‘Psychologically informed coping with the uncontrolability and uncertainty arising from the COVID-19 pandemic’.

10.04.2020: As I write this blog this week, after almost 2 weeks in self-isolation, with some personally quite challenging moments due to COVID-19, I have found myself reflecting on one of the biggest difficulties facing all of us at this time; that of dealing with the uncertainty and the lack of control. As the Lead for Psychologically Informed Environments (PIE) within Centrepoint), I had the next few months planned out (and even drew up a colourful Gant Chart outlining these grand plans!), regarding the delivery of our PIE staff training and Reflective Practice groups across the organisation. COVID-19 has delayed many of these plans, to yet undetermined dates in the future, and I have found my skills and knowledge as a Clinical (and Forensic) Psychologist have been in demand in a different manner in the charity; through brief therapeutic interventions, reflective spaces and staff support.

Throughout this past week, I have remained immensely humbled by and proud of the amazing staff within Centrepoint, who have adapted to ensure that we are able to deliver many of our usual offers for homeless young people. For example, the Health Team offering remote support sessions, the Engagement Teams challenges / remote activity packs, and all our Housing & Support (and redeployed staff from other areas) keeping all of our ‘frontline’ services across the UK open to provide accommodation and support to homeless young people during this crises. I am hearing stories of staff that are going ‘above and beyond’ to source Personal Protective Equipment (PPE) for our staff and ensure it is delivered to services, as well as the ways that they are protecting and caring for the homeless young people who are self-isolating within services (e.g. ensuring that entertainment and basic food supplies are provided). It has also been wonderful to hear of the stories of positivity, the community relationships and partnership working being developed (c.f. https://twitter.com/centrepointuk/status/1247904628819103745). Moreover, many of our ‘support’ teams are continuing to undertake vital work, often behind the scenes’, to ensure our delivery in these challenging times, including fundraising and sourcing of resources through our donors and via Centrepoint’s Emergency Funding Appeal (c.f. you can donate here: https://coronavirus.centrepoint.org.uk/).

However, wherever we are in the organisation, it can be hard to continue to work in this climate of uncertainty and uncontrollability, and this has been a theme of many of our PIE Team’s discussions with staff during support sessions. We are under increasing and prolonged stress, and this is a challenge to us all psychologically as well as with regard to our physical health. This has lead me to reflect further on what can be helpful from a psychological perspective in these circumstances. Previous blogs over the past couple of weeks have covered specific tips for remote working as well as managing the stress on the ‘frontline’, but as this ‘lock-down’ continues, this week it has felt that one of the hardest remaining challenges has been to accept what I can and cannot control in the current situation. It can be so easy to become over-whelmed by events that are out of our control, and have no definite end date. This is a ‘threat’ to our sense of self and our ‘everyday’ life that seemingly has no end at the moment, so of course we may at times feel anxiety, low mood and distress. This is to be expected; it is ‘normal’ to have a ‘wobble’.

Consequently, one particular psychological therapy approach that I have been finding increasingly helpful in these current times has been Acceptance and Commitment Therapy or ACT (Hayes, 1982). ACT is an empirically based psychological intervention, which utilises the concept of ‘acceptance’ and mindfulness strategies, combined with commitment and behaviour-change strategies to increase psychological flexibility and mental wellbeing. ACT asks us to focus on our values or ‘what is important to us’, and then encourages us to be motivated to focus our energies on behaviours congruent with our values, whilst also letting go of things that are not as important. This can have a positive impact on our mood and sense of well-being. The past few weeks have been a challenge to all our values and priorities in life, as we have had to adapt to changes in circumstances. Therefore, it can be helpful to think about what are our values? What are the most important things to us right now? How can we accept our current circumstances better by focusing our energy on what is important to us and let go of what actually, in the greater scheme of things, we may have realised isn’t so important right now? For example, I have certainly had to manage my own expectations of how much home schooling is likely to occur during this ‘lock-down’!

This is a period when all of us have lost control of many aspects of our normal daily lives, so many things that we took for granted (such as seeing friends and family, or spending time sunbathing in a park!) are not possible right now because of ‘physical distancing’ rules to halt the transmission of COVID-19. Whether we are trying to work from home, or travelling into potentially risky situations on the many ‘frontlines’ right now, life certainly looks different for us all, and we have no idea when things will return to ‘normal’. Something I have been talking with staff about, and thinking personally about this week, is when we do start to get naturally overwhelmed by this, can we try and stop to consider “what can we control and what we can’t control?’ It is important to remind ourselves that we are only ‘one person’ and “we can only do what we can do”. We can for example, perhaps only minimise a risk rather than eliminate it entirely. We might not be able to do everything we used to be able to do to support a homeless young person, but what can we still do with the resources we have available, or what else can we do instead? Do we have to be the perfect spouse, worker, parent, friend; all the time right now, or can we be ‘good enough’?

ACT, along with other similar psychological approaches, also encourages us to have a different relationship to our negative thoughts through meditation, so that they do not control us or overwhelm us, and we can ‘let them go’. One particularly good video, based on ACT principles as well as highlighting, as per a PIE (e.g. Keats et al, 2012; Homeless Link, 2017) the value of reflection, that I have come across this week is available here: https://vimeo.com/402222864. This is a 5-minute breathing and relaxation exercise that anyone can do at the end of their working day, whether completing a ‘frontline’ shift or signing off from remote working at home, which encourages us to reflect and then move our focus from our working lives back towards our home lives.

We can also manage our current uncertainty through connections. This is a shared global experience. In the past few weeks, there have been many humorous memes and videos shared online, evidence of the power of the shared human experience of humour. For anyone who knows me personally, after many years of working in forensic settings, I have quite a black sense of humour(!). However, humour gets us through adversity and challenge. It is the ability to share a common joke or experience that builds connection and healing with others, which ultimately helps us overcome a shared trauma such as COVID-19. For example, I particularly enjoyed watching BBC1’s ‘Have I Got New for You?’ last week, and seeing them do the TV programme via virtual meeting app Zoom. Strangely it felt like I was more connected to the presenters in their living rooms rather than a studio, as they seemingly struggled at times to manage the remote technology in a new format and I recognised their new way of working was similar to my own right now.

I have also tried to stay connected to things that give me ‘joy’ this week. Joy is often something we are often too busy to appreciate unless it is something that is so obvious, like a birthday party or special event. Moreover, when life is full of difficult and distressing things, it can be easy to stop seeing the good or joyful things. But joy can exist alongside sadness and anxiety, and it can be so uplifting to spend just a moment turning our attention to seek out the joy and beauty around us in a single moment. Being present in the moment to notice any joy, however small, can help us feel safer, calmer and more optimistic. Even in a moment with pain or fear, it helps us realise that we can also be OK. I have very much enjoyed ending my day sitting at the end of my little patch of garden, listening to the evensong of the birds around me. Where I live in London this sound is usually drowned out with the noise of the roads and air traffic, but not lately, which has been lovely! Therefore, I challenge those reading this blog to spend a moment, maybe just a couple each day, to focus on their own joy or what they are grateful for. This might be the simple pleasure of having a cup of tea during a break from work, getting a smile from a young person you have helped or sharing a joke online with a friend or colleague, or listening to the wildlife and nature around you (even in the city!) When everything feels so uncontrollable and uncertain, nature’s rhythms continue. The sun will rise and set, the birds will sing and the spring flowers will bloom. It is a nice reminder that there is always good somewhere, even if just for a moment.

This current loss of control and uncertainty has also made me reflect more on the experience of homelessness and the similarities in psychological impact. I am relatively comfortable in my period of self-isolation and for this, I am truly grateful. Whilst I am stuck in a city, with unfinished building work and a temporary kitchen(!), neighbours and friends have rallied around to provide basic supplies and I have a small garden that I can sit in. Within a PIE, it is argued that the physical environment is critical for our psychological wellbeing (c.f. Keats et al, 2012; https://eprints.soton.ac.uk/340022/1/Good%2520practice%2520guide%2520-%2520%2520Psychologically%2520informed%2520services%2520for%2520homeless%2520people%2520.pdf , p.19). Therefore, it will be important that we use our ‘homes’ to create our own ‘secure bases’ (c.f. Bowlby, 1988) and safety in these times, and ensure that they not only places to work, but also places to relax or ‘play’ within. However, not everyone, particularly those in high density or temporary accommodation is so fortunate. Moreover, when you are homeless, you often experience a loss of control over your own life, from where you might be safe to sleep to how you can meet your basic needs. Life can be very unpredictable when you are ‘surviving’ and not necessarily ‘living’. This population are also particularly at risk of COVID-19 due to the challenges of self-isolating and the underlying health conditions resulting from rough sleeping. This week I have been thinking about how whilst COVID-19, as a viral pathogen does not discriminate, the impact it has upon us (it’s hosts) is likely to vary by our socioeconomic status and other factors of health inequality (c.f. https://www.huffingtonpost.co.uk/entry/coronavirus-bame-bme-data-deaths-poverty_uk_5e8dc720c5b6359f96d06c0a?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAETjeN_6Ut8DmOj6mKbo7dOhdtKRCELa73WW5kWHqjnSfg0SkVMv0svSy5dR08TByn7Ko_ZrPXfyoVh_6iXgt2WoC0MeiU9jl3iodBdCTyzVBIqNJLsNyv8PkvXu4kc0dU-L03fgNbU-uIOwynscAc6Vw7crrIvu2lVwJgHeCzB1 ).

We can also manage our feelings of loss and unpredictability, by considering what we can gain during this time. Perhaps it is simply more time connecting virtually with friends and family because we are at home, perhaps it is that recognition of knowing that your role is ‘key’ and your value is recognised more widely than previously in society. However, it can also be a time for opportunity and learning. Life has not stopped, it continues albeit we may have to think of different kinds of opportunities. Where is that ‘to do list’ you have been keeping for a rainy day? What can you do this Easter Bank Holiday weekend if you aren’t working? Can this be a time to learn a new skill, read that book we have wanted to for ages, watch that Netflix box set someone recommended, or do some gardening (if we have one)? Or do we just want to do ‘nothing’ and just rest. Perhaps for us, this ‘lock-down’ will be about survival and coping with the additional challenges to our everyday life (e.g. socially, mentally, physically and financially). We might not be able to learn to cook with a celebrity chef, as it will just be about managing to feed our family. And of course, that’s OK too! There is no shame or guilt in not doing yoga / Joe Wicks PE class every day or coming out of ‘lock-down’ having failed to learn a new language! We can only focus on the things we can do for ourselves, and others, ‘right now’, and as highlighted by the psychologist Paul Gilbert (c.f. https://www.theguardian.com/lifeandstyle/2020/apr/08/people-want-to-help-you-let-them-how-to-be-compassionate-in-a-crisis ) remain compassionate to ourselves, through this period.

As noted above ‘wobbles’ are normal. We are not going to feel good all of the time. It is impossible with this level of uncertainty and unpredictability. Some days will be harder than others. Some days it will feel more difficult to be positive and cope with these significant changes in our lives. Those days we may need to reach out and get support from our networks, whether they be friends, family, colleagues, external agencies or support helplines. We will have BIG feelings at times, and want to cry or be frightened or fearful. It is not helpful to repress or ignore these feelings. Rather, to cope we need to honestly accept these feelings to process them and then afterwards, turn our focus back to the things we can control, the joy we do have right now in the present moment. When it comes to COVID-19, as the picture on this blog shows, there are many things we cannot control or cannot predict. We do not know when this period will be over, but if we focus on each day at a time, and on what we personally can control such as how we think or feel, and what we can do for ourselves and others, rather than anything outside of our control, then hopefully this period of significant uncertainty and lack of control won’t feel so overwhelming. Moreover, we will see that we are resilient and we can cope, particularly when we do it together…