Covid-19 is changing our ways of working. It is also affecting the psychological health of staff. While individual doctors react differently to the crisis, we are already observing characteristic patterns of emotional response to the unfolding situation. These are summarised in this article. This article relates to doctors, though what is written is generalisable to all staff.
Anxiety is the most common emotion felt by doctors during times of crisis. It is experienced both in physical terms (restlessness, tension, palpitations, butterflies) and mental terms (worry, rumination, preoccupation and intrusive thoughts and imagery). There are also anxious behaviours such as excessive checking of news items and social media feeds, avoidance of everyday mundane tasks and repetitive reassurance seeking from colleagues and loved ones.
Anxiety is in the most part a healthy and normal emotion at this time of enormous change. It signifies our body is exposed to a threat and we need to therefore take action. The treat during covid-19 is the global health pandemic and the action is to maintain physical distancing, wash our hands, and isolate if we are symptomatic or a contact. Anxiety typically tends to subside as the situation evolves, as we gain more control over our environment, learn more about the threat and its consequences, and use task-orientated situations to distract our bodies and minds.
We are hearing from doctors that they are experiencing overwhelming feelings of guilt. Doctors are compassionate and caring people who take pride in their work and often have an exaggerated sense of personal responsibility. So, when their patients and loved ones are threatened by this fast-spreading and frightening viral illness they immediately want to do everything within their power to help. Put bluntly, doctors want to help everybody all the time. This is impossible and for some these feelings of guilt become unbearable.
As covid-19 starts to take hold, doctors who cannot for any reason work, can also feel guilty. They might feel they are letting people down and not “doing their bit.” This is a normal emotion and it is important to remember that each one of us, working in clinical practice or not, is doing “their bit” to help the effort of defending our communities against the threat. Even helping our neighbours and posting helpful messages on social media lifts the spirits of others.
Grief is an emotional response typically associated with a single profound loss. It is one of the most challenging psychological experiences we face as humans, and all of us will experience it at some point in our lives. The emotions of grief range from shock and denial to anger, bargaining, sadness, and finally (for most of us) acceptance.
In covid-19 doctors present with grief related to a range of losses, including loss of life through bereavement, loss of job role, loss of income, friendship networks, childcare, work teams, sense of safety, certainty and predictability in life.
This grief, like any grief, is profound and can be unbearable leaving doctors without a sense of anchoring or hope. Feelings can come on suddenly, stopping them in their tracks as they try to go about their newly chaotic and constantly changing lives. Time and the support of friends and family and where needed seeking professional help can alleviate the symptoms and help us to process this grief.
Trauma is a normal part of human experience. For most they will feel a brief stress response when faced with a life-threatening situation. This includes intrusive thoughts and imagery related to the threat, heightened arousal, hypervigilance, sleep and appetite disturbance, erratic mood, and avoidant behaviours. These are common transient symptoms reported by many doctors dealing with covid-19 and are normal in the face of what we are all experiencing.
As with grief, this traumatic stress response can be quite overwhelming, distressing, and disruptive for the person experiencing it, but unlike grief it usually subsides quickly within days or weeks. Just a small percentage of traumatised individuals will be left with persistent symptoms beyond this time and may need specialist psychological support to help them resolve this.
It is important to gain some understanding of how to cope with these different intense, but normal, emotional responses to covid-19. This is a simple set of solutions which can be used by everyone.
- If you are feeling anxious, overwhelmed and uncertain: plant both feet on the ground, take a few deep breaths and think about what you do know and what you can do today
- If you are feeling guilty, remember it is because you are a compassionate and caring person and you simply want to help, remember we are all doing our bit to fight covid-19 no matter how small and no matter what it is we do
- If you are feeling grief, try to ride the waves of emotion, express them safely, be patient and kind to yourself, this will likely take many months to pass
- If you are feeling traumatised, connect with your loved ones more often, try not to avoid fearful situations, remember this is normal and will likely pass quite soon and limit your less healthy coping behaviours (such as excessive use of alcohol)
And please remember—whatever you are feeling you are not alone and there is help availalble. We will get through this together.
Caroline Walker, psychiatrist and specialist in doctors’ wellbeing, clinician and therapist at NHS Practitioner Health and founder of The Joyful Doctor
Clare Gerada is medical director of NHS Practitioner Health and a practising GP.
Competing interests: None further declared.
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