Wouldn’t it be cool to eliminate intense emotions like anger, grief and panic in seconds? Or more importantly, perhaps to have the choice as to whether to feel these emotions or not, putting us instantly back in control. Earlier on this week, I attended a Psy-Tap practitioner course helping to support 50 other therapists training in this unique system. If you haven’t yet heard of Psy-Tap, I’d suggest having a look at the website. http://psy-tap.com/. Despite the name, Psy-Tap has nothing to do with tapping. It stands for “Psychosensory Techniques and Principles”. It was developed by Kevin Laye who was a former executive with Dolby. He has used an engineer’s mindset to create techniques which are unique and work seriously quickly. We are talking seconds to minutes to eliminate lifelong traumas and phobias. It’s being used in schools to help calm students and reduce anxiety and there’s no doubt you will be seeing more of it out there in the near future.
Over the ten years, I’ve been a university GP, I’ve seen many students sitting exams. It can be a tense time and below are some of the hacks that students have told me have worked for them. I see revision as a kind of training – more of a marathon than a sprint. Sitting exams and revision does seem to get easier and more familiar with practice.
Stress can affect sleep as sleep comes when we feel safe and can let go. Around exam time, the head can feel busy with thoughts playing through the mind. A regular mindfulness practice e.g. Calm or Headspace apps can really help decompress the active mind. Keep a regular sleep routine so that your body gets used to it and avoid napping during the day. I’d suggest avoiding the use of sleeping tablets around exam time as they can affect cognitive performance and memory in subtle ways. Pause is really helpful app that some of my students have found helpful https://www.google.co.uk/amp/s/techcrunch.com/2015/10/08/pause-ustwo/amp/. It’s best used a couple of hours before bedtime as the blue light from screens in the hour before sleep can keep us awake.
It’s really tempting to spend long hours in front of books and screens chalking up the revision hours. As humans we are not really designed to be stationary for this long and I quite frequently see students in the surgery with muscular neck and back pains from sitting. I think the record for one was 8 hours without moving! Long hours in front of screens also can reduce the blink rate of the eyes increasing the chance of eye irritation. If the eyes start to become irritated, lubricating eye drops can be purchased from most pharmacies. Any red eye pain or visual disturbance should be discussed with a optician or medical professional.
We seem to work better when we take frequent breaks to move and rest our minds temporarily. A fantastic resource is the work of Francesco Cirillo and his Pomodoro technique https://francescocirillo.com/pages/pomodoro-technique. Basically the idea is that you pick your task and work on it without interruption for 25 minutes (set a timer). The 25 minutes is one pomodoro. Then have a five minute break before starting on the next 25 minute pomodoro. After four of these, have a longer break 20-30 minutes. These tests allow the brain to rest and assimilate the new information.
Eating and drinking
Working brains need nutrition and central to this is adequate hydration. The body is comprised of 50-60% water https://www.livestrong.com/article/340756-healthy-body-water-percentage/ and so drinking plenty of water is important. The amount recommended per day is around eight x eight ounce glasses or two litres of water. There are some studies that suggest that mild dehydration can affect cognitive performance https://www.healthline.com/nutrition/how-much-water-should-you-drink-per-day. Eating little and often (5/6 meals per day)seems to work best as large meals can make us feel sluggish and bloated. The same goes for high fat/sugar foods such as pastries and cakes. It’s better to stick to proteins from lean meats/fruits and grains and snack on healthier snacks like dried fruits and grains https://www.schooldays.ie/articles/5-tips-for-healthy-eating-when-studying. Caffeine is a bit of a double edged sword and many of my students swear by it for improving concentration. I’d suggest keeping it to a minimum (max 1-2 cups / day) as it can make people feel jittery and anxious. Try to avoid drinking it after midday as this may hinder sleep.
Schedule time for connection and play
Humans are social creatures and are meant to be in connections with other humans https://greatergood.berkeley.edu/topic/social_connection/definition#what-is. Prolonged periods in isolation while revising affects us and I have come across students experiencing quite profound drops in mood because they have not caught up with their family and friends and have let their leisure activities and hobbies go by the wayside. It is often necessary to cut back on some commitments but scheduling time for meals out and social gatherings can be really helpful. Studying in a group or with friends is also a useful antidote to isolation. Face to face connection seems to be the most helpful as opposed to interacting on social media. Spending time outdoors in nature appears to have significant health benefits http://www.bbc.co.uk/earth/story/20160420-how-nature-is-good-for-our-health-and-happiness
Are you struggling with stress? Please contact me for a free telephone consultation to see how I can help
Dr Lizzie Croton GP
Health apps are transforming our experience of self-care and allowing us to have access to expert advice and support through the medium of technology in a way that could only be dreamed of a few years back. It’s not uncommon now for me to “prescribe” an app to some of my patients if I feel that it would help the particular issue they have come to me with. Before I recommend anything, I road test it thoroughly myself. Here are four of my favourites
Buddhify is a mindfulness meditation app with a slight difference. It’s designed to work around whatever you are doing and so there are meditations for walking, phone use and dealing with difficult emotions. By slowing down and paying attention to what is happening now (as opposed to what has happened or what might happen) we start to experience things differently. Over time this mindfulness (paying attention), actually changes the structure and function of our brain which is a pretty awesome fact. We can become less reactive and more present in our lives. It’s not always easy but it’s worth it. I first started meditating 6 years ago and it’s transformed my life personally and professionally. Buddhify is different from some other meditation apps in that purchase is a one-off flat fee with no subscription service. In fact, the developers hope that one day, you won’t actually need the app as mindfulness becomes more and more of a daily habit in your life.
Curable – the app for chronic pain
Subscription (approx as original prices in US dollars)
Some of you may remember my chronic pain article from the previous issue of Altrincham Today. Chronic or persistent pain is a huge problem and despite medical intervention, many people remain in pain. This app focusses on the hidden emotions believed to be at the root of chronic pain. It’s described as an online pain psychology programme. The basis of the Curable approach is that factors in our brains such as our thinking patterns and behaviours play a role in how pain is experienced. Over time, the brain becomes programmed with cycles of pain. The good news is that this programming can be reversed and the pain diminishes. Sufferers gain relief through a daily exercise lasting 5-20 minutes. Check out the website for more details as to the science behind Curable https://www.curablehealth.com/science
Please see your doctor first if you are experiencing any kind of chronic pain for a medical check-up and relevant tests before commencing the Curable programme. This is to rule out any physical illness or disease.
Calm – reduce anxiety, sleep better and feel happier
Subscription (approx as original prices in US dollars)
Calm is a smorgasbord of different features. There is a huge amount of content on the app which is broadly divided into mindfulness for anxiety and sleep and focussed practices for habit control and performance. There’s a section for improving your relationships and emotional awareness. There are sleep programmes and a fabulous “Bedtime Story” section for adults and kids read by some famous voices. I really like the masterclasses which tackle issues as diverse as screen addiction to mindfulness for pain. There’s quite a bit of free content and you can sign up for free for the first seven days to see if you get on with the approach and style. All of these apps track your progress which is a key feature of habit change and allow you to share what you are up to with your contacts on social media. We live in a world where human connection is under threat in some areas and by working on our insides, we can be more available for our fellow humans. It’s a virtuous circle.
Sleepio: an online CBT programme for sleep problems
Annual cost £286.00
Sleepio is an evidenced based online sleep improvement programme developed by Professor Colin Espie from the University of Oxford. Most people have heard of CBT or Cognitive Behavioural Therapy from its use in the NHS as a therapy to help those experiencing symptoms of anxiety and depression. Simply CBT looks at the relationship between thoughts, feelings and behaviours and aims to help people change these when they are unhelpful or causing problems. An example from sleep would be experiencing worrying thoughts about not being able to sleep. This pattern is likely to increase stress in the body and make sleep less likely to happen. An awareness of this pattern allows us to make changes and sleep better. Sleepio creates a tailored programme for the individual depending on what the particular sleep issues are. There are regular meetings with a virtual sleep expert and helpful tools to practice. Over time, the brain functions differently and sleep becomes easier. On the downside, it’s expensive but I think could be considered an investment in one’s future health given the health risks associated with poor sleep. I believe it is funded by the NHS in some areas although I was unable to find further information on this. There is also a corporate programme with some employers funding access.
Dr Lizzie Croton
This is a really simple exercise. The first part is not something I developed and I have not yet found the source. I have heard this described in Buddhist teachings and also have heard it described by Andy Puddicombe, the co-founder of the Headspace App (https://www.headspace.com/?utm_source=google&utm_medium=cpc&utm_campaign=917256451&utm_content=51529951612&utm_term=217943262717&headspace&gclid=EAIaIQobChMIy7PYkf-_2wIV5p3tCh2zzgmNEAAYASAAEgKj4_D_BwE)
It’s a really simple way of helping to get some distance from difficult thoughts and feelings. The thing is that it isn’t so much the thoughts and feelings that we experience that cause problems but our reactions to them. I was actually quite offended when I first heard this but after careful examination, it does appear to be true.
What happens to cause pain is that we experience the thoughts and/or feelings and we attach to them. If these experiences were foodstuffs, we metaphorically throw them into a pan, cook with them and perhaps even serve them at a dinner party! The attachment creates pain.
Now simply, the next time you experience a painful thought or feeling, practice acknowledging it by simply saying “thinking” or “feeling”. You will normally find that this allows some space for the thought or feeling to be let go of. Interestingly this also can work with unpleasant images that pop into the mind – “picturing”. I suppose, if we work on the premise that all thoughts, feelings and pictures are messages in some form, the labelling presents us with the choice of letting go. It also tells the sender of the message that it has been received and so both parties are happy.
This aticle is designed for educational purposes only and is not intended to replace professional, personalised advice from your doctor. Please, if you feel ill and are unsure or concerned, seek advice from a qualified health professional which could be your GP or Accident or Emergency if you have a life threatening medical problem. If you unsure, NHS 111 in the UK can be accessed by dialling 111 from any phone.
From a colleague
My name is Rachel, I work in the medical field. I enjoy writing and sharing my experiences with others. Over the last 25 years I have experienced periods of deep sadness, anger and thoughts of not wanting to be alive anymore. Thankfully they do not last long – perhaps a few days.
As a doctor, It’s very tempting to “diagnose” myself. Is this depression? Having that sort of label can be very comforting when in pain. It appears to make the whole experience understandable. It places it in a container and it feels easier to understand something tangible. It’s also easier when talking to others, “I’m struggling with depression.” Most people have heard of “depression” before. They know the Royals talk about it and there are various campaigns out there designed to raise awareness. I applaud this work. It’s important to talk about how we feel.
I started writing articles around 20 years ago. I was probably experiencing similar feelings then, although back then it felt normal and it lasted longer. I found writing down my thoughts helped. These days, I am more interested in finding out what I can do to get myself out of this head space. This helps me to help others to do the same. I find this very rewarding.
At the moment, I am struggling myself. This article is hard to write. In actual fact, its much easier to write about the “difficult stuff” than the “positive stuff”. There is a critical voice screaming at me and It feels as though my head has become stuck and the usual fluidity of my thoughts has stalled. But I know it will change and that gives me hope.
So what helps? These things help me and perhaps they will help you too. I should say that if you are experiencing thoughts of wanting to harm yourself and you feel unsafe, please do seek help immediately and talk to someone. This may be your GP, or the Samaritans or someone who you trust. This article is very helpful https://metanoia.org/suicide/
1. Sitting and thinking about how bad things are doesn’t help. It actually seems to make things feel much much worse. This is a habit for me and I can kid myself into thinking that I am doing something productive. It increases the feelings of stuck-ness and inertia. Doing something, anything other than this is going to be helpful. This might mean getting out of the house, walking briskly or a change of scenery.
2. Taking the pressure off is helpful. I have a tendency to be self-critical at times and I drive myself extremely hard to perform and succeed. This is another habit and these habits can feel normal and comfortable. A few months back, I started to see the price of this behaviour and now painful it could be. So I started to give myself permission to rest. To do nothing at times. To accept that a “good enough” piece of work was ok. To tune into myself and pay attention to what it was that was needed at this moment in time. To be kind. Interestingly I also found that when I was kinder to myself, it was easier to be kinder to others and that helps to make the world a better place. Self-compassion for our humanity is really important. Kristin Neff’s work on compassion is really worth looking at. Here’s one of her TED talks http://m.youtube.com/watch?v=lvtZBUSplr4
3. Get out of bed, shower and dress. It helps.
4. About social media. I think social media has many positives. I think it can also be a miserable place at times. The key I find is to cultivate an awareness of how we are feeling and asking the question – Is our social media experience making things better or worse for us at this moment? If the answer is that it is making things worse, stop for the moment. I think a key for understanding and getting out of these head spaces is noticing the supposed cause / effect nature of things. The things that make the situation worse (and better) are usually pretty predictable. Do less of things that make things worse and more of the things that make things better. It’s about getting to know yourself better. This takes practice and is not an overnight job. Be kind to yourself.
5. Spending time with people. Spending time with people who accept where we are at the moment can be very helpful. There is also a human need to be understood and accepted. I’ve certainly noticed a real need to communicate how I am feeling to others. If I sense that they accept me as a person despite how I’m feeling, this is deeply helpful. People may not understand and I think it’s important not to take this personally because they may not have a frame of reference for the experience. They may not be able to cope with strong feelings in others. There could be something else going on – who knows? I tend to choose the people I spend time with when I am feeling like this. I have many good relationships but some people don’t really know what to say or do and that is ok. It is what it is. The only person who can change me is me but being with others sometimes helps to facilitate this.
6. Do something for someone else. This is helpful. I know many people who volunteer or help the homeless in their spare time.
7. The comparison habit. This is a common one. I think I heard the TV presenter Fearne Cotton describing it as to “compare and despair” If you think about it though, you are not really comparing “like with like” as people are so individual. I think it is more helpful to compare “oneself with oneself” over time. To see progress and to celebrate progress.
8. “This too shall pass” This is a slogan from the 12-Step program of Alcoholics Anonymous. I’ve found it best applied after the event. Once we have experience of knowing it passes, we can apply that experience the next time. I think Winston Churchill described it well when he said “If you’re going through hell, keep going.” It does and it will pass.
9. Damage limitation. For me, getting through these episodes is akin to preparing a boat to ride through a storm. It’s generally a good idea to batten down the hatches, reef the sails and make things as straightforward and simple as possible. Put off large decisions that can be put off, protect close relationships by avoiding arguments and allow people to be supportive. Sleep, eat sensibly and make time for rest.
10. Remember these experiences are not you. They are things that the brain and the mind do and the totality of what makes “you” “you” is so much more than this. It like confusing the trombone with the entire orchestra.
I spoke to a group of consultants yesterday about the work of the Sick Doctors’ Trust, a charity that exists to support addicted doctors and dentists. Following the talk, a number of my colleagues welcomed the information given, as apparently, it’s not always clear what sources of help are out there for this group of professionals. Here’s a quick synopsis:
For doctors and dentists
If you are concerned about your drinking or drug use, talk to somebody. Addiction is a great isolator and the denial is usually very strong. Ask yourself “Is this problem costing me more than money?” If the answer is yes, then please seek help. You can obviously see your GP who can refer you into NHS or private addiction treatment services. Some other resources are listed below.
The Sick Doctors’ Trust
The Sick Doctors’ Trust is a charity that was set up in 1996 by a group of doctors recovering from addiction. They operate an 24/7 phone line which will be answered by one of their trustees and they are happy to take anonymous enquiries. All of their trustees have personal experience of addiction. They can put you in touch with other recovered professionals in your area and help you to find sources of face to face help and treatment.
The Practitioner Health Programme
PHP is a specialised NHS service for doctors and dentists. They will see and provide treatment for those with addiction issues. There is currently funding for London residents. Those outside London can access PHP as a self-funding patient or through local CCG funding (if approved). If you are a GP or GP trainee in England, you can also self-refer to the GP Health Service.
Narcotics and Alcoholics Anonymous
These are countrywide mutual support groups that are based on the principle of the 12 Steps. It’s a spiritual, not a religious programme and all are welcome. Meetings are plentiful in the larger cities with many daytime and evening options. There are also online meetings. Cost is by donation at the end of the meeting. To find a local meeting, put your postcode into the meetings finder box on the website and turn up.
Alternatively, you can ring the helpline listed on the website and the coordinator should be able to arrange for a local member to meet you at the meeting.
This is another style of mutual-aid recovery meeting which is countrywide. There are quite a few meetings in the larger cities and environs. There are also online meetings for those who prefer this format
Action on Addiction
A national charity providing residential and community based addiction treatment
For family members
Addiction affects the whole family and typically, family members and friends will constellate around the individual who is drinking or using and try to help them stop. This is completely understandable behaviour and usually ineffective because, try as we might, we cannot make someone else change. The decision has to come from them and helping a friend or relative into recovery requires a “tough love” approach which appears counterintuitive. If you are a family member or friend, get some help and support for yourself first. There are a number of groups out there specifically for you.
Families Anonymous for the families and friends of those using drugs
Al-Anon for those concerned about another’s drinking
SMART Recovery also run family groups and details of these can be found on their website
The British Doctors and Dentists Group
A country-wide recovery group for doctors and dentists wishing to recover from addiction. There are currently 17 groups in the UK and Ireland – mainly in the big cities. They meet monthly and provide a useful source of support for those in recovery. Please contact the Secretary Andrew M for specific times and locations of the meetings
This time of year, we tend to see a lot of people experiencing symptoms of (mainly) colds but sometimes flu. More confusingly, people will sometimes think they have the flu when really they have a heavy cold. Sometimes it can be difficult for medical professionals to tell. More confusingly, heavy colds that are not flu are sometimes referred to as “flu-like” illnesses. So what is what? And are there any helpful pointers that help us to decide what it is what and more importantly what we can do to help ourselves?
So what is the difference?
This information is taken from NHS Choices with a little bit of my own observation thrown in.
Flu or to give it its full name – Influenza, is a viral infection spread by coughs and sneezes. It predominately occurs in the winter.
People often ask me how you get it and the simple answer is that you get close enough to someone to take the virus into your own respiratory passages via droplets of their cough or sneeze. You can also catch flu from touching a surface or a tissue which has the flu virus on it.
The flu strains may change every year and there is a vaccine available which contains the most common flu viruses thought to be circulating that season. The vaccine is thought to take a couple of weeks to work and this is why the recommendation is to have it as early in the season as possible (around September – October). You can find out more about the flu vaccine here https://www.nhs.uk/conditions/vaccinations/flu-influenza-vaccine/
Flu generally comes on very quickly (within hours) and people tend to feel a lot more unwell that they would with a cold. It also tends to affect more than just the nose and the throat. Typically cold symptoms involve a snotty nose, a mild temperature between 37-38 degrees, sore throat and general aches and pains. Interestingly, although the NHS choices website says that colds tend to come on more gradually, I think they can actually come on quite suddenly as well. However, flu tends to have wider reaching effects on the body and people feel more unwell.
With flu, there will be a sudden high fever (>38 degrees) with a myriad of other symptoms. These may include:
- Generalised body aches
- Feeling very tired with a loss of appetite
- A dry cough
- Sore throat
- Loose stools
The key for me in distinguishing between colds and flu is the degree of functional impairment. With flu, people are wanting to stay in bed, wanting to rest and getting up and going to work is generally not an option. There is a standing joke amongst doctors and patients that if you have managed to get into the surgery, you have probably not got flu! Thankfully flu in most people will get better on its own within seven days. So why do we vaccinate against it? Well the simple answer is that it can kill or cause complications such as pneumonia or a worsening of asthma.
Certain groups namely the elderly, children, pregnant women and those with chronic disease are thought to be most at risk. This is why the flu vaccine is offered free on the NHS to these groups.
How to treat yourself
Rest is key here and rest means rest. It means switching off emails and distractions and focussing on getting better. Sleep is also helpful to allow the body to heal. It does seem that increasingly people find it very challenging to stop doing things. Recently I’ve come across a number of workers who are unwell but have chosen not to go into the office but “work from home”. This means that they unlikely to pass the illness on to their fellow colleagues but they are hardly resting and I suspect this will delay their recovery. It’s ok and essential to put the recovery first.
Treat fevers and aches with paracetamol or ibuprofen. I’d suggest checking with your pharmacist if you have a history of liver disease, stomach ulcers or asthma or kidney problems as these medications may not be the most appropriate ones for you. Drink plenty of water (so that the urine runs a light yellow colour). The advice above is also applicable to colds which are generally less disruptive than flu.
When to seek medical advice
This advice is taken directly from the NHS choices website. It’s recommended that you contact NHS 111 or your GP if:
- You are worried about a baby or a child’s symptoms
- You are 65 or over or pregnant
- You have a long-term medical condition – for example heart, kidney or lung disease
- You have a weakened immune system – for example someone receiving chemotherapy or taking long-term steroids
- Your symptoms don’t improve after 7 days
This article is designed for educational purposes only and is not intended to replace professional, personalised advice from your doctor. Please, if you feel ill and are unsure or concerned, seek advice from a qualified health professional which could be your GP or Accident or Emergency if you have a life threatening medical problem. If you unsure, NHS 111 – http://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/NHS-111.aspx can help you decide.