get from other people. We try to do better. We might repeat some mistakes, but we are trying. We generally need the other person to understand what they did wrong before we can forgive them. We might need to have a dialogue with them to explain the hurt that they caused. If the person then expresses remorse and indicates that they want to do things differently, they are generally forgiven. In the course of this dialogue, we might find out that we too have caused hurt. If we take responsibility for this, we are likely to be forgiven. We can forgive ourselves. The principles of compassionate communication (see p.225) are helpful if we are having this sort of conversation. Occasionally, a person repeatedly hurts us. We communicate our hurt and our unmet need, but they put their needs first. This is usually about their own unmet needs. They feel insecure in the world (less loved, less valued). Their solution is to feel ‘more than’ by putting us down or damaging us. Where a person repeatedly hurts us, we may decide that we need to distance ourselves from them. It may still be possible to forgive them, but we will do this from a safe distance. It can help to think of the other person as a child or adolescent. We might imagine what circumstances led to them being so damaged that they have to put their needs ahead of others. They have not learnt how to have reciprocal relationships. Most of us can think of a person in our lives that we have not forgiven, and this troubles us. It may be time to forgive them so that we can move on. It would be a relief to let go of our resentment. 269

Our place in the world

With time, we often gain perspective. We see the bigger picture. We have new things to focus on; things to be grateful for. We might forget the details of our resentment. We might acknowledge that we played a part. Forgiveness does not mean that you think what happened was OK. It means that you know that it was not right, but are prepared to forgive anyway. Mahatma Gandhi once said, ‘The weak can never forgive. Forgiveness is the attribute of the strong’. If we can forgive, we are not stuck with negativity. Forgiveness is a reminder of our shared humanity. We are all fallible. We can raise one another up if we forgive. It is a huge relief when we do.

Tune in Is there a person in your life who you have been hurt by and have you held on to that hurt? How would it feel to forgive them? Is it safe to reach out to them? If the person is no longer alive, or if you do not feel safe contacting them, how would it feel to write a letter to them? Your letter can set out how they hurt you, the lasting impact and how, despite this, you have managed to find the capacity for forgiveness. You can destroy your letter in a ritualistic way once you have written it, as a symbol of having let go.

Go deeper Is there anything you need to forgive yourself for? Sometimes this is the hardest thing to do. You have probably made some bad choices in life; you would hardly be human if you hadn’t. The important thing is that we can take responsibility for our bad choices and learn something from them. If you have been forgiven by others, it is pointless to continue berating yourself or obsessing about past mistakes. This is a waste of your energy. It will divert your attention away from all the things which give you joy, and the things which bring joy to others. You might write a letter to yourself to grant forgiveness. This time, hold on to the letter. You may need to remind yourself that you are forgiven and you can move on. 270

Adversity

Notes 1 Mugerwa S, Holden JD. ‘Writing therapy: A new tool for general practice?’ British Journal of General Practice 2012 Dec;62(605):661–663. 2 Knaevelsrud C, Böttche M. ‘Schreibtherapie nach traumatischen Belastungen: Therapieansätze und Wirkmechanismen [Writing therapy after traumatic events: Therapeutic approaches and mechanisms of change]’ Psychotherapie Psychosomatik Medizinische Psychologie 2013 Sep;63(9–10):391–397. German. 3 Gallegos AM, Crean HF, Pigeon WR, Heffner KL. ‘Meditation and yoga for posttraumatic stress disorder: A meta-analytic review of randomized controlled trials’ Clinical Psychology Review 2017 Dec;58:115–124.

271

14

A better world

As I write this chapter, we are living through a global pandemic and we face potentially catastrophic human-made climate change. And yet this chapter is looking towards making a better world. It is about our role in making the world a better place. We will look at global inequality, and how our everyday choices impact those who have the least in the world. We may assume that we can do nothing to alter global economics, but we have huge power in where we spend our money. Mindful consumption has profound implications for the way we live in this world of precious natural resources. We will look at building compassionate communities. This model of social prescribing is built on the collaboration of the NHS, local authorities, charities, the independent sector, businesses and community organisations. We can work together to transform the lives of people who are lonely and isolated, including ourselves. If you think you are powerless, then consider these words from the anthropologist Margaret Mead: ‘Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has’. As AHPs we have influence. Our insight into holistic health, in lifestyle medicine, in inspiring others to improve their lives, means that we have a central role to play in the future of public health. We can make use of social prescribing to build compassionate, connected communities. In our post-Covid world, this will be all the more important. We can build better. We have the power and the knowledge, the wisdom and the compassion to start changing our world. 272

DOI: 10.4324/9781003165125-18

A better world

Global citizenship Where we were born in the world makes a big difference to our life chances. If we were born in Europe, North America, Australia or New Zealand, we have a good chance of leading a healthy, wealthy life. If we were born in central Africa we have the worst life chances. Central Asia and South America are somewhere in the middle. The current wealth of nations is closely linked to colonialism and the slave trade. Countries who had their natural and human resources removed from them by European empires and North America are still struggling to recover. ––

A child born in central Africa is 60 times more likely to die in childhood than a child born in Europe.

––

Children born in the richest countries will receive 16–20 years of education. Children born in the poorest countries will receive 4–8 years of education.

––

There is a 117-fold difference between the average yearly income per person between the richest nation and the poorest nation. In Europe, it averages around $40,000. In central Africa and central America, it averages $5,000.1

In the last century, consumption in developed nations has spiralled out of control. We no longer buy things to meet our needs; we buy things to make ourselves feel good. Our culture of liberal capitalism has fed us the message that we can do what we want and consume what we want. We heat our homes inefficiently. We take unnecessary journeys. We waste food and water. We don’t think about where our plastic waste goes. We buy more clothes than we need. In our quest to build more and buy more, we have destroyed 17 percent of the Amazon rainforest, adding carbon dioxide to the air, disrupting the global water cycle, causing the extinction of species and drastically reducing biodiversity. We manufacture so much single-use plastic that there will be more plastic than fish in the sea by 2050. The burning of fossil fuels to manufacture our cars and goods has led to global warming, which has resulted in rising sea levels and warming temperatures. This is causing extreme weather events around the globe, including forest fires, hurricanes and flooding, and will lead to 273

Our place in the world

mass destruction of homes and livelihoods, making some parts of the planet uninhabitable. Why am I depressing you when this is a book about wellbeing? Because it is damaging to our wellbeing to do nothing. It is damaging to our wellbeing to passively accept that global destruction is our fate. We can do something. The earth has an incredible capacity to adapt and heal, but it needs our help. Terrible things happened in the 2020 Covid pandemic, but it did show us that the natural environment can recover when humans scale back their activities and tune into nature. For instance: –– –– –– –– ––

––

––

Air pollution dropped in all major cities because car and aeroplane journeys reduced dramatically. Renewable energy, from hydro, wind and solar, supplied more of the UK’s electricity than fossil fuels. People paid more attention to the wildlife in their gardens, feeding the birds, making bug hotels and leaving areas to re-wild. People became more aware of nature and seasonal changes, noticing blossom, wildflowers, hedgerow produce and fungi. Wildlife populations increased, with less interference from human activity. Otters, orcas, cuckoos, falcons, partridges and owls were all spotted in greater numbers, and in places they hadn’t been seen for decades. People shopped more locally and bought into local farm box schemes. They sourced their supplies more carefully, making more thoughtful purchases. Sales of organic food rose by 14 percent. People in the UK reduced their food waste by a third.2 They checked their existing supplies before making a shopping list. They batch-cooked and froze leftovers.

This suggests that we can change our behaviour, given the right circumstances. There was mass compliance with infection control measures in the global pandemic, indicating that if the population understand the need, they will change their behaviour for the common good. We have witnessed human ingenuity in response to Covid-19. We can also tap into the creativity of human beings in order to find 274

A better world

solutions to our climate-change problems. In fact, we already have solutions; we just have to mobilise them. For instance, we already have solutions for the reduction of carbon emissions,3 limiting our environmental impact,4 planning for food sustainability5 and reducing plastic waste.6,7 We all have a part to play. We can use our power when we vote, and we can use our power when we spend. Here are some considerations which can inform our choices today and for the rest of our lives: ––

––

––

––

––

––

–– ––

What is necessary? What is luxury? How can we avoid buying things we don’t really need? Get into the habit of writing a wishlist. Think twice before you ‘buy now’. Our pennies are our power. Where we choose to spend our money will give a powerful message to companies. Support sustainable, ethical brands. Look for ‘fair trade’ and ‘no palm oil’ labels on food brands. Choose organic, or food produced using ‘regenerative agriculture’. Regenerative agriculture protects biodiversity, enriches the soil, reduces water use and captures carbon in the soil. Reduce your use of plastic. Buy fruit and veg from a local box scheme. Use refillable containers for dry goods and use reuseable bags. Reduce your consumption of meat and dairy, especially factory-farmed meat and dairy. This has a bigger environmental impact than any other change of behaviour. It significantly reduces carbon emissions, land use, water use and environmental destruction. Always have a reuseable cup in your bag or car so that you don’t need to use a single-use plastic cup. Have a reuseable water bottle and drink tap water. Don’t buy fast fashion. Save up and buy better quality items that will last. Use charity shops. Audit your bathroom cabinet. How many toiletries and makeup items do you actually need? Try to write a wish-list, rather than buying on impulse. 275

Our place in the world

––

–– ––

––

––

––

Reduce unnecessary travel. Use public transport, walk or cycle. Think carefully about your next purchase of a vehicle. How big or powerful do you really need it to be? Think about how you are heating your home. Switch to a renewable energy supplier. Insulate your home. Our good intentions are often forgotten at Christmas or when we are throwing a party. We get a bit over-excited. Be aware of this, and plan wisely. Talk to your family about Christmas presents. Can you agree to reduce your gift-buying? You might each buy for one other person, or you might gift experiences or charity donations. Change to ethical banking. Ethical banks do not invest in commodities like oil, tobacco or weapons. They do invest in green energy and community projects. Talk about the steps you are taking with everyone: your friends and family, colleagues and managers. Let everyone know that this is important to you. This will influence their behaviour too.

Tune in How does it feel to throw away food because you bought too much? How does it feel when you think about a purchase carefully and make the best choice? Focus on why you are making these choices. Focus on the people around the globe, the stability of their homes and livelihoods, their access to resources. Focus on the rainforests or coral reefs you are protecting. How does it feel to look after everyone and everything with the power of your pennies?

Go deeper Developed nations have been living well at the expense of undeveloped parts of the world. We can try to redress this by supporting organisations who are there to make a long-term difference. Consider supporting organisations like Unicef, Oxfam, WaterAid and PlanUK. 276

A better world

Figure 14.1  We’re in this together

Compassionate communities Loneliness has been identified as an epidemic in our society. We have never led more disconnected lives from our neighbours and local communities. People are likely to suffer worse physical health if they are not included and involved in their community. They are likely to more chronic health conditions which require management by GP practices and health and social care services. There are also people who do not present with health conditions, but whose loneliness leads them to seek social support from their GP or health and social care services. In recent years, the Somerset town of Frome has started a social experiment to tackle loneliness.89 They identified that if they had a 277

Our place in the world

more compassionate community, they could support lonely people outside of health and social care services. The lonely people were not necessary the obvious ones. They included those with families and jobs, who also needed to connect with their community. Local businesses and community groups bought into the scheme; for example, cafes became Talking Cafes with a table for social connection. The compassionate community project has four key features: ––

––

––

––

All existing community resources are compiled in a service directory. This includes businesses, charities, volunteers and community groups. A network of willing volunteers, known as Community Connectors, are trained to offer support to those in need and to guide them to appropriate community resources in the directory. Setting up new groups as requested by members of the community to meet newly identified needs, e.g. DIY skills, knit-andnatter groups, community gardens. The creation of one-to-one support relationships through liaison with Health Connectors.

The effects have been impressive. They include: –– –– –– ––

–– ––

278

Reduced use of GP appointments, so that GPs have time to spend with those who need their services. Reduced emergency admissions to hospital, with a 21 percent cost saving to the NHS Trust. Better use of health and social care services by those who need them. Local businesses becoming more involved in community projects and making ethical decisions about their workforce, business development and the environment. The town becoming known for its community ethos, bringing more investment into the area. Practical solutions to people’s everyday problems: cooking, cleaning, household maintenance, shared garden space to grow food, walking dogs.

A better world

––

–– ––

Compassion being valued across the community, so that no one gets left behind. Community and Health Connectors are trained to listen and empower. The formation of countless friendships across the town. People living healthier lives, both physically and emotionally.

Tune in How does this model make you feel? Does it remind you of any projects you have been involved with? Does your service make use of social prescribing or community groups? Could you take this idea to anyone within your organisation?

Go deeper If you feel that you would like to explore this concept more, you might enjoy articles in the ‘Resurgence and Ecologist’ magazine. There are articles to inspire collective action to meet the needs of our local communities and the needs of our environment. George Monbiot’s article entitled ‘A Manifesto for Compassionate Communities’10 is recommended.

AHPs and the future of the world Covid-19 has rocked our world. For the first time in generations we learnt that anything can happen. There are some situations you just can’t anticipate. A learning point from the pandemic is that we can do hard things. We can come together in a time of crisis. We have a society full of compassionate people who want to do their bit for their community. This has included organising food and prescription deliveries for those in need, checking in on vulnerable neighbours and following advice to stay at home, and when out and about, maintain social distancing. 279

Our place in the world

AHPs have done particularly hard things. This has included changing roles to support another service, changing the service delivery model, or mobilising staff to get mass vaccination centres up and running. AHPs have a ‘can do’ attitude. We went into this profession to help. But we don’t just have a willingness. We have expertise, and we need to share this expertise with the world. The NHS was set up to treat very sick patients, largely with acute conditions. Health care has evolved, and the majority of the work carried out in the NHS now is around managing long-term chronic conditions. Many of these conditions can be helped with lifestyle medicine, alongside conventional medical treatment. Lifestyle medicine is the content of this book, particularly the first two sections. It is how we breathe, sleep, move and eat. It can include building resilience and using mindfulness and meditation techniques. Just like us, we want our service-users and the wider community to not only survive, but to thrive. Our service-users look to us to lead the way. We might reference the mind–body connection and the stress response. We might share our tried-and-tested strategies and invite our service-users to tune in, and find out what works for them. In our professional roles we know how to empower our patients. AHPs have a vital role to play in public health and in social prescribing. Social prescribing means allowing people in need to access a range of community services that will help address their health and wellbeing needs. This might include volunteering, arts activities, hobbies and sports, learning and skills-sharing groups. These resources might specifically address the needs of children, young people, parents, carers, older people, people with learning disabilities, people experiencing depression or anxiety, people experiencing substance misuse and so on. This model of empowerment can include teaching people how to shop or cook, or how they might move more. There might be specific groups for teaching mindfulness or meditation. Community engagement has been shown to be particularly effective for empowering marginalised or vulnerable communities.11 The ‘compassionate communities’ strategy on the previous page is a good example. Social prescribing reduces the pressure on the NHS, resulting in more than 25 percent fewer admissions to A&E and fewer GP appointments used.12 Health professionals have more time to spend with their 280

A better world

patients. It also means that there is a role for AHPs to work in public health either within or outside of the NHS, in independent practice, with local authorities, charities and businesses in order to influence the social prescribing offer in their community. There is a wonderful potential here for collaboration, and for spreading our expertise. AHPs might be there at the start of the project, consulting with local communities. It is important to understand the communities. When we are co-designing a project, we need to ask questions like: –– ––

––

––

––

–– ––

What are the biggest problems or challenges in your community right now? Which groups might be the most disenfranchised? What are the barriers preventing them from accessing health care or living their best lives? What resources are already present in the community? Who, what and where are they? When do they operate? Why are they successful? How do they engage the community? Where are the people we are trying to reach? Can we take our message to where they are? For example, train stations, supermarkets, schools. What untapped resources might there be in this community? What skills are there? For example, cooking and gardening skills, volunteering capacity, unused indoor or outdoor spaces. What has worked in the past, which we might use again? Which schools, colleges, community centres, local businesses, charities, arts groups and sports facilities can we mobilise to support this work?

Once the objectives have been set, AHPs might train community link workers. They might produce videos, posters and other resources that can be disseminated by link workers and local organisations. AHPs might visit community centres to give talks and regularly engage with the communities. They might have drop-ins to discuss people’s specific needs. There might be a register of AHPs so that link workers can pick up the phone and talk to them about a specific issue or group’s needs. 281

Our place in the world

AHPs might attend community events. This might inspire local people to become link workers, or train to be AHPs, and increase the diversity and representation within the profession. Specific examples of how AHPs might be involved include: ––

––

––

––

––

282

Dieticians: working with community groups to provide cookery classes appropriate to local cultural groups. Working with cafes and food outlets to improve the quality of the food offer. Working with supermarkets and shops to promote healthy choices: which product lines are most visible, which are promoted through marketing campaigns on social media, which recipes are featured in posters or leaflets. Working with local businesses to reduce food waste by donating fresh produce to food banks. Working with the local authority for a coordinated food strategy. Working with a food waste charity to provide food boxes or cooked meals for vulnerable groups. Occupational Therapists: involvement in cooking and gardening groups to promote optimal use of functional skills. Advising on posture, equipment and adaptations to make these activities accessible for all. Physiotherapists, Osteopaths, Orthotists and Podiatrists: working with sports centres or clubs to make sessions more accessible to those with health conditions or disabilities. There might be specific classes for people with diabetes, or arthritis, for instance. Setting up community events like Park Run or community walks to reduce loneliness at the same time as increasing physical activity. Art, Music and Drama therapists: working with schools, colleges, day centres and community groups to link them with arts organisations in the community. Prevention and early identification work with schools for eating disorders or anxiety. Having a joined-up approach to relieve curriculum pressure and promote wellbeing in schools.13 Speech and Language Therapists: resources and training sessions on total communication, making use of Makaton signing for people with learning disabilities, slowing down and giving time for those with hearing impairment or language impairments to

A better world

understand spoken communication, and providing high-quality translated resources for community languages. –– Drama, Music and Art Therapists and Speech and Language Therapists: setting up of music or library groups for parents and young children to foster community connections, and to promote babies’ and toddlers’ communication and language skills. –– Orthoptists: targeted screening in schools, or in day centres for adults with learning disabilities. Raising awareness of when people might need to seek help. This may be the barrier that is preventing their participation in community activities. –– Orthotists: mobile services in the community might be trialled. There might be a pilot project to analyse attendance. Appointments might be coordinated with other health care appointments. Links might be made with appropriate activity groups, e.g. music therapy. –– Community Specialist Paramedics: training in first aid and in health awareness to prevent unnecessary emergency services call-outs. Visiting frail and elderly patients to prevent falls in the home. Attending community events to promote safe practice. –– Community-Based Radiographers: offering some X-ray or ultrasound services at non-hospital locations, especially for marginalised or vulnerable groups. Analysing health inequities in the community and targeting specific groups. Working with community or church groups to increase take-up of screening services. –– All AHPs: developing peer roles such as link workers within the community. The link workers might bring complex cases to the AHP at regular supervision sessions, or they might bring people to drop-in sessions with an AHP. The link worker might identify a specific need in the community and have access to a directory of relevant AHPs in the community. –– All AHPs using our influence to initiate change for our local services and in the public health domain (see ‘We have influence’ on p.284) 283

Our place in the world

Tune in Does this sort of work inspire you? Could you imagine yourself being more involved as an AHP in your local community? What would this mean for your own wellbeing?

Go deeper Read policy documents about AHPs and social prescribing and AHPs and public health online. Think about becoming involved. If not you, then who?

We have influence This chapter has helped us to explore how we might make the world a better place. We may have some ideas about how we could improve things. We want to be part of the public health conversation. We want influence policy around health, education and social care. How do we do this?

As AHPs we have influence. ––

We spread an important message by how we behave. Our values are communicated by how we interact with service-users, carers, colleagues and managers. We can live and breathe compassion, inclusivity, mindful consumption … –– If we consistently behave respectfully towards others, people will be open to our ideas. When we demonstrate calm responsivity, we infect others. It radiates outwards. –– Ideas can be spread through conversations. We can start to have conversations around issues which are important to us. We can gauge current understanding and levels of interest. We can spark others’ interest and bounce ideas off one another.

284

A better world

––

––

––

––

––

––

–– ––

If we have an idea, we might want to research it. We can look for research evidence. We can think about the risks and benefits for our service. We can explore what has already been tried. We can consult our service-users and stakeholders. We have access to those in power. This may be via our colleagues and managers. Management like to know what is important to the workforce. You might feed this back in a variety of ways, including open forums, conversations with key people, our annual appraisal and the staff questionnaire. We have access to professional supervision, in which we set the agenda and seek out what we need to achieve our personal and professional goals. Our organisation may also be able to provide us with coaching or leadership support in order to realise our ambitions. We can join specific forums in our organisation where we can join forces with like-minded individuals. These might have specific membership, for example BAME, disability or LGBTQ+ staff networks. There may be working parties for specific issues, such as our organisation’s environmental strategy or the staff wellbeing strategy. We can link up with relevant national and international organisations or interest groups. For instance, The King’s Fund’s work around social prescribing. NHS Horizons provides resources geared towards transformations in health care. It has a ‘school for change agents’ and a library of tools for influencing, collaborating and transforming services. We are all registered with the Health and Care Professions Council (HCPC). We also have our profession-specific colleges. We might also have associations with particular charities or other organisations. These bodies also have forums and resources for influencing. We might start a wellbeing group at work, and promote this more widely in our organisation. We might start to think about how the principles of self-care might be built into care pathways for our service-users. We might plan to routinely talk about self-care with service-users

285

Our place in the world

and their carers. We might explore community resources that can support the work that our service carries out. –– We can read, share and contribute to policy documents which outline our future role in public health,14 social prescribing15 and the NHS.16 We are already known for holistic health and wellbeing, and we can lead on this work. –– We are stronger together. We are a diverse group of 15 professions, making up a third of the NHS workforce. We have links with education and social-care professionals, the independent sector and charitable trusts. We have wide influence.

Tune in Do you believe that you have influence? How can you start to test this out? Do you need any self-care strategies from this book to help you prepare for conversations? Do you need any self-care strategies to help you process and progress your conversations? (see the chapters on ‘Resilience’ and ‘Purpose’).

Go deeper Explore sites such as ‘NHS Horizons’ for tools around innovation, influence and leadership. A regular meditation practice can help build resilience for this wider work. Regular meditation affords us a strong and stable base, which we return to every time we sit down to meditate. We come back to our sense of purpose and our core values. We tune into our thoughts and feelings. We allow ourselves to make mistakes and to learn from them. We allow ourselves to rest when we need to. We tune into what we need now and where we go from here.

286

A better world

Figure 14.2  We are allied

Notes 1 Figures from ‘Our World in Data’, a free online resource created with The Global Change Data Lab, a registered charity in England and Wales (Charity Number 1186433). 2 WR AP. ‘Citizen responses to the Covid 19 lockdown: food purchasing, management and waste’ 2020. 3 Gao J, Hou H, Zhai Y, Woodward A, Vardoulakis S, Kovats S, Wilkinson P, Li L, Song X, Xu L, Meng B, Liu X, Wang J, Zhao J, Liu Q. ‘Greenhouse gas emissions reduction in different economic sectors: Mitigation measures, health co-benefits, knowledge gaps, and policy implications’ Environmental Pollution 2018 Sep;240:683–698. 4 Lauriola P, Crabbe H, Behbod B, Yip F, Medina S, Semenza JC, Vardoulakis S, Kass D, Zeka A, Khonelidze I, Ashworth M, de Hoogh K, Shi X, Staatsen B, Knudsen LE, Fletcher T, Houthuijs D, Leonardi GS. ‘Advancing global health through environmental and public health tracking’ International Journal of Environmental Research and Public Health 2020 Mar 17;17(6):1976. 5 Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, Brinsden H, Calvillo A, De Schutter O, Devarajan R, Ezzati M, Friel S, Goenka S, Hammond R A, Hastings G, Hawkes C, Herrero M, Hovmand PS, Howden M, Jaacks LM, Kapetanaki AB, Kasman M, Kuhnlein HV, Kumanyika SK, Larijani B, Lobstein T, Long MW, Matsudo VKR, Mills SDH, Morgan G, Morshed A, Nece PM, Pan A, Patterson DW, Sacks G, 287

Our place in the world Shekar M, Simmons GL, Smit W, Tootee A, Vandevijvere S, Waterlander WE, Wolfenden L, Dietz WH. ‘The global syndemic of obesity, undernutrition, and climate change: The lancet commission report’ The Lancet 2019 Feb 23;393(10173):791–846. 6 Landrigan PJ, Stegeman JJ, Fleming LE, Allemand D, Anderson DM, Backer LC, Brucker-Davis F, Chevalier N, Corra L, Czerucka D, Bottein MD, Demeneix B, Depledge M, Deheyn DD, Dorman CJ, Fénichel P, Fisher S, Gaill F, Galgani F, Gaze WH, Giuliano L, Grandjean P, Hahn ME, Hamdoun A, Hess P, Judson B, Laborde A, McGlade J, Mu J, Mustapha A, Neira M, Noble RT, Pedrotti ML, Reddy C, Rocklöv J, Scharler UM, Shanmugam H, Taghian G, van de Water JAJM, Vezzulli L, Weihe P, Zeka A, Raps H, Rampal P. ‘Human health and ocean pollution’ Annals of Global Health 2020 Dec 3;86(1):151. 7 Rhodes CJ. ‘Plastic pollution and potential solutions’ Science Progress 2018 Sep 1;101(3):207–260. 8 Abel J, Clarke J. ‘Compassion is the best medicine’ Resurgence and Ecologist 2018 March/April 307. 9 Brown M. ‘The compassionate project’ Resurgence and Ecologist 2018 March/April 307. 10 Monbiot G. ‘A manifesto for compassionate communities’ Resurgence and Ecologist 2018 March/April 307. 11 O’Mara-Eves A, Brunton G, Oliver S, Kavanagh J, Jamal F, Thomas J. ‘The effectiveness of community engagement in public health interventions for disadvantaged groups: A meta-analysis’ BMC Public Health 2015;15(129). 12 Polley MJ, Pilkington K. ‘A review of the evidence assessing impact of social prescribing on healthcare demand and cost implications’ University of Westminster 2017. 13 Educare. ‘The Times Educational Supplement ‘Ofsted’s new focus is on welfare and wellbeing, not data and statistics’ online article. 14 Hindle L, Charlesworth L. UK Allied Health Professions Public Health Strategic Framework 2019–2024 available at ahpf​.org​.​u k. 15 Driving Forward Social Prescribing: A Framework for Allied Health Professionals Royal Society for Public Health, NHS England and NHS Improvement policy document July 2019. 16 Look out for updates to documents such as Allied Health Professions into Action on NHS England and equivalent sites.

288

Index

active listening 216, 260–261 addiction: dopamine reward system 73, 110; phone: 112 adrenaline 8–9, 153 adversity 101, 250–251, 253–271 agency xviii, 2, 100, 120, 158, 167, 224 air hunger 28–29 alcohol: dependency xvii, 3; coping strategy 122, 257; effect on the brain 41; effect on gut microbiome 7 allergies 5, 29 alternate nostril breathing see breath anxiety: xvi, 17, 26, 33; sleep 48; disorder 256; outdoor time 56; restorative yoga 61; loving kindness meditation 145; flow state 113; role of emotions 121; serotonin 105; social prescribing 280; hormonal imbalance 84; cultivating wonder 106–108 Art Therapists xix, 52,93, 132, 147, 283, 119 arthritis 2, 5, 10, 80, 135 asthma 2, 5, 10, 80 autoimmune diseases 2, 5, 10, 80 autonomic nervous system 1, 8, 47, 139 autonomy 186, 200 awareness as mechanism for change 12, 209 blood glucose 2, 5, 8, 10, 47, 61, 73, 77, 84, 86, 139, 178 blood lipids 61, 73 

blood pressure: self-care xvi, 1–2; stress response 8–10; breathing 31, 39; gratitude practice 102; flaxseeds and chia seeds 88; meditation 135; outdoor time 56 blood sugar see blood glucose blue light 41–42 blue zones 170 body clock, circadian rhythms 39–42, 51 body image 118, 121 body scan 138–139 bone density 4, 54, 84 Bostock, Richie 29 boundaries: acceptable behaviour 212; between home and work 168; personal 209, professional 128, 197, 222–224, 236 brain health: anthocyanins 80; brain fog 84; food and dopamine response 72, 75, 79; effect of meditation 135; effect of movement 54, neurotransmitters 120, 122; sleep 38–40, 47, breakfast 77, 87–89, breath: 25–36 alternate nostril breathing 33–35; apply this at work 35–36; breath control 25–26; mouth breathing 26–32; nasal breathing 26–32; stress response 8–9; yoga nidra 49–50; yoga breathing 61–67 British Dietetic Association (BDA) 74, 87 289

Index burn-out xix, 182, 230 Buteyko method 29–30 caffeine 41, 78 Can’t Be Arsed CBA 129–131 cancer: effect of movement 54–55; food 80–81; genes 2, 19; oestrogens 85; SCFAs 5–6; repair of oxidative damage 10 carbohydrates cardiovascular disease see cardiovascular health cardiovascular health: body scan 139; breathing 33; compassion 214; food 80–81, 85–86; genes 2–4; gut microbiome 6; meditation 135; mind–body connection 15–19; movement 55, 169, 171; SCFAs 5; sleep 38; yoga 61; yoga nidra 47 carotenoids 80, 82 Chiropodist xix see also Podiatrist circadian rhythms see body clock circulation 54 see also cardiovascular health coffee see also caffeine: breakfast 89; gut microbiome 6–7, 80, 82; outdoor time 56; mindfulness 74; polyphenols 80; reliance on xvii; small treats 103, 162; timerestricted eating 78 cognition: cognitive decline 54; food 81; genes and epigenetics 3–4; relationships 203 Cognitive Behaviour Therapy (CBT) 258 cognitive decline see cognition colleagues: wellbeing of xx, 74, 89, 129, 151; ripple effect xix; showing up for xv commissioning 187, 223 compassionate communication 209, 225–256, 269, compassionate communities 272, 277–279 compulsive behaviour 265 computer use xiv, 28, 168 conflict 128, 154, 166, 208–227, 268 connected team 203 core values 234–237, 286 290

coronary heart disease see cardiovascular health cortisol: cortisol curve 153–154; hormone health 84–85; stress response 8–10; thought stresses 154; yoga 61–67 counselling 250, 254–256, 260 Covid 19 274, 279 cravings 7 creativity: at work 208; capacity for 211; core value 236; flow state 113–115; food preparation 75; in finding solutions 274; movement 55; outdoor time 57 curcumin 82 dahl recipe 92 dancing 11, 44, 56, 113, 243 decision-making 186, 231–232, 240 deep non-REM sleep see sleep deep sleep see sleep depersonalise 220–222 depression: emotions 122; food 80; hormones 84; meditation 135; movement 54–55, 169; outdoor time 56; SCFAs 5; social prescribing 280; stress response 10; yoga 61–67 desk yoga 172–176 diabetes, Type 2: food 80–81, 86; genes and epigenetics 2, 19; gut microbiome 5, 80–81; movement 54–55; outdoor time 56; sleep 38; stress response 10 diagnostic radiographer 35, 51 dietary fibre 5–6, 72, 79–81, 85–87, 178 Dietician xix, 73, 74, 93, 282 digestion: digestive enzymes 3, 75; digestive health 4, 6, 16; digestive organs 9, 142; digestive problems xvi, 78, 87; digestive tract 8, 75 digital detox 109, 132 disability 118, 285 distraction behaviour 263–266 DNA see epigenetics dopamine 47, 72, 79, 110, 122, 177 drama therapists xix, 52, 69, 132, 147, 282 drug use 3, 4, 72, 79, 110, 122, 257

Index EAT Foundation, Lancet report 73 eczema 2, 5, 10, 80, 119 Eisenhower’s Matrix 118 emails xiii, 12, 30, 32, 184, 189, 193–196, 248 emergency self-care kit 261–262 emotions: mind–body connection 13–17; music 243–244; posttraumatic stress 256–257; processing of 44; release of 18, 121–124; story-telling 218 empowerment xix, 185, 197, 258, 280 environmental impact 106, 141, 275 epigenetics 2–4 exercise see movement extrinsic rewards 231–235 Eye Movement Desensitisation and Reprocessing (EMDR) 258 face-to-face interaction 194–195, 215–216, 222 fats: fatty acids 8, 79, 85; healthy fats 74, 85–87, 178; omega fats 85–87; SCFAs 5–6; trans fats 72 feelings see emotions fermented foods 6–7 fibre see dietary fibre fight, flight or freeze see stress response finances xvi, 12, 124, 213, 236, 237, 264 flavonoids 82 flaxseeds 83, 88 flow state 101, 113–115 food: choices xvii, 8, 23, 76, 168, 177–178; environment 94, 168, 177; manufacturers 72; preparation 75, 93 forest-bathing 56 forgiveness 236, 254, 268–270 friendly bacteria see gut microbiome friendship see social connection Frome, Somerset 277 gastrointestinal health see digestion genes see epigenetics General Practice, GP appointments 277–280 genetics see DNA and epigenetics global citizenship 273

glucose see blood glucose goals: long-term 188–189; personal 112, 171, 246–250; shared team 185–187; SMART 246–247; SCRUFFY 247 gratitude practice 16, 17, 19, 102– 104, 118, 125, 151, 216, 236, 251 green spaces 56–58 greens, leafy 80, 86, 87, 91 Greger, Michael 96 grief 256–257, grounding 143, 160 gut microbiome 4–8, 79–80, 85–89 Gynae Geek, book 87 habits xv, xvi, 17–19, 40, 91 hair 118, 121 happy hormones see serotonin, dopamine, oxytocin headaches 40, 69, 85 Health and Care Professions Council, HCPC 222, 285 heart disease see cardiovascular health Heart rate variability (HRV) 61 herbs 6, 80, 82, 90, 92, 178, 261 higher purpose 155, 230–231 highly-processed foods 6, 72, 74 hobbies 115, 204–205, 235, 240, 280 home-working 168 hormones: adolescence 118; breathing 27; epigenetics 4; fats 84–85; food 84–85; gut microbiome 5; happy hormones 101, 105; processing of 85–87; regulating appetite 86, 178; stress hormones 2, 8, 10; variety of 120; see also neurotransmitters How not to die, book 83 I’m ok, You’re ok, book 220 Illness xvi, 10, 46, 118, 124, 254 immune system: autoimmune conditions xvi, 2, 10; breathing 27; compassion 214; epigenetics 4; food 79–81; gratitude 102; gut microbiome 5, healthy fats 178; 79–81; inflammation; movement 54–55, 57; sleep 38; SCFAs 79; stress response 8; writing therapy 254; yoga 172–176 291

Index indigestion see digestion inflammation: epigenetics 4; healthy fats 85; SCFAs 5, 79; stress response 9–10 Inflammatory Bowel Syndrome (IBS) 5 see also digestion influencing 209, 285 insomnia 40, 48 see also sleep insulin: resistance 10; response 5, 55, 77, 86 see also blood sugar and diabetes intention 154–156 intrinsic reward 113–114, 246, 249, 265 intrinsic worth xi, 208–211 job satisfaction 135, 223–224, 241 just like me excercises 163–164,210–211 learned behaviours 231–234 lifestyle medicine 272, 280, light non-REM sleep see sleep limbic system 122–124 loneliness 121, 124, 277, 282, loving kindness meditation 145–147 lunch 74, 89–91, 182, 223, lungs 5, 8–9, 26–31, 35, 55, 58, 137, 139, 142, 158, 161, 173–174 See also breath make friends with your body 20, 117–120 meditation: 134–147; applying at work 147; benefits of 135; body-scan 138; breathe in whole of creation 139–140; feel a sense of wonder 141–142; for longterm health conditions 280; for resilience 286; for trauma 258; loving kindness 145–147; mindful meditation 136–137; scientific research 2, 135; we are made of stars 143 see also breath meetings 168, 170–171, 196–197, 197–200, 203 melatonin 40–41, 84 menopause 40, 84, 87 menstrual health 47, 84 mental health 25, 57, 168, 203 292

metabolism 54 microbiome see gut microbiome micronutrients 5–6, 72, 81, 85, 178 migrane see also headaches mind–body connection 1, 13–17, 280 mindfulness: consumption 104, 272, 284; eating 74–76, 83, 86, 89, 91; lifestyle medicine 280; moments 161; purchasing 104; see also meditation and wonder Mindfulness-Based Stress Reduction MBSR 259 Mitra, Anita 87 money see finances mood: awareness of 4, 127; food 81, 84, 178; improve 242; movement 54–55, 60, 162; outdoor time 56; regulation 38, 84 moral injury 259–261 mouth-breathing see breath movement: 54–69: at work 68–69; evolution 18, 54; goals 247–249; intuitive 14; joyful 55–56; movement breaks 59, 168–169, 181, 198; playful movement 56, 58–61; through the day 56, 170–172; yoga 61–67, 171–176 muscle mass 54, 84 musculoskeletal health 15, 16, 168–169 Music Therapists xix, 52, 132, 147 nadi shodhana see alternate nostril breathing nasal breathing see breath natural gifts 231, 232–234 nature 56–59, 76, 107, 140, 230, 236, 274 negative bias 39, 115, 125 nervous system 1, 8–9, 15, 26–27, 47, 58, 84, 139 Nestor, James 29 neurological diseases 10 neurotransmitters 4–5, 84, 120 Newman, Gemma 93 night-shifts 42 non-judgement 129, 209, 212–215 non-REM sleep see sleep non-verbal communication 164, 213, 215

Index nose-breathing see breath nutrients 8, 27, 72, 75–76, 79 see also phytochemicals nuts 6, 74, 80–83, 85–86, 88–89, 90, 92, 178 observing thoughts 124–126 obsessive, about food Occupational Therapists xix, 36, 52, 93, 282 oils see fats omega fats see fats Operating Department Practitioners xix, 36, 132, 147 organic food 106, 274, 275 Orthoptists xix, 36, 68, 132, 283 Orthotists xix, 51, 131 Osteopaths xix, 36, 69, 282 overnight oats 86, 88–89 oxidative damage 6, 10 oxytocin 105, 123, 162 pandemic xvi, 145, 168, 259, 272, 274, 279 panic attacks 250 see also breath Paramedics xix, 35, 51, 68, 132, 147 parasympathetic response 8–13, 16, 25, 27, 47, 56–58, 85, 87, 123, 135, 139, 153, 158, 216 people-pleasing 190 perfectionist 190 Period Power, book 87 periods see menstrual health Physiotherapists xix, 36, 282 phytochemicals 6, 57, 72, 80–82, 120 phytoestrogens 82, 86–87 pineal gland 40–41 pituitary gland 8 Plain English 192, 194 planetary health diet 73 plant foods 6, 79–81, 88 Plant Power Doctor, book 83 playful movement see movement Podiatrists xix, 51, 282 Polycystic Ovary Syndrome (PCOS) 87 Polyphenols 80 post-traumatic growth 255–257 post-traumatic stress 254, 255–257 Post-Traumatic Stress Disorder (PTSD) 254, 256–259

Prebiotics 7 premature death 56 probiotics 6–7 processed foods see highly-processed foods project plan 191, 192 Prosthetists xix, 51, 131 see also Orthotists public health xx, 93, 272, 280, 283–286 purpose 237–242 Radiographers xix, 35, 51, 68, 132, 147, 283 random acts of kindness 105–106 Ravindra, Ravi xii red Thai curry 92 regenerative agriculture 275 relationships 118, 203, 209, 218, 222, 240, 247, 250, 254, 268– 267, 278 relaxation response see parasympathetic response REM sleep see sleep rest and digest see parasympathetic response restorative yoga 61–69 reward system see dopamine riding the wave of emotion 121–124 ripple effect xix, 203 safeguarding xiv, 127, 189, 200 satiation 5, 122 screen time 41, 109–112, 181 SCRUFFY targets 246–247 seeds 5, 6, 74, 80–83, 85–88, 90, 177–178 self-destructive behaviours see distraction behaviour self-talk 115–117, 263 self-transcendence xx, 230 serotonin 47, 105 sex 13, 84, 122, 256, 264 shift work see night shift Short Chain Fatty Acids (SCFAs) 5, 79 sitting 169 skin health 2, 4, 84, 118, 121 skipping breakfast 77 sleep: 38–52 apnoea 30; at different life stages 14, 39–40; breathing 30; effect on body systems 19, 24; 293

Index epigenetics 3–4; food 77, 84; gratitude practice 102; habits 40– 42, 46; hormones 84–87; lifestyle medicine 280; meditation 46, 135–136; menopause 40; screentime 110–113; snoring 30; stages of sleep 39; yoga nidra 47–51 small treats 103, 162 SMART targets 246–247 snacks 72, 77, 177–178 snoring see sleep social connection 203, 278 social isolation see loneliness social media: addiction 110, 264; body image 118, 121; choices xvii, 41, 74, 83, 111, 235, 237; influence 212–213; negative bias 101, 103, 210, 282; self-esteem 121 social prescribing xx, 93 272, 279–281, 284–285 spaghetti bolognese recipe 92 Spector, Tim 83 Speech and Language Therapists xix, 36, 52, 68, 282–283 Spoon-fed, book 83 stages of sleep see sleep standard Western diet 7 Stir-fry recipe 92 story-telling 68, 123–124, 218–222 stress hormones see adrenaline and cortisol stress response 1, 8–13, 25, 122, 153, 280 stroke see cardiovascular health substance misuse 264, 280 see also distraction behaviour sugar: in food and drink 7, 72, 77, 79, 90, 177; spikes 5 see also blood glucose supermarkets 72, 76, 281, 282 supervision 128, 170, 171, 187, 189, 197, 200–202, 232, 256, 260–261, 283, 285

294

suprachiasmatic nucleus (SCN) 40 sustainability 73, 77, 236, 237, 275 sympathetic response see parasympathetic response team-building 203–206 The Power of Now, book 10 The Stories We Tell Ourselves, book 220 Therapeutic Radiographer xix, 51, 68, 132, 147, 283 time-management 184, 189 see also Eisenhower’s Matrix Tolle, Ekhart 10 toxins 3, 79, 142 trauma see PTSD turbinates 26–27, 31 Type 2 diabetes see diabetes unblock your nose 29–31 unmet needs 209, 226, 269 Untamed: Stop Pleasing, Start Living, book 190 urgent and important tasks 187–190 vagus nerve 9, 75 visualisation 51, 140, 267 vitamins see micronutrients wholegrains 6, 73, 80, 85–86, 88, 90, 178 wonder 61, 101, 102, 106–109, 113, 121, 125, 132, 139, 141–143, 176 work-life balance 224 workstation 168–170 writing therapy 128, 222, 226, 254–245, yoga: at work 68; brainwaves 2; desk 172–177; flow state 113; goals 248; restorative 61–69, 265; yoga nidra 40, 47–51