Coronavirus: latest psychological advice for patients and families with mitochondrial disease (March 23rd 2020)
The government have recently announced ‘shielding guidelines’ to protect extremely vulnerable people from coming into contact with the novel coronavirus. Undoubtedly, this is likely to have produced feelings of anxiety for those living with a mitochondrial condition or those caring for someone living with this condition. The Newcastle Mitochondrial team would like to offer regular psychological guidance for those who may be experiencing increased feelings of anxiety and worry.
It is very important to note that these feelings are completely normal and natural under the circumstances, and it is important that you are kind to yourself and to others in such a situation. As well as reading this advice, it is also very important that you engage in usual daily activities that keep you well, including maintaining a good sleep pattern and diet.
This week, Dr Russ Harris shared ‘FACE COVID’; a set of practical steps for responding effectively to coronavirus using an Acceptance and Commitment Therapy (ACT) framework. This is summarised below. If you would like more information about Russ’ work or ACT, please visit www.thehappinesstrap.com. The summary below is an edited version of Russ’ original guidance – which can be found here – https://drive.google.com/file/d/1_O8grFdwMDuGVIE_RvdRfhHhf6xf3tY8/view
‘FACE COVID’
F = Focus on what’s in your control
A = Acknowledge your thoughts & feelings
C = Come back into your body
E = Engage in what you’re doing
C = Committed action
O = Opening up
V = Values
I = Identify resources
D = Disinfect & distance
F = Focus on what’s in your control
Right now, the corona crisis may be affecting you emotionally, physically, socially and psychologically. This may be even more so now that the new ‘shielding guidelines’ are in place. In one way or another, the mito community are having to change the way they would usually live their lives in response to the ongoing situation. This isn’t just the case for those living with mito, but also the doctors, carers, researchers, charities and genetics community who aim to alleviate the challenges faced by those living with the condition. Indeed even if you aren’t affected by mito, you will likely experience this disruption. This is a truly human-level situation.
What connects us all is a shared feeling of fear and anxiety; this is inevitable and entirely normal in response to situations that may be dangerous and uncertain. It’s all too easy to get lost in worrying and ruminating about all sorts of things that are out of your control: what might happen in the future; how the virus might affect you or your loved ones or your community or your country or the world – and what will happen then – and so on. And while it’s completely natural for us to get lost in such worries, it’s not useful or helpful. Indeed the more we focus on what’s not in our control, the more hopeless or anxious we’re likely to feel.
The single most useful thing anyone can do in any type of crisis is to focus on what’s in your control.
You can’t control what happens in the future. You can’t control coronavirus itself or the world economy or how your government manages this whole sordid mess. And you can’t magically control your feelings, eliminating all that perfectly natural fear and anxiety. But you can control what you do – here and now. And that matters.
Because what you do – here and now – can make a huge difference to yourself, and anyone living with you, and a significant difference to the community around you.
The reality is, we all have far more control over our behaviour, than we do over our thoughts and feelings. So our number one aim is to take control of our behaviour – right here and now – to respond effectively to this crisis.
This involves both dealing with our inner world – all our difficult thoughts and feelings – and our outer world – all the real problems we are facing. How do we do this? Well, when a big storm blows up, the boats in the harbour drop anchor – because if they don’t, they’ll get swept out to sea. And of course, dropping anchor doesn’t make the storm go away (anchors can’t control the weather) – but it can hold a boat steady in the harbour, until the storm passes in its own good time.
Similarly, in an ongoing crisis, we’re all going to experience ‘emotional storms’: unhelpful thoughts spinning inside our head, and painful feelings whirling around our body. And if we’re swept away by that storm inside us, there’s nothing effective we can do. So the first practical step is to ‘drop anchor’, using the simple ACE formula:
A = Acknowledge your thoughts and feeling
- By taking the stance of a ‘curious scientist’ – pay attention to your thoughts, feelings, emotions, memories, sensations, urges etc. Just acknowledge whatever is going on, just as a scientist would.
- Whilst paying attention to and acknowledging your thoughts and feelings, also…
C = Come back into your body
Try to connect with your physical body or senses. This could be anything, and try and be creative with this. Some examples include:
- Slowly pushing your feet into the hard floor
- Slowly straightening your back and spine; if sitting, sitting upright and forward in your chair
- Slowly pressing your fingering tips together
- Noticing the feel of your hands or body on a chair or bed; noticing how the material feels on your finger tips or body
- Slowly breathing
The aim here is not distract from what is happening in your internal world. The aim is to remain aware of your thoughts and feelings, continue to acknowledge their presence …. and at the same time, come back into and connect with your body, and actively move it. Why? So you can gain as much control as possible over your physical actions, even though you can’t control your feelings. (Remember, F = Focus on what’s in your control).
And as you acknowledge your thoughts and feelings, and come back into your body, also…
E = Engage in what you’re doing
Get a sense of where you are and refocus your attention on the activity you are doing.
Find your own way of doing this. You could try some or all of the following suggestions, or find your own methods:
- Look around the room and notice 5 things you can see.
- Notice 3 or 4 things you can hear.
- Notice what you can smell or taste or sense in your nose and mouth
- Notice what you are doing
- End the exercise by giving your full attention to the task or activity at hand
Ideally, run through the ACE cycle slowly 3 or 4 times, to turn it into a 2- 3 minute exercise.
The better you anchor yourself in the here and now, the more control you have over your actions – which makes it a lot easier to do the next steps: COVID
C = Committed Action
Committed action means effective action, guided by your core values; action you take because it’s truly important to you; action you take even if it brings up difficult thoughts and feelings.
Once you have dropped anchor, using the ACE formula, you will have a lot of control over your actions – so this makes it easier to do the things that truly matter. Now obviously that includes all those protective measures against Corona – frequent handwashing, social distancing, and so on. But in addition to those fundamentals of effective action, consider:
- What are simple ways to look after yourself, those you live with, and those you can realistically help?
- What kind, caring, supportive deeds can you do?
- Can you say some kind words to someone in distress – in person or via a phone call or text message?
- Can you help someone out with a task or a chore, or cook a meal, or hold someone’s hand, or play a game with a young child?
- Can you comfort and soothe someone who is sick?
- Or in the most serious of cases, nurse them and access whatever medical assistance is available?
Repeatedly throughout the day, ask yourself ‘What can I do right now – no matter how small it may be – that improves life for myself or others I live with, or people in my community?’ And whatever the answer is – do it, and engage in it fully. This may include:
- Taking time for yourself; to make sure you are being kind, compassionate and supportive of your own wellbeing
- Focusing on keeping yourself well, by making sure you follow guidelines given to you by health professionals such as:
- Taking your regular medication
- Following exercise guidelines
- Practicing good personal and sleep hygiene
O = Opening up
Opening up means making room for difficult feelings and being kind to yourself. Difficult feelings are guaranteed to keep on showing up as this crisis unfolds: fear, anxiety, anger, sadness, guilt, loneliness, frustration, confusion, and many more.
We can’t stop them from arising; they’re normal reactions. But we can open up and make room for them: acknowledge they are normal, allow them to be there (even though they hurt), and treat ourselves kindly.
Remember, self-kindness is essential if you want to cope well with this crisis – especially if you are in a caregiver role. If you’ve ever flown on a plane, you’ve heard this message: ‘In event of an emergency, put on your own oxygen mask before assisting others.’ Well, self- kindness is your own oxygen mask; if you need to look after others, you’ll do it a whole lot better if you’re also taking good care of yourself.
So ask yourself, ‘If someone I loved was going through this experience, feeling what I am feeling – if I wanted to be kind and caring towards them, how would I treat them? How would I behave towards them? What might I say or do?’ Then try treating yourself the same way.
V = Values
Committed action (C) should be guided by your core values: What do you want to stand for in the face of this crisis? What sort of person do you want to be, as you go through this? How do you want to treat yourself and others?
Your values might include love, respect, humour, patience, courage, honesty, caring, openness, kindness …. or numerous others. Look for ways to ‘sprinkle’ these values into your day. Let them guide and motivate your committed action.
Of course, as this crisis unfolds, there will be all sorts of obstacles in your life; goals you can’t achieve, things you can’t do, problems for which there are no simple solutions. But you can still live your values in lots of different ways, even in the face of all those challenges. Especially come back to your values of kindness and caring. Consider:
- What are kind, caring ways you can treat yourself as you go through this?
- What are kind words you can say to yourself, kind deeds you can do for yourself?
- What are kind ways you can treat others who are suffering?
- What are kind, caring ways of contributing to the wellbeing of your community?
What can you say and do that will enable you to look back in years to come and feel proud of your response?
I = Identify resources
Identify resources for help, assistance, support, and advice. This includes friends, family, neighbours, health professionals, emergency services. And make sure you know the emergency helpline phone numbers, including psychological help if required.
Also reach out to your social networks. And if you are able to offer support to others, let them know; you can be a resource for other people, just as they can for you.
One very important aspect of this process involves finding a reliable and trustworthy source of information for updates on the crisis and guidelines for responding to it.
D = Disinfect and distance
I’m sure you already know this, but it’s worth repeating: disinfect your hands regularly and practice as much social distancing as realistically possible, for the greater good of your community. And remember, we’re talking about physical distancing – not cutting off emotionally. (If you aren’t quite sure about what this means, read this: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
This is an important aspect of committed action, so align it deeply with your values; recognise that these are truly caring actions.
In Summary
So again and again and again, as problems pile up in the world around you, and emotional storms rage in the world within you, come back to the steps of FACE COVID:
F = Focus on what’s in your control
- You can control what you do here and now. And that matters!
A = Acknowledge your thoughts and feelings
- Just notice what your mind / body might be telling you – be a scientist and observe without judgement – just let them be as they are
C = Come back into your body
- Be with what you can feel with your body
E = Engage in what you’re doing
- Observe what is around you – connect with your senses
C = Committed action
- Do what matters; right now
O = Opening up
- Be kind to yourself – what you are feeling is normal
V = Values
- Connect with your values – love, humour, courage, honesty, kindness
I = Identify resources
- Identify people and information that you trust to help you
D = Disinfect & distance
- These actions are values based behaviours; they are truly caring actions