Stress and Resilience

“Stress is an unavoidable part of life and is necessary in order to build resilience. Resilience can be defined as the ability to recover quickly from difficulties. It implies a certain “toughness” as well as flexibility – it is a quality that helps individuals and communities to thrive and grow despite difficulties.” (Prof Rita Thom)

The current pandemic is exposing us to prolonged periods of stress, with no certainty as to when this will all end, which means we will continue to experience high levels of stress in the months to come, so we need to monitor our stress levels carefully.

Key message is not to be afraid of stress:

If we look at some of the physiology - in our brains there are top-down and bottom-up regulatory mechanisms which can help us manage stress and maintain equilibrium, or if they are overwhelmed, can result in dysregulation and an ability to cope and feeling overwhelmed.

It is important to experience stress in order to develop resilience. It is the pattern of stress that is important. In the current COVID-pandemic scenario, where there is a high chance of unremitting, unpredictable, severe and uncontrolled stress, there is a risk of the brain’s regulatory mechanisms being overwhelmed, which then can result in a state of hyperarousal, and later exhaustion and burnout.

As stated above, stress can be positive or negative. When stress is predictable, moderate and controlled, this can be seen as positive as it can lead to an increase in resilience. When stress is unpredictable, severe and uncontrolled, this can result in a greater vulnerability to the effects of stress.

HCWs may have little control over the pattern of stress they are exposed to during Covid19, the environment in which they work, and other stresses experienced outside of work, it is possible for individuals to either shift the pattern of stress to develop more resilience to stress or to increase vulnerability to distress.

Instituting helpful daily self-care routines can be very helpful in shifting your stress pattern. Here is a helpful self-care checklist. 

Here are some tools to help manage stress

Macro recharges are opportunities to take time out (like a holiday), but where this is not possible, consider the benefits of Micro-recharges:

It’s important to institute protective measures to prevent dysregulation and burnout. Even very short interventions can help to maintain equilibrium. They can be as short as 90 seconds. These strategies need to be intentional and built into daily routine. Instituting some rhythm in one’s day at work and at home can help to counter some of the unpredictable parts of the day.

Here are some suggestions for how you can incorporate micro-recharge moments into your day:

o   When you wash your hands do it mindfully and slowly, taking deep breaths as you do so. This will downregulate your sympathetic nervous system

o   Breathing exercises

o   Connect with others – laugh, make eye contact, share frustration.

o   Increase social connection at every opportunity

o   Be compassionate with yourself.

o   ‘I am doing the best I can’ / Spiritual verses / Positive Affirmations

o   Walk up the stairs, mindfully counting the stairs

o   Doffing on and off / Mindfully

View the 30:3:30 Approach to Self-Care

Don’t underestimate the value of social interactions:

Social connectedness is also highlighted as a key regulatory mechanism. Positive social interactions (even when you are physically disconnected) with people who can help you feel better and self-regulate are important. Regular, even small doses of human contact, wherever possible, can also be regulatory. Although this pandemic is taking a long-time to run its course, it is important to emphasize that this current situation is not going to last forever, giving people hope.

Social connectedness can also increase dysregulation (described as “relational contagion”). When individuals are exposed to others whose emotions are dysregulated - which may happen in a workplace where people are feeling very stressed – this can have a negative impact. This is where leaders can play an important role. A self-regulated leader can help the whole team to calm down. But where leaders are hyper-aroused and stressed, that can escalate anxiety in your staff.

“It needs to be borne in mind that frontline healthcare workers may have a history of trauma, both from their professional or personal lives. It is likely that increased numbers of healthcare workers will develop trauma-related disorders during the pandemic. One should expect that these will emerge post-pandemic, requiring treatment.” Prof Ruth Thom

These webinar links, shared by Prof Thom, provide a detailed background to stress and resilience and how HCWs can improve their stress-response systems using a trauma-informed psychological first aid approach.