Tips for navigating Christmas and reducing stress 

We are heading rapidly towards Christmas and this is traditionally a busy time of year for us all.  I see many patients around this time of year who are experiencing stress and looking for ways to reduce or manage this.  I’m always interested in approaches that work and I’d like to share some tips that have helped others navigate Christmas and enjoy the holiday period. 

  1. Be mindful of alcohol consumption Alcohol consumption “appears” to provide a predictable and quick way of calming racing thorghts and difficult emotions which is possibly why we can reach for a drink when stressed. It’s better to be mindful instead of the underlying emotions and stressors and look for ways to problem solve.  Also alcohol may blot things out for a time but prolonged use affects sleep, mood, relationships and comes with a host of other health consequences.  If alcohol use is costing you more than money, then it’s worth looking closely at your consumption.  Talk to your GP or find out more information below (1).
  2. Schedule some time to “switch off” More than one patient of mine has experimented with a “smart phone switch off” over Christmas.  I think the record was one week, which for a daily iPhone user was quite impressive.  Smartphones and tablets can easily get in the way of face to face relationships and it’s so norrmalised now, that we don’t really notice it. Those that do “switch off” report feeling closer to people, having more memories of amusing conversations and funny anecdotes and less stress.  Social media can make people feel quite miserable, particularly if there is a sense that others are having a better time than we are.  So switch off, go for a walk and spend some time paying attention to your surroundings.  You may notice new things about your environment that you haven’t seen before.
  3. Making time to practice relaxation. Modern day life is hectic and busy has become a new normal. However, we seem to function better with periods of “doing nothing” incorporated into our days. A great way to do this, is to use one of the commercially available apps such as Headspace or Calm. There are also a number of free relaxation meditations available on YouTube. The key is to practice regularly (at least daily) and pick one you enjoy. It doesn’t have to take long, 15-20 minutes once or twice daily is beneficial. 
  4. Repeat prescriptions. Every year, a few of my patients run short on their medication as they forget to request it from the GP or pharmacist. It’s worth thinking about it 2-3 weeks before Christmas, checking supplies and making sure it is ordered in time. If you use a local pharmacy, many will order the medication in for you and collect the prescriptions from the surgery on your behalf. If you have elderly relatives taking medication, it’s a good idea to check that they have enough to tide them through the festive period. 
  5. Volunteering. Helping others is a fantastic way to build relationships in the community and make a difference to others. Many of my patients have spent part of Christmas helping out at homeless shelters or working to make Christmas special for those who would otherwise be on their own. Groups of people you could consider volunteering with are the elderly, asylum seekers, international students of those spending the holiday period in hospital. The Do-It website provides a searchable index of opportunities available locally. (2) 
  6. Relationships.  This is something that a lot of my patients worry about over the holiday period.  Christmas is traditionally a time when we spend extended periods of time with relatives.  Sometimes these relationships can be difficult for all manner of reasons.  People often feel quite stressed with all sorts of divided loyalties to in-laws and immediate family.  Accepting people how they are takes the pressure off wishing that they were in some way different and also perhaps cutting them some slack depending on the nature of the difficulty – if only for one day.  A colleague of mine, really stuggles with the behaviour of one of her relatives and so decides beforehand to visit them earlier in the day so that they have the option of leaving after a few hours to do something else.  In doing so, they have the chance to connect but also the option of leaving in a timely fashion.  That said, if someone’s behaviour is grossly abusive or violent, it’s completely acceptable to limit contact whilst the behaviour persists.   
  7. Count your blessings. Being grateful is a very powerful practice and it really doesn’t take much effort.  Simply writing down three things that you are grateful for morning and evening is a fantastic start. Being grateful has been linked with all sorts of health benefits (3) and there is a really neat app called Five Minute Journal which allows you to record gratitudes and pictures together.  It has a really nice interface which is downloadable and exportable as a PDF to help you reminisce 

Dr Lizzie Crotonn

GP 

www.boundlessflow.co.uk 

  1. https://www.alcoholconcern.org.uk/
  2. https://do-it.org/
  3. https://greatergood.berkeley.edu/article/item/is_gratitude_good_for_your_health

Some thoughts about self-harm – a guide for those affected

Self-harming behaviours are common – estimates from the Royal College of Psychiatrists suggest that one in ten young people may self harm at some point in their lives. Self-harm can happen at any age and the figures quoted here are probably an underestimate. It’s important to know for those who do self-harm that you can get better. It doesn’t have to be a life-long problem. I’ve included a link with information from the Royal College of Psychiatrists about self-harm which may be helpful: https://www.rcpsych.ac.uk/healthadvice/problemsdisorders/self-harm.aspx
People self-harm in different ways. Cutting is common (probably the most common behaviour that I see as a GP) but there are other methods individual to the person involved. I think the common denominator in all behaviours of self-harm is the presence of emotional pain. Emotions are part of what makes us human and can feel very powerful and overwhelming at times and we tend to want to move away from pain and get rid of it as quickly as possible. This is very understandable. Sometimes when people are in immense pain, something quick and predictable that affects the experience of that pain may be used. Self-harming behaviours may do this.

When I talk to people who have self-harmed, they may often describe feeling numb and the pain “waking them up” or they may describe feelings of wanting to punish themselves or something similar. Self-harm is a strategy for dealing with pain and is at that time understandable for the person concerned. It is not a particularly helpful strategy in the long run (I think everyone would agree with this) but at that time it is felt to be the best or only option available. People don’t always think rationally in the presence of strong emotions. When a behaviour seems to work, it’s easier to do it again and so a pattern may be set up.

Tips for helping yourself

Self-harming behaviours often thrive in secrecy and there can be a lot of perceived shame attached to them. It can feel very difficult to ask for help or speak to friends or relatives. Behaviours that thrive in isolation are often improved by connection. Do you have a friend you could talk to? Or perhaps a parent or older adult? Failing this, speaking to a heath care professional, counsellor or teacher is another option. Seeking professional help is important in the long run and your GP can put you in touch with services that can help. I’ve put some links below of services that we refer to. Please ask us for more information.

Can you distract yourself? The urge to harm can feel overwhelming but it can also be tolerated until it passes. I’m not saying it is easy by any means but it gets easier with practice. People tell me that getting outside, moving, brisk walking, exercise and meaningful social connection helps. If you slip up, start again where you are and try again. This is a practice not perfection. Celebrating small victories will help you to feel better about yourself and extending the compassion that you would feel towards a good friend, towards yourself is also helpful.

I’m aware of an app, CalmHarm that has been promoted on social media and within the NHS https://calmharm.co.uk/. I’ve spoken to people who have used it and found it helpful. If it’s your kind of thing, then it’s out there.

Be aware of the effects of social media and also certain social groups. Self-harming behaviours can thrive in groups as a way to cope and if this is going on in a friendship group that you are part of, it can fuel the behaviour. So too can the “perfect lives” of others on social media. Becoming aware of your mood in these situations and patterns will help you to know whether the environment is helpful and allow you take steps to look after yourself.

Finally and most importantly, if you are experiencing thoughts of wanting to end your life then please seek help immediately. This could from your GP (please ask for an urgent appoint or speak to us over the phone), your local A and E department or the Samaritans https://www.samaritans.org/. If there is immediate risk to life, then please phone 999 for the ambulance service.

Helping others

What people have told me has helped them most when they are feeling desperate is the presence of another person being sitting with them until the urge passes. The most unpleasant, powerful feelings pass eventually and this can be helpful to bear in mind.

If you are that person, it can be helpful to sit with the person for a while and resist the urge to do or “fix”anything. If the person wants to talk about how they are feeling, this is fine. Sometimes people are not aware that they necessarily feel anything, perhaps they feel “stuck” or “numb”. This is also fine. You might make them a cup of tea or perhaps go for a walk with them. There is sometimes a tendency to try to talk someone out of how they feel or rationalise with them. This approach doesn’t tend to work very well when emotions are running high. Once the person is calmer, they may wish to reflect on how they felt and this is fine. Try to avoid any language that implies criticism or blame (even if you feel it doesn’t).

Again, if there is a threat to life or you feel that you are unable to cope with the person’s behaviour, seek professional help using the sources above under “Tips for Helping Yourself”.

The following are sources of support in Birmingham:

https://www.forwardthinkingbirmingham.org.uk/

Sources of non-emergency support

https://www.forwardthinkingbirmingham.org.uk/services/13-pause

For students at the University of Birmingham

https://www.forwardthinkingbirmingham.org.uk/events/120-university-of-birmingham-pop-up-pause

https://www.birmingham.ac.uk/undergraduate/support/index.aspx

Please note: This information is designed for information purposes only and whilst accurate, does not substitute for personalised medical advice. If you are concerned about your own health, then please do contact us for advice.

The Benefits of Gratitude

I’ve been reading in lots of places recently about the benefits of being grateful.

The practice can take many forms, but a common format is to record daily what we are grateful for. These might be things, people, circumstances – anything that brings benefit to us in some way. And the more we look for things that we are grateful for, generally, the more we find.

It’s a great tool, as gratitude breeds more gratitude and is an effective antidote to the negative thinking that we can so easily find ourselves in. This is explainable by the inherent negativity bias of the human brain and I’ve referenced an article by Rick Hanson below which explores this further(1).

So it kind of seems logical that the practice of gratitude would be helpful in improving our mental health, right?

And in fact, this seems to be the case. I’ve referenced below a study from the Department of Counselling and Educational Psychology, Indiana which looked at college students who were seeking mental health counselling.

They were randomized into three groups. All students received counselling, but one group was instructed to write regular gratitude letters to other people and the other group was instructed to write about their thoughts and feelings in regards to negative experiences. Compared to students who received counselling or wrote about negative experiences, those who wrote gratitude letters, reported significantly better mental health at four and 12 weeks after the writing exercise ended. There’s an interesting discussion as to why gratitude was beneficial and I’d really encourage you to read the article to find out more (2).

So how do we practice gratitude? Well there are loads of different ways and the best thing is to find a way that works for you and to do it daily. Some people buy a nice notebook and start with writing down three things in the morning and perhaps three things in the evening when they review the day before bed. This helps people to sleep better as well. I’ve been practicing gratitude regularly for around six months and I use an app called Five Minute Journal which is a paid app (£4.99) which I love for various reasons, one being that it allows you to take pictures and embed them within the narrative. There is a free app called “Three Good Things” as well. If you don’t fancy using an app, then the notes section on a smart phone will do just as well.

The key seems to be in finding new and different experiences daily to be grateful for and really pushing yourself to do this. As you think about these experiences, immerse yourself in the feelings of gratitude they produce.  They don’t have to be “big flashy” experiences, they can be small things as well.

Most things in life have multiple perspectives and this search for the many things we have to be grateful for, changes our outlook and perspective. Like everything, this is a skill and the more it is practiced, the better the brain becomes at doing it. Try it for yourself and notice the effect that it has on your life.

  1. https://www.rickhanson.net/how-your-brain-makes-you-easily-intimidated/
  2. https://greatergood.berkeley.edu/article/item/how_gratitude_changes_you_and_your_brain

A GP’s advice to Freshers starting university

The new university term starts at the end of September and tens of thousands of Freshers will embark on the next stage of their lives as students. At my practice in Birmingham we look after over eight thousand students and these are my top tips for navigating Freshers

1. Feeling a range of emotions is normal and okay. It’s a big life change.

2. Get the basics right in the first few months and allow the other things to fall into place. This means finding somewhere to stay, eating healthily, prioritising good sleep and exercise and turning up to the seminars and lectures that are scheduled.

3. Register with a local GP and Dentist and prioritise your health. There’s usually a “student practice” close to campus where people tend to register. You might never need them, but they are there if you do. It’s possible to claim for help with health costs via a HC1/2 form. You can check if you are eligible by going to https://www.nhsbsa.nhs.uk/nhs-help-health-costs.

4. Ask for help and pace yourself academically. The first term and set of assessments can be quite stressful for people because it’s all new. There may be less structure and more free time when compared to a school environment which can take some getting used to. Ask if you are not sure about any aspect of the learning program. Most students will be assigned a personal tutor during the year and these generally are a good first port of call. You can buddy up with other students and support each other. Students from the year above are often good sources of wisdom when it comes to studying as they have already been though it. If you have any health problems or disabilities that you feel may impact your work, make sure that your department are aware of these well in advance. They may require a supporting letter from your GP which most practices are happy to do.

5. Keep safe. It’s basic stuff really, take care when walking around, particularly after dark in cities and stick with other friends where possible. If you are out at night, work out how you are going to get home in advance. Don’t accept lifts from people that you don’t know and be mindful of your alcohol consumption. If you are sexually active, it’s much safer to use a condom with new partners to reduce the risk of sexually transmitted infections (STIs). Many of these infections have no symptoms and can have serious health consequences. Your GP or local sexual health service can provide testing for STIs. Find out more here, https://www.nhs.uk/Service-Search/Sexual-health-information-and-support/LocationSearch/734

6. It’s okay not to know right away what you want to do with the rest of your life. Every experience is a learning experience. Follow your bliss, find out what excites you.

7. Have fun, experiment, join some fun clubs. At the Freshers’ Fair, you will be bombarded with all sorts of activities that you can take part in. I even joined the trampolining club for a short while. Being at university is a great opportunity to take up a new sport or activity and meet new people.

8. Look out for new friends. Some of the friends you meet at university, may well become friends for life. We tend to gravitate towards those we feel are like us, but keep your eyes open and you may well find friends you didn’t expect to find!

Enjoy the experience!

Five ways to ease a panic attack

Panic attacks can be scary and are a common reason for people to see their GP. They are sometimes treated with medication but not everyone wants to go down this route. Here are some ways to help ease the symptoms quickly using the power of your own nervous system.

What are panic attacks?

Quite simply they are when the body and mind perceives some sort of “threat” to the person. Various changes take place very quickly to deal with the threat and help, at its root to keep the person safe. There may be feelings of overwhelming panic, a sense of “impending doom”.

The heart may race and the person may sweat, feel out of control or worry that they are going mad in some way. It can feel very unsettling and people can become very worried about having another attack.

It’s really important to remember that at its root anxiety and panic are protective factors designed to keep us alive. They are usually being over-protective and so to deal with panic, we have to learn to teach our nervous system that things are safe even if they don’t feel it. Then things will start to calm. (1)

Using the breath

Breathing in a specific way when panicky is really helpful. Commonly I’ve noticed that people will either stop breathing temporarily or breath shallowly. This tends to exacerbate feelings of panic. Slowing the breathing down and allowing the out-breath to be slightly longer than the in-breath helps to turn on the relaxation part of our nervous system. It’s best to practice this when things are less intense and the brain learns to calm itself quicker and quicker with practice (2).

Tapping

Tapping with a couple of fingers under the chin and around the mouth for a few minutes also helps to switch on the calming part of the nervous system (3).

Connection

It’s not uncommon for people to feel embarrassed and then want to withdraw from others when they are experiencing panic. It can be really helpful to find someone who you feel safe with to sit with until the anxious feelings subside (which they will). Being with others who understand is profoundly calming. If you are with someone who is panicking, doing less is more. Generally it’s not helpful to try and talk them out of it or offer lots of suggestions. Calm yourself and sit with the person, perhaps encourage them gently to breath and wait. Strong emotions will generally peak and then start to fade.(4)

Using the phone

This can be useful in a public place as a kind of calming and distraction technique. When people feel anxious, the senses are often heightened and there can be a sense of wanting to hide and avoid eye contact with others. It’s becoming more and more socially acceptable for people to be looking at their phones in public and so this is a way of utilising this. It works best if it is prepared in advance. Go onto Google Images and find a picture with a repeating pattern on it – I like the “Where’s Wally” pictures myself because they are amusing and remind me of being a child. Screen-shot the picture and keep preferably several different pictures on the phone. Then breathe and count the number of squares / people / whatever takes your fancy. When I was testing this, I counted the number of people wearing hats on a Where’s Wally picture. Once I’d got them all, I moved onto another category.

This works because it engages the thinking part of the brain. This part can go offline with high anxiety and engaging it in a non-threatening task (Where’s Wally) combined with breathing helps to calm the nervous system down. (5)

The Tesco trick

This method came to me whilst standing in a queue in Tesco. It was around Christmas time and the store was crowded and noisy and I started to feel anxious for some reason. I was standing next to the drinks section and I started to notice the labels of some of the drinks. I realised that I could calm myself by spelling out the letters of the name of the drink one by one in my head. In this case it was a bottle of Tango. So the trick is to breathe in and say T, out and say A, in and say N and so on. Then move on to another label until you feel calmer. This can be done with any written word that’s out there – Road signs, place names, street signs. Obviously be mindful if you are driving and pull the car over and stop if necessary.

1. https://www.mind.org.uk/media/1892482/mind_anxiety_panic_web.pdf

2. https://www.breatheology.com/delicate-nervous-system/

3. Personal communication from Kevin Laye (http://psy-tap.com ).

4. https://www.google.co.uk/amp/s/www.psychologytoday.com/us/blog/in-practice/201607/how-help-someone-anxiety%3famp

5. http://www.panic-attacks.co.uk/course/5-the-brain-and-panic-attacks-emotional-hijacking/

With huge thanks to Garner Thomson for his help with the contents of this article

https://www.medicalnlp.com

Psy-Tap – seriously fast change

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.     

For more information, visit Kevin’s website http://psy-tap.com to find a practitioner near you or my website at www.boundlessflow.co.uk

How to handle exam stress

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. 

Sleep 

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. 

Working smart 

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

http://boundlessflow.co.uk/contact-me/

 

Dr Lizzie Croton GP

http://www.boundlessflow.co.uk