12 steps providers can adopt to better cope with the effects of COVID19

Considerable and well-deserved attention has been paid to the mental health of those heroic frontline healthcare workers in hospitals and ERs caring for COVID-19 patients.

However, there are many other providers, like primary care physicians, internists, and specialists, as well as PAs, NPs, and RNs, who are also experiencing exceptionally high levels of depression, anxiety, and fear.

I study the influence of pressure on performance and how elite athletes, pilots, soldiers, and others in high-stress positions have learned how to mitigate its negative effects. My colleague at The University of Exeter in the U.K., Luciana Torquati, PhD, is a lecturer in nutrition with a background in studying the relationship between diet, physical activity, and health outcomes in nurses.

Recognizing that all providers today need help coping with the COVID-19 crisis, we partnered with Dignity Health Global Education (DHGE) to create a one-hour micro-course called Strength to Endure. Here are twelve steps that research tells us are vital to help providers manage the stress, depression, and anxiety associated with COVID-19.

Care for your mind

1. Control your mindset. Science tells us that the most successful people in any profession are often the most positive. They work hard to keep doubts away and focus on their own development rather than comparing to others.
2. Prepare, plan, and set goals. Recognize that managing anxiety and worry during the current health crisis is going to be difficult. Prepare and plan for it. Set goals to manage your stress and anxiety and think around the barriers that may prevent you from sticking to them. Then, “just do it” — get going so your actions become a habit. Stick to your plan and remind yourself why you set specific goals.
3. Work to be more mindful. Mindfulness is the awareness that emerges through paying attention in the present moment, non-judgmentally, to the unfolding experience. To reflect on your own mindfulness status and habit, ask yourself where your mind goes when you stop and sit. While many of us reflect on the past, don’t spend time reliving old failures. Work to focus on the here and now (let that be one of your goals).
4. Treat yourself as you would a best friend. Doctors, who often set very high goals for themselves, can be their own worst enemies. However, compassion and kindness for oneself are vital during a crisis. Self-compassion is neither a show of indulgence nor complacency, but one of courage. When you limit self-judgment, you can perform to your greatest ability.
5. Be aware of your environment and feelings. Are you getting enough sleep, are you eating and hydrating well? Are you dealing with reality but focusing on how you react to what you can control? Remember that what we dwell on has a massive impact on how we interpret our external environment and react to it.
6. Adopt a challenge mindset to stress. If perceived demands are greater than perceived coping resources, we enter a threat state. If perceived coping resources are greater than perceived demands, we enter a challenge state. Challenge states (believing that we can cope) are associated with a range of positive outcomes (performance, emotional and psychophysiological). Keep this famous quote by Henry Ford in mind: “Whether you think you can or think you can’t, you’re right.” 

Care for your body

1. Aim to have a main meal before you go to work. Don’t rush; take a moment to relax. Avoid heavy foods that make you feel sluggish and remember that fresh is best.
2. Practice what you preach. That means choosing nutrient-dense foods like complex carbs, lean protein, and lots of fruit and vegetables that are high in antioxidants.
3. Go ahead and snack. Small nutritious bites can provide energy and help you avoid feeling hungry between meals. Think cheese and whole-grain crackers, single-serve nuts, etc. And because we are in a COVID world, avoid snacks that require contact with your own and others’ hands, like sharing chips, pretzels, or whole fruits with peels.
4. Stay hydrated—go for water whenever you can. Other options include no-sugar flavored water, milk, or fresh-squeezed juice. Avoid sodas, and products that contain high amounts of sugar and caffeine, as these impact sleep and increase irritability. Drink between 6 to 8 glasses (about 8 ounces) of fluid per day.
5. Be mindful when drinking coffee. When a pick-up is needed, it is OK to have a cup of java. However, know how much you are drinking. An average beverage from a coffee shop has 125 mg of caffeine; 300 mg is the recommended maximum daily intake. Anything higher, and you’ll run the risk of nervousness, high blood pressure, and insomnia—especially if taken close to bedtime.
6. Find an exercise you enjoy and make time to do it. Walking is a proven way to manage stress, especially if done in daylight hours. But other activities can be done as well. The key is, just as you eat, drink, and go to work, you must also make exercise a part of your routine.

While there is hope on the horizon, the COVID-19 crisis and its aftermath will continue for the foreseeable future. There will continue to be unprecedented challenges and uncertainties. However, we do know that to care for patients, you must first care for yourself physically and mentally. Follow the guidance you give those you care for, and remember to be mindful, positive, and most importantly, kind to yourself.

_{About the Author}

_{Mark Wilson, PhD, is a Professor of Performance Psychology and Head of the Department of Sport and Health Sciences at the University of Exeter in the United Kingdom—one of the world’s top schools for the study of sports’ performance psychology.}