ACT on Coronavirus and COVID-19 Stress
The world is currently in an unprecedented state of stress. What can you; a parent, brother, sister, nurse, doctor, essential service employee, grandparent, or you home alone... do when faced with the daily stress and worry that is coming in waves?
The aim of these notes is to introduce you to the psychological skills that come with an approach in psychology called Acceptance and Commitment Therapy or ACT (said as the word) for short. ACT was developed by Steven Hayes and colleagues through the 1980s and 90s. Hayes’ most recent text is Hayes, S.C. (2019). A liberated mind: How to pivot toward what matters. New York: Penguin Random House.
ACT is a set of psychological principles and skills that can help all of us, at the best of times, let alone now with the struggles of being human in the middle of a pandemic. It is also a Cognitive Behavioural Therapy, which right now, we can all use a little of to help with the stress of this crisis.
Rather than going into theory or detailed explanation, I will present the nuts and bolts and give you an ACT exercise. To do this however I need to take you on a few key points or ‘stepping stones’.
The first take-home point is ‘Not all thoughts are useful’. In ACT, much of what goes on in our heads can be less than useful and sometimes may even be harmful.
Thoughts are real, can be powerful, can be devastating, can be frightening, can be useful but not always. So, if we look at our thoughts with some sense of objectivity, observing, noticing them as they come and go, we can select the stuff that is useful and let go of use-less and even harmful stuff.
Okay, here is a thought I just had: “Is this really worth doing; writing this... will anyone ever read it?” I can buy into this thought... or not. I can look at that thought and ask myself, “Is this thought useful? Does it help me to move in a direction I value? The answer to both questions is no. I can look at that thought and re-align with what is giving me purpose right now (what I value) and that is trying to put some ideas down that might help people like you and me who are struggling with all of this stress and mayhem.
Perhaps you are reading this with a sense of being stuck at home complying with self isolation and social distancing and feeling miserable. Maybe there are troublesome thoughts coming to mind.... ‘I can’t cope with this’; ‘I am lonely’, ‘I really miss...’. ‘How long is this going to go on for?’ What if I get the virus and die? What if my loved ones get it?
Every one of these thoughts is valid but are any of them useful in moving you in a direction that is meaningful and useful to you... right now?
Okay, here is an ACT exercise to illustrate.
Take a piece of A4 paper sideways and write on it whatever you are struggling with right now. If you have a sense of being ‘stuck at home’ it might be something along the lines above.
If you are an NHS doctor it might be the dread of the next phone call you have to make to a distressed relative that their loved one has just died and no, they can’t see him or her.
If you are a nurse it might be your frustration and anger at not having enough PPE. Or it might be ‘I can’t deliver the standard of care that I should be giving to all these patients’.
Write or draw a picture on the paper that represents what is worst about all this for you, right now. Something that you can’t but wish you could, control or fix or ‘get over’.
Okay, maybe there is a window or a picture on the wall, or the corner of the ceiling you can see from where you are sitting or standing.
Lets say, what you can see out the window or the picture or the corner of the ceiling represents what you Value or maybe one or two of Your Values.
Values? Just to clarify, values are not things that you can tick off a list. Values are more akin to a direction like north or south.
For example, I value helping people to live and work with the stress that comes with being human. I also value improving the management of pain in children and adolescents (along with teaching, confidentiality and being a good listener). I also value being a supportive partner and parent. I will never get to the point where I can tick any of these off the list and say I have done it. I am always ‘moving towards being...’. In this way, values are like heading in a direction but it is a direction that has personal meaning.
Right now, I value the notion of helping people to live and work with the unavoidable stress that is with us in this pandemic.
A goal I have set myself, which is in line with this value is to write these notes and put them on my webpage for anyone to access... here we go, back to your values and the ACT exercise.
You should have on a piece of paper something that represents the thing or things that are really getting to you right now.
Now, think of a couple of things that you value and write them down on another piece of paper. If you need a little help it could be something like:
Being a loving and supporting partner
Supporting my colleagues in the really difficult moments
Delivering the best care that I can
Being the most reliable and dependable employee that I can be in this ward/clinic/hospital
Standing up and showing leadership in the face of adversity
Being part of a team of essential workers who will get the job done today and tomorrow and get us through this crisis and whatever comes our way.
Okay, back to what you can see out the window or the picture on the wall or the corner of the ceiling. Choose one of these to represent the Values you have just written on the second piece of paper. Look at that point and say to yourself ‘That represents what I value, what is important to me, what really matters, what I stand for, the direction I want to be, to move towards.
Now, with outstretched arms, elbows locked, hold up the piece of paper sideways with the words or image(s) that represent your biggest worry, what you can’t control, what is really troubling you in front of your eyes.
Hold the paper at both arms length between your eyes and the point that represents your values. Position it so you can’t see the corner of the ceiling or what is out the window or the picture on the wall.
All you can see is the piece of paper and that is what you are struggling with. Keep your arms straight and hold that position for one minute.
While you are doing this, look closely at the ‘problem’ piece of paper and what it represents. Can you see what you value, can you connect with those things that you value while this thing that you are struggling with is in the way?
How do your arms feel? Are they tired? Are they heavy? Imagine doing this, holding that position for 10min, 30 min. We use a lot of energy when we are in a struggle with something that we can’t control.
Now relax your arms and bring that piece of paper with its problem/issue/struggle down and hold it face up on your lap.
Now look out the window or at the picture or the corner of the ceiling at what represents your values. Can you see them? Can you interact with them? Can you move towards them?
Maybe you can tuck the piece of paper on your lap under your arm and hold it close. You are holding the ‘difficult stuff’ close to you. Acceptance in ACT is ‘being with’, ‘making room for’ the difficult stuff, especially the stuff we can’t control. It is the opposite to avoidance. If avoidance works for you, for example, “I am not going to let this get to me” and it is not getting to you, fine. If however ‘it’ is getting to you and the more you try to avoid/control/fix/get rid of... the more it seems to be troubling you then maybe let go of the struggle and try holding it close while re-aligning with your values.
Acceptance is letting go of the need to control unpleasant thoughts and feelings and allowing ourselves to have a wave of emotion, anxiety, frustration, grief, sadness and so on.
The curious thing with all this is that as we let go of the struggle, whatever it is that was causing us so much distress and pain tends to diminish as a byproduct especially when we shift the focus and move meaningfully in the direction that is consistent with our values.
Lastly, I began with the waves of stress and worry that are coming our way on a daily basis. There is nothing more ‘normal’ than to be stressed and worried in a pandemic. The notion of waves is a useful one because the thing about waves is... they go up... then they go down; it will be the same with COVID-19 and the coronavirus.
Sadly, we may lose friends, colleagues and loved ones too soon. I hope these notes will give you some ideas and skills to help negotiate this current storm, follow the guidelines and come out the other side safely.
Dr Bernie Whitaker RN PhD. Reigate, Surrey United Kingdom