Covid-19

Outdoor Activities for Health and Wellbeing

19 August 2020 by Steph McClean

By Karen Silverthorne

Whatever you have going on in your life right now, it’s important to pay attention to your health and wellbeing. Looking after your physical needs can have a knock-on effect on your mental state and this can put you in a better position to help yourself and those around you.

Exercise can provide a plethora of health benefits including helping to:

reduce your risk of heart diseases;
manage your blood sugar and insulin levels;
keep your thinking, learning and judgment skills sharp as you age;
strengthen your bones and muscles, slowing the loss of bone density as you grow older;
control your weight;
reduce the risk of some cancers;
reduce the risk of falls – something that can increase with age;
improve sleep;
improve your mood due to the chemicals that are released in your body when you exercise.

Exercise can take many forms and maybe one of the things to consider is: ‘Should I exercise indoors or out?’. Like anything, there are pros and cons to either choice.

But as the weather in this country often provides a reason to stay inside, why not take advantage of the British summer and leave exercising indoors to when the winter months arrive?

The exercise itself will help produce endorphins in your body which are a feel-good hormone that boosts your mood.

Outside activity can help ward off seasonal affective disorder (SAD), depression and anxiety because sunshine naturally increases serotonin, another hormone that has a positive affect how you feel.

Often referred to as the sunshine vitamin, being outside in the sun, gives your body a chance to produce vitamin D. This vitamin has several important functions; probably the most well-known being that of bone health. But there is also some limited research to suggest people who are depressed are more likely to have low levels of vitamin D, and people with depression who received vitamin D supplements noticed an improvement in their symptoms. More studies are needed though, before any definitive conclusions can be drawn.

If you’re unsure what type of exercise to start with and perhaps don’t want to spend a lot of money on something until you’re sure it’s the exercise for you, outdoor exercise can also be a lot less expensive than, for example, signing up for a gym membership.

Living by the sea, as so many of us do in this area, means that swimming is free, though it’s probably best not to swim alone, particularly as some of our beaches don’t have lifeguards.

If you’d prefer to stay on dry land, walking needs only a decent pair of shoes – don’t forget to take some water with you.

Cycling can be a little more expensive at the outset, but at the moment, through the Department of Transport, the government have set up a ‘Fix Your Bike Voucher Scheme’ which allows members of the public to receive a voucher worth up to £50 towards the cost of repairing a bike. The scheme is open to anyone in England who has an unused cycle in need of repair.

If you think running might be your thing, but can’t imagine pounding the streets for mile after mile, the NHS have put together a Couch to 5k plan that sets out a nine week running plan for absolute beginners and takes you to the 5k stage.

Perhaps all of this seems too energetic, but you like the idea of outdoor activity? If you’re lucky enough to have a garden, then maybe now is the time to make the most of it.

Research conducted by the University of Exeter and the RHS analysed data from nearly 8,000 people between 2009 and 2016. They found that people who spend time in the garden are significantly more likely to report general good health, higher psychological wellbeing and greater physical activity levels than those who don’t spend time in the garden.

You might want to improve the soil, redesign the layout, do some planting or even establish a kitchen garden where you can grow your own veg. Having a herb garden doesn’t take up much space and, if you enjoy cooking, could give that added satisfaction of being able to pop outside and pick what you need.

If gardening doesn’t appeal, you can still make the most of your outdoor space, whether it’s a garden, patio or balcony. Yoga, meditation or simple stretches are all transferable in the good weather. Other non-exercise activities you might like to try are painting or photography – this could be in your own garden, a public park or one of the many private gardens run by places such as the RHS and National Trust.

So why not make the most of the many outdoor activities available and improve your health and wellbeing at the same time?

References

Benefits of Exercise: https://medlineplus.gov/benefitsofexercise.html

Benefits of Vitamin D: https://www.healthline.com/health/food-nutrition/benefits-vitamin-d

Vitamin D and depression: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908269/#__ffn_sectitle

Seven health benefits of outdoor exercise:

https://www.piedmont.org/living-better/7-health-benefits-of-outdoor-exercise#:~:text=Outdoor%20exercise%20can%20help%20ward,It%20challenges%20your%20body.

Department of Transport Fix-a-bike voucher scheme: https://www.gov.uk/guidance/fix-your-bike-voucher-scheme-apply-for-a-voucher#:~:text=Contents&text=The%20Fix%20your%20Bike%20Voucher,cost%20of%20repairing%20a%20bicycle.&text=Vouchers%20are%20being%20released%20gradually,more%20will%20be%20available%20soon.

NHS Couch to 5k: https://www.nhs.uk/live-well/exercise/couch-to-5k-week-by-week/

https://www.rhs.org.uk/advice/health-and-wellbeing/articles/study-on-the-benefits-of-spending-time-in-gardens

Anticipatory Grief – What Is It and How Do We Recognise It?

17 June 2020 by Steph McClean

By Mette Nielsen, Counsellor.

Every one of us will be experiencing the loss of a loved one during our lives. Some of us will be carers for a short or a long time due to illness or a life limiting condition. We may experience feelings and emotions which we find distressing and difficult to manage and this is known as ‘anticipatory grief’. Recognising anticipatory grief may help to make the most of the time you have together.

What is Anticipatory Grief?

You may mourn the loss of the person you are caring for even while they are still alive. The grief you are feeling may not only be for the person who is dying but the life you currently lead. Your life and relationships may have changed dramatically when you became a carer. You will have taken on a great responsibility and may find you are no longer able to plan things, which can be stressful and might leave you feeling guilty. You might have fear, anxiety or panic about “What is going to happen next?” and “How will I manage?” which can take a great toll on your mental wellbeing and stability. This may lead you to feeling unable to concentrate or being distracted. These are normal when you experience anticipatory grief.

The process of anticipatory grief is described as three stages:

Experiencing shock about the upcoming loss
Denying the reality of the loss
Eventual acceptance

What are the signs of Anticipatory Grief?

Anticipatory grief is a normal part of mourning when someone is expecting a death. The signs of anticipatory grief are similar to the grief we feel after someone has died. You may be feeling a whole host of things like anger, frustration, desperation, depression, anxiety, isolation, panic, insecurity, guilt, shame or even being fed up. These are all normal and natural to feel as part of the process.

Not everyone will experience this or you might feel reluctant to talk about how you feel because you may think that it will take the focus away from the person who is dying. Although you may feel it is inappropriate to say it out loud, you may wish that it was all over. It is also natural to feel like that. It is important to remember that we all experience grief in different ways.

Anticipatory Grief includes some differences to the grief we feel after someone has died, and you might experience the following:

Increasing concern for the dying
Imagining or visualising what the person’s death will be like
Preparing for what life will be like after a loved one is gone
Attending to unfinished business with the dying person

How can we best use this time?

This time can be particularly helpful for various reasons as it allows time to prepare and time to talk.

Allow feelings of grief to help you prepare – understand the stages of grief, how they may affect people differently. Express your feelings through talking to a friend or family member, a counsellor or a spiritual or religious mentor.
Educate yourself about what to expect – research a particular illness or condition or read about other people’s experiences and how they have overcome similar difficulties.
Connect with others may have similar experiences – contact local support groups or charities. Being able to talk about and share your experience with others who have some understanding will help to reduce stress and feelings of isolation and loneliness.
Enlist help and continue to live your life – Reach out to services such as hospices and other healthcare providers for help and advice. They can offer professional support and guidance with additional care, funding, and other financial, medical and psychological support you may need.
Include your friends and family- keep them updated on what is going on and don’t forget to ask for help and support from them too.
Create moments your loved one can enjoy – looking at photographs, reminiscing of fond memories and telling stories, playing your favourite games, listening to your favourite songs together.

You will be experiencing feelings and emotions which may be distressing and difficult to manage, however, you can minimize the anxiety and stress of anticipatory grief by staying physically and mentally healthy. Here are some helpful practices and you can do whatever you feel works best for you:

Manage your stress
Be realistic
Give yourself credit, not guilt
Take a break
Eat a healthy diet
Accept that there will be changes in your loved one’s health status
Know you aren’t alone

Helplines and information:

www.mind.org.uk

www.cancerresearch.uk

https://www.thegoodgrieftrust.org/need-know-info/pre-bereavement-advice/

Psychology Today: https://www.psychologytoday.com/gb/blog/stonewall-strong/201908/how-resilient-people-get-through-anticipatory-grief

Planning for the Future: things to consider

17 June 2020 by Steph McClean

By Karen Silverthorne

It seems there are so many extra difficulties to face at the moment and the idea of making end-of-life plans may be something you find difficult. But by giving consideration to this now, it can lessen anxiety if you become unwell and can help those you are close to if you’re not in a position to make your wishes known.

For example, a lasting power of attorney (LPA) is a document that allows the person you appoint to help you make decisions or to make decisions on your behalf. There are two types of LPAs:

Health and Welfare LPA: this can be used to make decisions about things like life-sustaining treatment, your medical care, when to move to a care home or even your daily personal care routine. A Health and Welfare LPA can only be used once you are no longer able to make your own decisions.
Property and Financial Affairs LPA: this covers decisions about your finances, such as managing your bank account(s), collecting benefits and paying bills, as well as about your property, such as when to sell your home. If it is what you want, it can be used from the time it is registered and means that the person you appoint can help you with decisions or can act on your behalf.

You can appoint more than one person in an LPA. You should think carefully about the person or people you might want to nominate.

A solicitor will draw up a Power of Attorney for you, but you can also download a form from the government website: https://www.gov.uk/power-of-attorney for free. Once this is completed, it has to be registered with the Office of the Public Guardian. There is a charge for registration.

It may be, should you become seriously ill, there are some types of life-sustaining medical treatment you would want to refuse, such as being put on a ventilator or receiving cardio pulmonary resuscitation (CPR). Provided you are 18 years or older and deemed to have sufficient capacity to decide your own medical treatment, you could make a Living Will or Advance Decision so that healthcare professionals are able to follow your wishes.

Unless your requests are written down and signed by you and a witness, they cannot be carried out, should you not be in a position to make or communicate those decisions yourself. It is important to state clearly which treatment(s) you want to refuse and in what circumstances. You might want to talk to your GP to discuss options before you make up your mind. You can make a Living Will through your solicitor or the charity Compassion in Dying has a form you can use for free on their website. There is also advice about who to give a copy of your Living Will to once it has been written and signed.

Making a will is another way to ensure that your wishes are carried out after your death because you can write down what you want to happen to your possessions, money and property. You can write a will yourself, but if it isn’t straightforward, it might be prudent to get legal advice. If you pass away and you don’t have a will, the law will decide what happens to everything you own.

As many of us rely heavily on technology these days, you might also want to ensure that anything you store digitally such as photos, or accounts you might have such as eBay or PayPal, will be available to those who you would like to have access.

The Law Society recommends keeping a Personal Assets Log that includes information about your digital assets. You might want to store information on a USB drive or set everything out on paper and keep the USB or document in a safe place known only to you and those others you wish to tell.

The Bereavement Advice Centre gives more information about dealing with digital information and the British Psychological Society (BPS) has produced a video on digital legacy planning.

Funeral arrangements are something else you might want to plan in advance, although with the current Covid-19 pandemic, all funeral arrangements are subject to guidance put together by the government and can be found their website: www.gov.uk.

If you make plans now, it can give you a sense of control and cause less anxiety both now and in the future.

Bereavement Advice Centre, digital legacy: https://www.bereavementadvice.org/topics/registering-a-death-and-informing-others/digital-legacy/

British Psychological Society, video on digital legacy planning: https://www.youtube.com/watch?v=_Y3JSpGkXFI&feature=youtu.be

Compassion in Dying: https://compassionindying.org.uk/making-decisions-and-planning-your-care/planning-ahead/

Covid-19: Guidance for Managing a Funeral during the Coronavirus Pandemic: https://www.gov.uk/government/publications/covid-19-guidance-for-managing-a-funeral-during-the-coronavirus-pandemic/covid-19-guidance-for-managing-a-funeral-during-the-coronavirus-pandemic

Make, Register or End a Lasting Power of Attorney: https://www.gov.uk/power-of-attorney

Making a Will: https://www.gov.uk/make-will

NHS: https://www.nhs.uk/conditions/end-of-life-care/advance-decision-to-refuse-treatment/

Self Care in Bereavement

10 June 2020 by Steph McClean

By Paula Noyce, Counsellor

As a palliative, oncology and bereavement counsellor, some of the most common descriptions I hear used by those who have lived alongside loved ones through illness and death are, ‘completely drained’, ‘exhausted’, and the feeling of ‘running on empty’. It is the inevitable impact of being alongside a significant person, whether as a carer, or a witness to the last months, weeks, days and moments of a life, of trying to ‘be there’ for our loved ones in a meaningful way at an emotional time. As the Holmes and Rahe Stress Scale shows us, stress, distress, or grief, (which are normal responses to loss and change) drain us.

Can you envisage your own energy levels, physical, emotional and mental, as battery capacity (see the above picture)? Significant bereavement can drain us immensely and the process of continuing to live requires us to restore our energy capacity. The meaning and purpose of self-care is to deliberately restore our energy capacity in response to events that drain us.

Worden’s theory suggests there are four ‘Tasks of Grief’;

to accept the loss
to acknowledge the pain of the loss
to adjust to a new environment
to reinvest in the reality of a new life

But these tasks are not states to achieve, more a process to accommodate a new normal lifestyle without what was lost. And, more than likely, these tasks are largely undertaken alone. When one is already feeling completely drained it can feel very overwhelming to go on.

However, it is possible to go on- so where and how to begin?

1.Recognise the flat battery. Acknowledge the exhaustion. It wears us down witnessing the decline of another person’s health, even if we are not directly caring for them. We are drained:

Emotionally– experiencing feelings of sadness, helplessness, the effort of trusting people we don’t know, even if they are professionals.
Physically– through added responsibilities, practical tasks, tensions from emotions and thoughts are caught in the body, as if we physically try to hold the world together, resisting the changes (suggested further reading below).
Mentally– the experiences challenging faith, beliefs and altering what gives meaning to our lives such as occupational and family role

2.Begin recharging. To work with the exhaustion, we must simply attend to the fundamentals of living, regular food, hydration and rest, to tend to our depleted selves.

3.Building the energy charge. When we are hurting and everything has changed who are the people and what are the pastimes and environments which support, sustain and energise you in the new circumstances?… It is not a sprint – adjustment takes time, as does the recharging of human energy…. It is difficult to address the complexities of the rest of our lives on reduced energy.

‘You don’t have to see the whole staircase, just take the first step.’ Martin Luther King Jr

4.Minimise the draining. Talking about how you feel, to a family member, friend, health professional or work colleague, or by processing your feelings in your own way can ease the drain on emotional capacity dramatically and lead to the understanding and acceptance of your experiences. Strong unpleasant feelings are natural when we experience unwanted change and we may never have experienced this depth of feeling before. Acceptance doesn’t mean liking the way things are now, but some acknowledgement of what has happened allows us to move, psychologically, in the new circumstances.

‘As long as you’re moving, it’s easier to steer’. Ed Lester

5.Managing the movement. When we experience periods of relative stability in our lives post-bereavement, there are new daily tensions we need to accommodate as best we can, such as handling health anxiety when we live alone. The process of sustaining our energy levels, of caring for ourselves, does not diminish. But we don’t have to be perfect, just enough.

There are many excellent online resources for managing and reducing anxiety and stress and for bringing restorative practices into our lives, such as relaxation techniques, yoga and meditation or mindful practice. You can also look for local organisations that offer bereavement support, talking therapy, befriending, spiritual support /friendship groups. When you feel consistently more energised, you may want to join (or re-join) a gym, golf, cycling or running club or dance studio.

For further support with self-care in bereavement:

www.mariecurie.org.uk

www.mind.org.uk>information>support>bereavement

www.counselling.directory.org

www.cruse.org.uk

For health anxiety support:: www.nhs.uk

Further reading on working with body tension:

The Body Keeps the Score Bessel Van Der Kolk

Penguin Books ISBN 978-0-142-97861-1

Mindfulness for Health: A practical guide to relieving pain, reducing stress and restoring wellbeing Vidyamala Burch and Danny Penman (Amazon books, Google Books)

For Holmes and Rahe Stress Scale: https://en.wikipedia.org

Picture by Paula Noyce

Facing Fear: How to Cope with Health Anxiety during the COVID-19 Pandemic

6 May 2020 by Steph McClean

By Steph McClean, Psychotherapist

Throughout life, most of us keep an eye on our health and wellbeing. However, there are times when we are more anxious about our health than others. It might be that we need to go back to our GP for a persistent issue, or we need tests or scans to see what is happening.

Now we are in a more extreme situation, with a global pandemic of unprecedented proportions nobody has ever experienced before. The country is in lockdown, and many of us have to shield and isolate for long periods of time in order to keep ourselves safe.

Routine medical procedures and treatments may have been cancelled and some people who are vulnerable might choose not to attend appointments for fear of risking contracting COVID-19. We may know someone who had it, currently has it or perhaps even someone who may have died from it. The news and media are constantly updating us and discussing it.

It seems to be all anybody can talk about.

This can create high levels of anxiety about health and a preoccupation with thinking about the virus and avoiding it at all costs.

Rational Anxiety

It’s important to recognise that anxiety is a perfectly rational response to a crisis situation, particularly if we are in a group who are at risk. It is hardwired into our survival system to want to react and respond when we know there is a threat. Anxiety is an understandable reaction at the moment, and it encourages us to behave in ways that keep us safe in the current circumstances.

For example:

Wanting to isolate or stay at home
Focusing on keeping our environment clean and hygienic
Communicating more with loved ones
Seeking reassurance
Monitoring our sense of wellbeing
Supporting and checking in with vulnerable relatives
Keeping up to date on current advice, guidance and updates from the media
Keeping your distance from others when outside your home

Problematic Anxiety

The difficulty with anxiety is that it can become problematic. Unfortunately the survival system in our bodies is not able to detect between actual danger and a perceived danger. If we get to a stage where our perception of danger is larger than the risk of actual danger, we end up becoming overwhelmed by our anxiety.

This may mean our mental and physical responses become heightened and stay heightened for longer periods of time. When this happens, our anxiety becomes more dominant and in turn we experience an increasing amount of unhelpful behaviours, difficult feelings and physical symptoms.

Signs of problematic anxiety include:

Changes to sleep patterns- you might find it difficult to get to sleep, or wake early in the morning
Mood changes- you may become irritable and bad tempered
Changes to appetite (including nausea, lack of appetite or overeating)
Increased alcohol or smoking
Fatigue
Lack concentration
Body aches and muscle tension
Feeling restless- like you need to constantly keep moving or doing things
Grinding your teeth or experiencing jaw ache and headache
Heart palpitations
Increased rate of breathing
Panic Attacks

Health Anxiety is a specific condition. This is where the above anxiety behaviours can be experienced alongside health-related anxiety behaviours. These tend to centre around fears of being or getting ill that are excessive or create difficulties in everyday life. These behaviours can be obsessive or compulsive, meaning you may feel you have no choice. They can interfere with relationships, work, and other aspects of normal functioning.

Some of these behaviours include:

Refusing to leave the house, even when allowed.
Obsessive checking of media- having the news on all day, constantly checking online, looking up symptoms repeatedly.
Constant body monitoring- taking your temperature excessively or worrying about every little feeling in your body.
Obsessive hygiene behaviours- constant or excessive hand washing or domestic cleaning, particularly of a certain area.
Intrusive or repetitive thoughts about health
Constantly thinking you might die or be dying
Inability to accept reassurance from others, including healthcare professionals
Hypervigilance- closely monitoring those around you for perceived symptoms or signs of illness (coughing is a common one at the moment)
Paranoia- monitoring other people’s behaviour that you believe is a risk to you or others (eg. checking people leaving their house, not observing social distancing or not wearing PPE when in public).

We may briefly experience some of these more problematic aspects of anxiety, particularly health anxiety during the current COVID-19 Pandemic, which is to be expected. These aspects of anxiety will often pass within a few weeks. It is also important to remember that according to WHO: “Illness due to COVID-19 infection is generally mild” and “for most people in most locations the risk of catching COVID-19 is still low” that only 1 in 5 people who do catch it need hospital care.

Anxiety can be managed in the following ways:

Regular sleep pattern
Regular meals
Taking daily exercise, even if it’s a short walk around your garden
Daylight and fresh air- try and keep curtains and a window open
Meditation and mindfulness
Gratitude Journal/ Writing
Yoga and relaxation
Breathing exercises
Regular routine
Talking to others about how you feel
Listening to music
Doing a creative project
Online/Peer support groups

If you are experiencing excessive anxiety that is distressing, lasting longer than a few months or frequent panic attacks, please contact your GP or mental health professional.

Guides to above suggestions:

Meditation/Relaxation Apps: www.calm.com www.headspace.com

NHS Yoga Guide: www.nhs.uk/conditions/nhs-fitness-studio/yoga-with-lj/

Guide to good sleep: https://www.nhs.uk/live-well/sleep-and-tiredness/how-to-get-to-sleep/

Guide to Gratitude Journals: https://positivepsychology.com/gratitude-journal/

Helpful resources for managing anxiety:

www.nhs.uk/oneyou/every-mind-matters/anxiety

www.nhs.uk/conditions/stress-anxiety-depression/ways-relieve-stress/

www.nhs.uk/conditions/stress-anxiety-depression/moodzone-mental-wellbeing-audio-guides/

https://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/self-care-for-anxiety/

References:

www.nhs.uk/conditions/health-anxiety/

www.anxietyuk.org.uk/anxiety-type/health-anxiety/

www.who.int/news-room/q-a-detail/q-a-coronaviruses

Organising a Funeral During the Covid-19 Pandemic

29 April 2020 by Steph McClean

By Paul Hatchard, Chaplain

When a loved one dies, one of the last things we do for that person is to arrange their funeral. Although this can be upsetting, making these arrangements can play an important role in the grieving process as we try to come to terms with our loss.

As with so many things at the moment, current restrictions mean that the way a funeral is organised has had to change. This is the same whether a person has died due to Covid-19 or any other causes.

When you contact your funeral director to discuss the arrangements, they will be able to tell you about the restrictions that are sadly in place, which can vary between funeral firms and also between crematoria.

Be assured; funeral directors will work hard to accommodate all that you ask for, but they are also required to do all they can to minimise the risk of infection both to the group of mourners and to all those key support workers involved in organising the funeral. Therefore, when you contact them they will be able to advise on such things as:

whether or not it will be possible to visit your loved one in the Chapel of Rest;
whether limousines or transport other than the hearse can be provided;
whether the family are able to act as coffin bearers;
whether the curtains are able to remain open during the service.

In line with Government guidance, funeral services should only be attended by immediate family who are not in a high-risk category, not self-isolating and do not have any symptoms of Covid-19. Advice is to have as small a group as possible to attend the service and many funeral directors are limiting this to ten people or less.

Those who do attend will be asked to follow social distancing guidelines unless they are there with members from their own household. This means staying two metres apart from other people and not being able to embrace or hug them.

Of course these restrictions can be upsetting for the bereaved family and it may feel that the funeral you want for your loved one is not going to be possible.

Do remember that once restrictions have been lifted, it might be possible to hold a memorial service to celebrate the life of the person you have lost and perhaps at that time you can include some of the things you think are missing from the funeral. And of course, you will be able to invite everyone who would like to attend.

For those unable to attend the funeral, there are some things that can be done to make people feel a part of the service:

Discuss with the funeral director if they can live stream the service;
Have someone film it or take photos to share afterwards;
Give everyone you would normally contact, the date and time of the funeral so that people are able to mark the occasion in their own homes should they wish to do so. This could be by lighting a candle, reading a prayer or playing a significant piece of music.

People can be asked to share a memory about the deceased which can be collated and shared at some future point, perhaps at a memorial service.

Below are some further links which you may find helpful:

Cruse: https://www.cruse.org.uk/coronavirus/funerals

Government Guidance on Funerals: https://www.gov.uk/government/news/guidance-updated-to-support-the-safe-management-of-funerals

National Association of Funeral Directors: https://nafd.org.uk/funeral-advice/

Also, for those who have been cared for by Oakhaven, the Oakhaven Chaplaincy team is able to assist with funeral planning and leading of services. For more information ask for a Help Planning a Funeral booklet and/or email FAS@oakhavenhospice.co.uk or contact the Oakhaven Chaplain on 01590 670346 or paul.hatchard@oakhavenhospice.co.uk