key: cord-0967170-mlcyvwxu
authors: Gloster, Andrew T.; Zacharia, Marianna; Karekla, Maria
title: Psychological Aid for Frontline Healthcare Workers
date: 2020-08-03
journal: Clinical neuropsychiatry
DOI: 10.36131/cnfioritieditore20200406
sha: c32a7e356bb81bec6b3d61a40d927db8d9d1dfee
doc_id: 967170
cord_uid: mlcyvwxu

Given the challenges of COVID-19, practical measures including psychological support for frontline healthcare workers are essential. The aim of this article is to provide psychological aid to frontline healthcare professionals based on evidence-based practices. Suggestions for self-care entail sleep, rest, regular breaks at work, physical activity and healthy nutrition. Given the high demands of the job, frontline healthcare professionals may be experiencing various difficult emotions (i.e., fear, frustration, guilt, sadness, grief, anger, shame), which are normal human emotions. Suppressing these emotions will not be effective in the long-term. It may be more helpful to recognize emotions and make room for them to exist, as struggling with emotions can cause more suffering. Concentrating on one’s own behaviour in line with meaningful life directions may be more helpful. Treating oneself with self-compassion, sharing emotions and experiences, offering mutual encouragement and staying emotionally connected with loved ones via digital methods can be helpful.

Although everyone is affected by the COVID-19 pandemic, frontline healthcare workers have a qualitatively different reality; while everyone else keeps a physical distance, healthcare workers move towards people in order to do their job. Given the challenges of COVID-19, practical measures including psychological support for frontline healthcare workers are essential. The following are evidence-based recommendations addressing this need.

As healthcare providers, self-care is a well-known concept -and one that is easier to prescribe than follow. For example, it is clear that sleep and rest are crucial to maintaining high levels of concentration and functioning, as well as staving off infections. Likewise, physical activity, healthy nutrition, and regular breaks at work help maintain well-being and reduce stress levels (Gifkins, Johnston, & Loudoun, 2018; World Health Organization, 2020) . The difficulty comes in implementing, and the first step is to choose to care about self-care despite lack of time, plan for when it can happen (even in small doses), and imagine how it will feel when engaging in it.

Feelings of stress are commonplace in frontline healthcare workers, but the response necessary to the COVID-19 pandemic has increased levels of stress dramatically, often leading to exhaustion. Further complicating the demands of the job, are normal human feelings of fear, frustration, guilt, sadness, grief, anger, shame, and others (World Health Organization, 2020).

These feelings by no means indicate that a person cannot perform their work or that they are weak. Unfortunately, these feelings do not disappear at will and the more one tries to actively supress them, the more bothersome they become. It can be helpful to recognize that, like waves, feelings come and go and to make some room for them to exist without struggle (Hayes, Strosahl, & Wilson, 2012) . This can be facilitated by consciously labelling thoughts, feelings, or sensations such as, "I'm noticing sadness", or "Here's grief", or "There's my mind worrying that I may be infected" (Karekla, Karademas, & Gloster, 2019).

Healthcare workers probably chose their profession because they value caring for those in need. Commonly, however, their own self-needs are neglected. Research has documented multiple benefits of treating oneself with self-kindness and self-compassion, including increased well-being (Barnard & Curry, 2011) . This is achieved by acknowledging one's emotions and choosing to respond similarly to the way one would speak to a patient in need: with a kind, warm, and caring inner voice, such as "this is a moment of suffering", "we are humans and it is ok to feel anxious, scared, or even terrified at times", and "I am not alone in this" (Harris, 2015) .

Fortunately, psychological science has found that concentrating on what we can control -namely one's own behaviour -is associated with increased well-being and decreased suffering, especially when one chooses Submitted May 2020, accepted July 2020 253 OPINION ARTICLE to act on the things they care about (Carver & White, 1994; Gloster et al., 2017) . Behaviour involves anything that can be done with one's hands, feet, and mouth. A good question to ask is: "What can I do right now, even if it is a small action, that improves my life?" This can be as small as taking a couple of slow deep breaths, while focusing the attention on that breath, stretching with purpose the arms and neck, taking a small break to step outside and feel the air, see and hear the sounds around, or engaging in any of the aforementioned acts of kindness towards the self. Finally, when difficult, newfound situations and crises arise, people at the front line may feel isolated or alone. These warning signs need to be taken seriously, as humans are social animals. Sharing emotions and experiences with others is a basic need and a source of vitality. There are many ways to meet this need from offering mutual encouragement among healthcare professionals to using digital methods to stay connected to family, and friends, if isolation is required (World Health Organization, 2020) .

Engaging in these scientifically tested strategies can help counteract the physical and psychological stress encountered (Huh, 2020) . If necessary, online support groups by trained clinical psychologists and psychiatrists can help extend these skills and provide further care for frontline health professionals.

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