Beginning to return to normal life - A confusing time

It is expected that today the lock-down measures may begin to be rolled back as they have in Wales. As we move forward into this next phase of the lock-down, it may be difficult to adjust to these new measures, just as initially it was difficult to adjust to the lock-down itself. Many of us may have become accustomed to living within our homes and have begun to feel safe there. It is obviously important to stay safe but as the lock-down begins to get withdrawn it is also important to be mindful of the development of safety behaviours.

What is a safety behaviour?

Imagine a six-year-old boy. He desperately wants a puppy and asks his parents repeatedly if they can get one. They explain to him that dogs are dangerous. He does not believe them as he has seen dogs on TV and in the park and at other people’s houses and is sure that dogs are nice. One day, as his parents bring in the shopping, he sees a dog tied up outside their house. He goes to stroke this dog and the dog bites him. He is hurt and upset and runs inside. His parents clean him up and give him a cuddle and say ‘We told you! You have to be careful around dogs!’.

As the years progress, this message becomes important for this young boy and he begins to avoid going into spaces where he might find dogs. This could be a park, a friend’s house, a high street or pretty much anywhere outside. As the years go by, he begins to associate being outside with being at risk of seeing dogs and spends more and more time at home. By the time he is 26, he only goes outside if he absolutely must.

Anxiety is a bad barometer

What is key here is that if we asked this young man why he does not go outside, he would most likely say ‘it isn’t safe’. If we asked him how he knew this, he would most likely say ‘it doesn’t feel safe’. As we go through our lives, we are told to trust our emotions and our bodies. Sayings like ‘trust your gut’ and ‘do what you feel is best’ mean that we begin to associate the way we feel as indicative of what is happening. For example:

‘I feel anxious, something is wrong.’

‘I feel calm, everything is great today!’

However, the emotion of anxiety is a BAD barometer! A barometer is a scientific machine that tells people what the weather is going to be. We tend to see our emotions in the same way. As indicators of what is happening, will happen, or has happened. But our emotions are unreliable! Think about the following examples:

·        Steven has smoked and drank excessive alcohol for 24 years but has had no symptoms associated with this and feels calm and relaxed.

·        Hannah has a phone interview for a new job and feels her mouth go dry as she tries her best to answer the questions.

·        Jamie is walking home from work and gets mugged by a group of three people who ask for his phone. His heart begins to pound.

Most of us know that drinking alcohol and smoking are bad for us and put us in danger, but very rarely do we feel anxiety about these behaviours. Often people may have a cigarette or drink to calm down! Many of us dread job interviews, but how much danger are we in, compared to how much anxiety we have? Is it proportionate? However also (just to make it confusing), in the example of Jamie, his anxiety does match the situation, as he is in danger. So, what does all this mean? What this shows is that anxiety cannot be relied on to indicate our safety. It is a bad barometer and not to be trusted all the time.

What does all this have to do with the lock-down measures? Well, going back to the boy that wanted a puppy, he is using his anxiety to confirm that he is in danger. Now obviously, there is a chance that he could be bitten by a dog and maybe even killed. But would we then recommend that he stay at home forever to make sure he is safe? Probably not, as the chance seems low and it would be a low quality of life trapped at home.

As we go into the beginning of the end of the lock-down era and are granted more freedoms to return to our normal lives, there may be a temptation to go the ‘extra mile’ than the recommendations just to ‘be on the safe side’. To stay home, even though we can return to work or see friends and loved ones. However, after a little while, we could start to end up in a situation where our quality of life begins to drop. A situation where we are missing out on times with loved ones or not enjoying the activities that we used to, despite being allowed.

So, what to do? If I cannot trust my gut what can I trust?

Remember the golden rule:

If it is true for others, it must be true for me

If it is OK for others to start to see loved ones or do fun activities when lock-down begins to lift, it is probably OK for you too, even if it does not feel like it. If the government ( and more importantly the science!) says it’s OK for others to begin to go out more, it is probably OK for you too.

Lock-down Low Mood

As we enter our seventh week of lock-down, the impact of this bizarre situation on our mood may be becoming obvious to both ourselves and those around us. The cumulative effect of an extended period spent predominantly indoors may be, for many of us, either the beginning of difficulties with low mood or the exacerbation of a struggle that already existed.

On this blog last week, we talked about social isolation. We talked about how our relationships with others are like natural anti-depressants and that without them we can find our happiness and joy in life impaired. We then looked at what steps we can take to overcome the isolation that we might be experiencing. But what if we do not have the motivation that we used to? What if we don’t feel like socialising with others or doing the things that we used to do that brought us joy?

Why might we be feeling this way?

For Knapen et al (2014) depression is characterised by, amongst other symptoms, a loss of interest, motivation and energy, generalised fatigue, low self-worth and confidence and a fear to move. We may be struggling to motivate ourselves and feel drawn to a lethargic state, with little interest in taking part in new activities.

Though experiencing these symptoms is very common and we shouldn’t necessarily think that we have depression if we experience the above without consulting a GP or mental health service, I was struck this past week by one of my friends saying that everyday has become a ‘pyjama day’. As a result of the lock-down, we have been forced to, at least with our behaviour, replicate many of the above symptoms. We have been confined to our homes for over 6 weeks with many of us not currently working or furloughed (a loss of purpose) and with a restricted freedom to be able to do what we love.

Another significant factor may be alcohol. Many news outlets have reported that there has been an increase in alcohol consumption. Though (as talked about previously in this blog), this is not the same thing as scientific evidence, if individuals have been consuming an increased amount of alcohol, it is important to note that it is scientifically proven that increasing alcohol use increases risk of depression (Boden and Fergusson, 2011).

Essentially, the combination of decreased social contact, an inability to engage in new activities, an increase in lethargic behaviour and increased alcohol use, may place us at high risk of experiencing symptoms of depression. A kind of ‘lock-down low mood’.

What to do?

In order to cope with this, we can engage in a CBT approach called Behavioural Activation. Behavioural Activation is the process whereby we reconnect with the things that we used to enjoy doing. It is the process of developing an action plan to overcome the avoidance that can occur when we begin to feel that things are too difficult. After identifying a list of activities that are routine, pleasurable and necessary, these are then graded in order of difficulty and then planned out for the week to help it become more manageable.

You can use this link to help figure out these activities: https://www.getselfhelp.co.uk/docs/BehaviouralActivation.pdf

And this one to help organise them: https://www.getselfhelp.co.uk/docs/WeeklyPlanner.pdf

It may seem that this is too obvious to help, but Behavioural Activation is scientifically proven to lift low mood and offset the symptoms of depression (Ekhers et al, 2014). As you go through this activity, it is important to remember to pace yourself, many of us have adjusted to lockdown and though we may remember being far busier, it is important to go steady to prevent becoming overwhelmed and then just abandoning the process all together. It helps to go into these activities as a scientist running experiments. I have tried sitting at home and watching Netflix and know how that makes me feel, I know the outcome of the experiment. Maybe trying out Behavioural Activation might get different results and maybe make me feel a little bit better.