New routes to resilience- lockdown 4 and beyond.

Day million of the lockdown and no end in sight. This week has felt particularly rough, with many of my patients really struggling.

I think that part of the reason, as we settle in for the long haul, is that previous effective coping strategies have not been useful our current situation.

A salient feature of my most robust and resilient patients is the sense that they can make effective future plans. They can make a adjust for any of life’s challenges. Part of my job has always been to help my patients get control in their lives, to help them make a plan.

One lady came to me, trapped in an abusive marriage. She was past the point of thinking that he still loved her, but she was completely dependant on him. Slowly we made plans. She opened up a bank account in her name. She got her driver’s licence. She started squirrelling anyway bits of money and reconnected with her family from whom she was alienated. Slowly, slowly, one plan built upon another, until she was able to leave him. Good future planning gave her autonomy in her life again.

The problem with the current situation is that my go to therapeutic tool for crisis situations – to help my patient come up with a plan – is simply not very useful right now.

My patients in the service industry are heavily affected. I can’t help my restauranteur make plans to keep her business going, because this will probably go on for many more months. A personal trainer enthusiastically made online training video sessions. But that is getting stale as fewer and fewer people sign on. Even those who are motivated and creative, are spluttering and stalling the longer they are not able to put plans in place.

“Catastrophising” is when patients always go to the worst-case scenario. In the past, when patients started catastrophising, my job was to guide them to more realistic ways of thinking about the problem. Paradoxically, it seems that when patients now go to the worst case scenario, they are more able to make plans which contain their current anxieties.

For the restaurateur, it was to realise that she won’t open for maybe a year, possibly longer. Letting staff go and losing her rental property made more sense than “waiting for lockdown level 1”. For the personal trainer, it was to start thinking of no income scenarios lasting several months.

In todays’ unsettling world, accepting the worse case scenarios, has helped patients settle in to less anxious, if sadder, states. At least they can then make plans against it, and if the scenario is better than anticipated, then all the better.

In making recommendations to my patients, I have stuck with the old gold standards of resilience, such as exercise and reaching out to loved ones. Meditation, good sleep and good routines. I have begun to realise that in today’s world, these recommendations are not always useful.

I think that the reason for this is that everything is much harder right now. I love exercising and find it a huge stress relief. In pre-COVID days I had a happy routine of walks on the mountain topped up with gym workouts. You don’t need to convince me about the benefits of ongoing exercise.

But now it’s so much harder to stay motivated. I do not enjoy exposing myself to crowds in the allocated time slots. I do online exercise routines, but they really aren’t much fun. I continue with it, because I have fully bought in to the value of exercise. But I can’t tell my patients, who hardly ever exercised, to get into it now. It simply doesn’t work.

All the advice to “make lockdown work” – doing a course, exercising, baking, zoom calls, charity work, the list continues – does not work. It is hard to do what’s important to you, never mind what you don’t much care for.

Which led me to realise that you must figure out what your values are. This is harder than it sounds. Everybody on Facebook has an opinion and exponential graphs shout for your attention. The universe whispers your values, your purpose, to you. If the world gets too noisy, we sometimes struggle to hear.

When the world is as crazy as it is now, we have to create that quiet space where we can watch ourselves and learn from ourselves. Notice what makes you happy, notice when you are impressed or angry.

If keeping your brain active helps give you a sense of meaning, prioritise it and do that course. That is where your effort must go. If connecting with people energises you, find a way, whether by phone or Zoom or email. It takes more effort to do these things during lockdown; it’s not easier just because you don’t have to leave your room. You have to consciously decide what your priorities are and focus on that. Otherwise we listlessly end up doing everything and nothing.

I think that we have to accept that this is still going to be long and hard. Using up energy fighting governmental laws, or neighbours, or ourselves, in this storm is going to leave us very depleted. We need to calm and focus our thoughts, which can only happen when we accept things as they are and focus on what’s important to us. It is not an easy task.

 grant me the serenity to accept the things I cannot change,
courage to change the things I can,
and wisdom to know the difference.

Serenity prayer