What the experts say - stress and anxiety advice for brain injury survivors during the Covid-19 pandemic

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What do the experts say is the best way to cope with stress and anxiety as Covid-19 constraints continue to impact brain injury survivors and their families?

If there was just one thing leading acquired brain injury advisers would recommend to tackle stress and anxiety, what would it be? Here are their top tips and honest insights:

Nature watch!

Increasing evidence points to the value of nature in lowering stress and anxiety levels.

“For me, off-road bike riding in nature works well,” said Mike Hope of the UK Acquired Brain Injury Forum (UKABIF) and Recolo.

“It releases endorphins and I can also see how the plants, birds and creatures are enjoying themselves without us!”

Richard Thorp, MD of Circle Case Management, based in the South West, an organisation that works with people with significant injuries and complex needs, agrees: “Take comfort in nature. Get outside as much as possible, even if it is only in the garden. Take time to look closely at Spring unfolding, and touch and smell all that is on offer.”

Switch off the news!

“It’s a good way to stay informed but watching the news can also lead to us feeling agitated and perhaps a little overwhelmed,” said John Ainscough MD of Ainscough Associates, a case management consultancy that specialises in working with children and adults with life-changing injuries.

“Maybe try to limit the amount of news watching that you do at the moment, perhaps to one key programme that you might normally watch, and for a shorter period.”

Routine calls!

We may not be able to go out and about as before but sticking to as much of a routine as possible is crucial, says Janet Cook case manager from Independent Living Solutions.

“Clients appear to manage their anxiety and stress better when they follow their usual routine, have a purpose to their day and can continue with activities even if these need to be altered to home-based activities due to the circumstances.

“Losing all structure and routine seems to increase the anxiety and stress people experience.”

Suss your stressors!

Ben Holden, Director and Case Manager at Ben Holden Limited, a specialist case management service for catastrophically injured people in Suffolk has used this unexpected time to reflect on his situation.

“The coronavirus emergency brought about an unexpected and welcome improvement to my wellbeing. Pre COVID-19, my lifestyle was dominated by work and work-related stress.”

He went onto say, “As the emergency took effect my pace of work slowed which brought my life into a much healthier balance. This crisis has provided us all with some much-needed reflection time, and an opportunity to create lasting change to our routines going forward”.

These insights were supported by Simon Berrell, Director of The Neuro Physio Service, a nationwide team of highly skilled physiotherapists.

“The positive changes which have presented themselves have been life-affirming, such as eating together every evening as a family (which never happened pre-COVID) and talking with neighbours who pre-COVID we only ‘nodded’ to”.

Simon went onto say, “It’s these basic interactions which have made me rethink how I would like to go forward after the lockdown ends.”

These views are supported by Headway – the brain injury association, “Take some time to consider what contributes to your stress”

“Identifying your triggers can help you anticipate issues and come up with solutions. You might find keeping a stress diary helpful.”

More lockdown support from Headway here: Corona virus and brain injury we are here for you

Call on the CIA!

We’re not talking Mulder and Scully here, but the CIA model for stress-relief: ‘c’ontrol, ‘i’nfluence and ‘a’ccept.

Here’s how a Krysalis neuro occupational therapist Joel Reynolds put it to good use helping a young client who was:

worried about not knowing his timetable if, due to Covid-19, school doesn’t start until next year.

concerned he would no longer be able to remember where he would have to go in school.

“I explained the importance of control, influence and acceptance in managing stress,” said Joel.

“We agreed he would have to accept not knowing the timetable now, but also that he could practice skills that could influence his ability to remember and plan successfully.

“He could also control this practice by having a new occupational therapy challenge which was to remember our next session and initiate emailing me about it.”

Hone self-help tools!

Worrying about things that don’t exist but might do in the future is likely a common concern amid Covid-19 lockdown days.

“It is natural for you to worry at the moment,” says the team at Psychology Tools, a global therapy resource library.

“But if you feel that it's becoming excessive and taking over your life, then it might be worth taking steps to manage your well-being.”

Further tips here: Psychology tools - a guide to living with worry and anxiety amidst global uncertainty

Occupational psychologist, Rosie Dixon, Specialist Brain Injury Case Manager for HCML, agrees it’s a good time to sharpen therapy tools that have proven useful in the past.

“I was speaking to a client who had pre-existing mental health issues which were a concern in the light of lockdown restrictions.

But I wanted to remind them of how positive their therapy had been for them, rather than have their pre-existing conditions hanging over them.

“So, I suggested they go back to their therapy tools, get out their therapy journal, and remind themselves of their journey. This was really valuable as a specific intervention in itself. “

Krysalis blogger and brain injury survivor, Anne Ricketts offers a wealth of advice on stress and anxiety coping strategies from her therapy toolbox in her Covid-19 diary series here:

Communication matters!

“We don’t have to rely on words alone,” advises Stephanie Ticehurst Founder of Communication Space, coaching, training, and independent speech therapy consultancy based in the South West.

“Make that call, Facetime, or send a text, an emoji, or flowers. Find out how others are, tell them how you feel and that you miss them. Share a smile, a song, or a tear.”

Liz Williamson, founder, and director of The Speech Group, an independent provider of speech and language therapy services for adults and children echoes the value of connection and community.

“Many of us report a sense of loneliness, a sense of being robbed of something. It occurred to me how much we depend on community interactions, COVID 19 has robbed us all of these connections.” But she goes onto say,

“Though this period seems to cut us off from one another we must try to stay close and connected. This is how we cope. We are a community.”

Connecting with furry friends

For some their pets create a special kind of connection. Pets not only provide ‘listening’ ears, but growing evidence suggests they also help to reduce blood pressure and facilitate the release of stress hormones when we stroke or hug them.

UKABIF treasurer, Peter Freeman describes how one greyhound proved a key part of rehabilitation by “providing a quiet, calm tower of strength for all the family”.

“A coat that could absorb tears, he never broke confidences and was always pleased to see you. Hug a greyhound!”

UKABIF Vice Chair Amanda Swain also tips animals as a wonderful way to guard against stress and anxiety.

“I take my therapy dog into many services. She is amazing whether working with physical, speech, or behavioral ABI programmes.”

More on the science behind animal-assisted therapy here: OT Beauty in the beast - animal-assisted therapy

Find out how Turkey the pet therapy hero is helping spinal injured Krysalis client, Carrie here: Carrie and Turkey the rescue pooch turned therapy hero!

Escape into an e-book or even opera!

“I am a crazy lover of opera and I regularly see it live at across the UK and Europe” says Ben Holden, Director and Case Manager at Ben Holden Limited.

“Understandably every performance planned for 2020 has been canceled. In the wake of this, I took out a subscription with Met Opera on Demand and have been enjoying opera every evening from my living room and regularly doing this simultaneously with friends connecting using WhatsApp!”

More about getting your opera fix here: MET Opera

Despite their closure due to Covid-19, many public libraries are still offering home delivery services to existing customers, as well as online access to e-books, audiobooks, and newspapers.

Jo Throp Clinical Director at Krysalis was lucky enough to recently win the novel, ‘A Good Enough Mother’ by Clinical Psychologist Bev Thomas. Bev works within the NHS as a clinician and this is her debut novel.

Books transport us to other worlds, they can lift us out of our reality into the world of our imagination

“The narrator of the novel Dr. Ruth Hartland explores, among other things, the dilemmas and challenges of motherhood, themes we can all relate to in lockdown. What is clear is that whilst we all have a different narrative, the themes or challenges are not that dissimilar. The novel has been a welcome distraction from my struggles with motherhood!”

For unlimited access to a world of books find your local library here: Gov.uk - Library services

Alternatively, The Book Trust is offering free online storybooks and games in abundance here: Booktrust.org - Have some fun reading

Here’s how The Book Trust’s virtual features helped one Krysalis client:

“My client was living away from a young family and was anxious about maintaining the role of a parent during the lockdown.

“We set up an activity in which you can share your computer screen with someone else – a child, in this case – and read the other a story. So far, this is working well at bedtime!”

It’s all in the mind!

Mindfulness, meditation and counselling are playing increasing parts in helping to manage depression, stress and anxiety.

“We don’t need complicated clever stuff. Start each day gently, smile, breathe, commit to compassion.” UKABIF Chair, Andrew Bateman.

Andrew recommends the following mindfulness advice: Thread reader - mindfulness advice

It is guidance echoed by John Ainscough of Ainscough Associates.

“When you’re suffering from stress and anxiety it can be difficult to focus on starting any new practices when just getting through the day can feel overwhelming,” he said.

“If that's the case, I would suggest you think of incorporating a five-minute meditation or mindfulness exercise into your day, so it doesn't feel too onerous to try to take on board.”

More about mindfulness here: NHS - Stress, anxiety and depression.

Activities of connection foster feelings of hope which is so essential for our wellbeing. Liz Williamson, founder and director of The Speech Group considers that,

‘We must not give up hope and offer that to each other’.

Healthy body, healthy mind

“The benefits of physical activity have long been established” says Simon Berrell Director of The Neuro Physio Service.

“As a Physiotherapist, my colleagues and I have been advocating and encouraging exercise even more than usual! Whether exercising indoors with those ‘sporty-types’ on the TV or outdoors in the fresh air exercise has definite and proven benefits to our physical and mental health”. He went on to say that,

“with all gyms being closed, I’ve personally rediscovered running and have taken the opportunity to drag the kids along as their PE lesson!”.

“Yoga is another form of exercise” says Vicky Baylis clinical manager (and yoga teacher) at Krysalis. “it is an ancient mind/body activity to help keep stress and anxiety at bay by equipping you with ‘relaxation response’ skills in posture, breathing and meditation”.

More here: Simple yoga techniques - PDF

Final thoughts

Our final thoughts go to Dr. Richard Maddicks Consultant Clinical Neuropsychologist and Director of Psychology Chartered. Psychology Chartered is a specialist psychological assessment and treatment service.

“...whatever we do, our brains will be generating thoughts and stories that undermine our efforts to be the person we aspire to be, a competent parent, a good partner, an adequate carer, a committed professional; your story is probably different to mine but it’s what our brains do.”

He goes onto say,

The pandemic could change landscapes and impact our lives in all kinds of ways. At the same time, ‘expert’ advice can often generate pressures to conform, ‘get it right’ and manage stress better.

“Our brains don’t need much help to create new unhelpful stories to go along with old, familiar ones. The challenge, as ever, is to recognise the stories for what they are, identify who we want to be, and, wherever possible, do the things that help us move towards that goal.”

We could not agree more!

Sending thanks and best wishes to all the contributors to this article. Extra special thanks go to the board of United Kingdom Acquired Brain Injury Forum (UKABIF) who continue to campaign on behalf of brain injury survivors. Further information regarding their campaign and brain injury can be found here www.ukabif.org.uk

More resources to help brain injury survivors and their families during Covid-19 here: Krysalis public resources

Over 200 stay at home activities for brain injury survivors and their families ...