key: cord-0931592-2nkpvnyb
authors: Stobbs, Christine
title: Maintaining personal resilience in this Covid‐19 era
date: 2021-03-05
journal: In Pract
DOI: 10.1002/inpr.19
sha: 1efdf71ee9537bd8d8c58cca104eace2888ca7a8
doc_id: 931592
cord_uid: 2nkpvnyb

The role of personal resilience in maintaining psychological wellbeing is now more important than ever. No matter what your role is in practice, you are still susceptible to making that unfortunate transition from feeling pressure (which comes with the job) to feeling stressed. The Covid‐19 pandemic has made these issues more acute, so it's worth taking time out to think about how you can preserve and enhance your mental health going forward.

▢ The impact that Covid-19 may have had on your personal/team psychological wellbeing; ▢ The role that resilience has in maintaining wellbeing; ▢ The importance of having self-belief, particularly in situations where things are out of your control; ▢ How to use various coping strategies, such as the 'STOP' technique, when the going gets tough; ▢ How and when to access support when you need it. This pandemic has placed an enormous strain on people's psychological health and wellbeing. Indeed, workplace relationships are floundering in some cases. Remote consultations have been rolled out across the profession, which is a big change for the veterinary sector. My experience is that most professions and industries have found that interacting effectively via video call is not as simple as just successfully connecting to a video platform. People have become much more transactional and less empathetic -small talk has disappeared and so has the communication etiquette, and unfortunately this is starting to cross over into face-to-face communication too.

Conversations may seem a little more strained than normal -colleagues may be grieving the loss of a loved one, be worried about family and friends, be under financial strain, or be simply scared by the loss of control in their day-to-day lives. Of course, the psychological toll that the pandemic has taken on you can also impact on your relationships with clients, who could have many of the same issues, as well as being worried about their pet. If left unchecked, these challenges have the potential to create a perfect storm for misunderstandings.

Being resilient means we're able to bounce back quickly and move forward after a setback. It helps us to deal with things in a constructive way and continue to perform to the best of our ability. Indeed, developing our personal resilience is key THERE have been several articles in the media recently about high stress and suicide rates in vets and, although topical, these issues are not a new thing -they were sadly also ubiquitous in the profession when I first started writing for In Practice 22 years ago.

However, it's encouraging to see the amount of research that has been done on this topic across many countries in recent years. Moreover, it is fantastic that it has been introduced into curricula at various vet schools -Bristol university has even developed a 'Mental Wellbeing Toolbox' to help combat the problem (Bates and others 2019).

From 2020 onwards, Covid-19 has added another dimension to the world of work. This has created some unique challenges for everyone, regardless of their role in practice, that may have been tricky to cope with. And so, the importance of personal resilience is greater than ever -looking out for yourself and your colleagues is key to getting through it.

Covid-19 challenges and their impact on psychological wellbeing in vets What challenges has the pandemic brought for the veterinary profession? From a practice management perspective, the challenges are diverse: You to our ability to cope with the pressures that come with the job, and prevent them from becoming something more serious -resilience is a critical factor in workplace performance and a protective factor for burnout and poor mental health.

So, how can we help ourselves build and flex those resilience muscles more effectively when they're a bit worn-out and tired?

There are many factors that influence our personal resilience and I have rarely come across anyone who does not have some element of resilience in their arsenal (Box 1).

In my experience, most people who demonstrate strong personal resilience have a range of attributes and attitudes, all of which can be developed by anyone. In my opinion, self-belief is at the core of personal resilience.

What is self-belief? People with good self-belief retain confidence in their own ability to perform, despite any setbacks. Having this inner confidence means we can effectively deal with problems that come our way, especially unexpected ones. Furthermore, it enables us to be flexible and cope with change, get back on track and try again, and maintain an open attitude to learning from our mistakes.

On the other hand, the people I see who are really struggling are the ones who lack, or have lost, their self-belief. A lack of self-belief stops us trying new things and tackling problems that need addressing. Staying in our comfort zone becomes preferable to taking on challenges, no matter how small, and our life becomes narrow and all about avoiding mistakes instead of trying to succeed.

Many vets are able to maintain a good level of selfbelief in their work life when things are stable -but Covid-19 has changed this for some people and taken many things out of their control. However, it is important to remember that although self-belief is a well-established part of our identity, it is not immutable and can therefore be strengthened over time.

Our self-belief is shaped by our internal dialogue, which can sometimes sound like an 'inner critic'. It has a big impact on our attitude to the future and influences how we view the past. Whether we have a constructive critic or an undermining one, this will have been influenced to some degree by what other people have said about us, or to us, and how we see ourselves in relation to the wider world. Throwaway comments made by others at critical times in our life can have a disproportionate effect on how we feel about ourselves. The result is that we start to doubt ourselves and fill our heads with theories about our own inadequacies. All of our 'failures' may flood back in sharp relief, but we somehow manage to artfully ignore all the occasions when we succeeded and did a good job, or overcame similar challenges.

Most of us have had to overcome such challenges in our lives, and you certainly need a good degree of resilience to become a vet! While we can learn to silence, or at least ignore, this inner critic, when things do go wrong in the real world any underlying self-doubt can quickly resurface.

There is often a significant mismatch between our real objective achievements and how we feel about ourselves and our capabilities. So, to the outside world we may be seen to be doing an excellent job, or others may think we are coping well, but our inner-critic is saying otherwise. It can then just be a small step from having this mentality to starting to believe that we really shouldn't be doing a particular job at all -this is known as the 'imposter syndrome' (Box 2).

Negative self-talk can completely undermine our confidence that we can deal with difficulties, and it can leave us helpless in the face of adversity. That inner critic tries to constrain and control us and so we end up with a myriad of beliefs about ourselves and others that act to reduce our personal resilience.

At a professional level, vets tend to benefit from having a strong sense of self-belief. But the question is, how do you maintain that, especially with everything that's going on at the moment. The fundamental point here is that our feelings and thoughts are not caused directly by negative events, but by our interpretation of those events. The beliefs we hold about ourselves perpetuate any feelings we BOX 1: ELEMENTS OF PERSONAL RESILIENCE ■ Self-belief -having the inner confidence that we can address obstacles and problems that we face, especially unexpected ones, and that we can fully apply ourselves and 'bounce back' if we fail or face a setback ■ Attitude to the future -thinking like an optimist, but looking for realistic positivity rather than blind hope ■ Challenge orientation -having a willingness to go outside our comfort zone and learn from our experiences ■ Willingness to seek support from others -recognising the value of having a varied support network ■ Flexible problem solving -focus on generating solutions, being prepared to look at problems from a number of different perspectives ■ Adaptability/attitude to change -a willingness to embrace change and to be flexible in our responses to it ■ Ability to regulate our emotions -the extent to which we are able to remain calm and in control of our emotions in stressful situations ■ Having purpose and meaning in our lives -asking the 'why' questions. What gives our life or our work purpose and meaning? Use your passion to help you power through You might have about our own inadequacy and distort the truth, so the key is to know what those beliefs are so that you can dispute them. Ways in which we can hush the 'noise' and banish that voice inside our head so that we can think more clearly and constructively are discussed later in this article.

One of the most serious consequences of stress is 'burnout'. This can have many causes, but being overly harsh in our self-criticism only adds to the likelihood of suffering from it.

It is important to be able to recognise signs of stress and burnout in ourselves and others. So, how do we know when we've reached a stage beyond stress, and have actually peaked at burnout? Box 3 summarises the main symptoms of burnout.

Burnout and depression are serious and should never be ignored. The perceived stigma of mental health should never prevent you from getting the help you need, or make you anything less than empathetic and constructive with other people who may be in the same situation. Contacting your GP is always a good starting point. There are also numerous organisations, some specifically for vets, that have confidential helplines (see useful resources). One of the key elements of resilience is recognising when you need support and being willing to seek it.

Coping strategies for when the going gets tough The 'STOP' technique I'm not immune from feelings of self-doubt, and the first technique I turn to when I'm feeling overwhelmed by unhelpful thoughts is the 'STOP technique' (Box 4). This is a mindfulness technique first developed by Jon Kabat Zinn, an influential mindfulness teacher. The technique sounds simple, but it certainly works for me and many of my clients.

Being resilient doesn't make us immune from pain and discomfort -these factors may be valuable warning signs that something needs to change.

BOX 2: OVERCOMING IMPOSTER SYNDROME ■ Believe in yourself -work on building your self-belief so that you aren't constrained by the unhelpful chatter that goes on inside your head. Say 'stop', pull yourself back into the real world and stop the irrational thoughts taking over -give yourself head space to challenge your negative thinking ■ Practise using logic and fact to evaluate your successes and failures -ask yourself these questions: What is the evidence for that? 

To put it simply, sometimes life sucks, and if we spend endless time trying to avoid pain and grief we're just wasting a lot of our energy. It can be much more effective to adopt an attitude that enables us to accept that sometimes life will be hard and we'll often be way outside of our comfort zone, but we can continue to function and perform in our role despite this.

Foster a culture of openness If you manage or own a practice, try to encourage a culture of openness in which staff can share with you what's going on with them (both good and bad), and in which they will feel supported doing so. If you don't already have one, consider buying in an 'employee assistance programme', through which staff can get free counselling (see useful resources). If you're the one supporting everyone else, think seriously about who or what your source of support is. Self-care is important -you can't help others if you don't have the means to also support yourself.

Don't underestimate the power of good interpersonal skills. Be aware of the need to flex your communication style and remember the importance of one-to-one meetings.

At the moment, many people are struggling to cope with the uncertainty and fear of what the pandemic will bring next. So, as always, be kind and be aware of how you interact with others. Think about whether you come across as intimidating or approachable. Likewise, always be aware of the context of your interaction and whether anyone else is party to it. It is more important than ever to make a conscious choice to cut people some slack and trust that they will do the same for you.

It is essential that you build recovery time into your day when you can. Take and appreciate your breaks -even five or 10 minutes can be enough to get you through to the end of clinic -and see that recovery time as sacrosanct. If you are able to, go for a walk around the block and get some fresh air between shifts.

Don't try to be a superhero Recognise that you are not a superhero and therefore not everything is within your control. There is no point wasting time and energy trying to control a situation that is out of your hands. Instead, recognise when your resources would be better directed towards influencing where you can, and taking control of what is within your power. In the words of Viktor E Frankl, the famous psychiatrist and Holocaust survivor, 'You cannot control what happens to you in life, but you can always control what you will feel and do about what happens to you' (Frankl 1946) .

Think about what changes you will make to help maintain your personal resilience; what steps you will take to empower yourself. Will it be learning to accept that life is not always great and that feelings of discomfort are just that? Or maybe you will try to better silence your inner critic? I would also recommend that you take on board the words of Marcus Aurelius, the Roman emperor and stoic philosopher: 'If you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment.' Now that is empowering!

The Mental Wellbeing Toolbox Handbook. University of Bristol

Further reading DAY, E. (2019) How to Fail: The Art of Succeeding Better. Fourth Estate RINALDI, K. (2019) It's Great to Suck At Something

Proceed with what you were doing, or don't; use the awareness you gained from taking a pause to proceed mindfully