Author Archives: Laura Woodward

  1. New Years Resolutions? Or New Years Intentions?

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    “When we cultivate a sense of caring and self-kindness toward ourselves, when we fail or experience shortcomings, instead of self-judgment and criticism, we build resilience that can contribute to motivation and lasting change”

    Have you made your New Year’s resolutions yet? Do you know that list of things you need to achieve this year? The things that, if achieved will bring you resounding joy and fulfillment, and if you don’t achieve (i.e. fail) will bring dismay, disappointment and reiterate the fact that you’re a loser?

    I recently talked with Matt, a vet from a large corporate practice.  He said that he used to be a “chaser.”  For most of his life, he chased happiness, perfection, and prosperity, frequently using the mindset “if only I (had the perfect job, had enough money, had the perfect marriage).,” or “when I (lose 10kg, get that promotion, find a girlfriend).” 

    Every year, he would make a New Year’s Resolution, connected to one of his “chases” – I will resolve to work out every day; I will start looking for a new job; I will join online dating… to finally feel fulfilled and satisfied in his life.  He was always successful out of the gate, but one setback spiraled him out of control, and by February, he felt defeated and a New Year’s Resolution failure, contributing to his sadness and depression.

    Sound familiar?

    This year, how about we set ourselves intentions rather than resolutions.?

     Unlike resolutions, which are tied to a specific outcome and can be more prone to failure, intentions allow us to recognize where we are in the moment and be present and aware at that moment, embracing the journey more than the result.

    Intentions focus on attitudes instead of outcomes and accomplishments. The problem with outcomes is that you do not have absolute control over what eventually materializes. For example, you can work hard, but you may not necessarily get that promotion, so resolving to get a promotion this year is risky business

    Every time we carry out our intention, we have achieved something worthwhile. If we resolve to cut down on eating (as opposed to losing 10kg), then, every time we deny ourselves a bag of crisps and every time, we don’t buy Snickers at the corner shop, we have succeeded. The reward can be instant if you allow it. Seems a bit airy-fairy? Because success breeds more success, it may be the reason that you succeed this year where you didn’t last year (or the year before that). Losing weight is the by-product of changing our attitude. Changing your attitude is a real success and something you do have control over.

    If your new year intends to spend 10 minutes or more in mindful meditation in the morning as soon as you have your coffee in hand. Once you’ve done it the first time, it feels like a real start. Twice and you’ve set a precedent.

    Three times and it’s become your new normal, a habit, part of your regular morning routine which you just do without questioning .and you’ve achieved your goal already because the goal was to meditate, not to become a monk by March.

     Because now the alarm is set on your phone for the same time each morning, you have literally ‘created time’ for yourself to benefit from however many minutes you’ve decided upon.

     If you skip a day, it doesn’t mean you’ve failed, it means you’ve skipped a day. It doesn’t undo the previous day’s work or negate its benefits. It doesn’t mean you can’t meditate tomorrow. It’s not a failure. It’s a skipped day.

     When we cultivate a sense of caring and self-kindness toward ourselves, when we fail or experience shortcomings, instead of self-judgment and criticism, we build resilience that can contribute to motivation and lasting change. Hence, when we stray off the path of our intention, if we learn from the experience, identify the triggers which push us off the path, and get back on the path without self-depreciation, it builds more resilience every single time. These are the ways we keep the good intentions running at full throttle for the whole 12 months.

  2. The use of language

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     “Don’t mix bad words with your bad mood. You’ll have many opportunities to change a mood, but you’ll never get the opportunity to replace the words you spoke.” – Unknown

    A truly eloquent friend of mine recently asked me“Have you noticed how many people describe being stuck in traffic as a ‘disaster’, or spilling a cup of coffee as a ‘mess’ or (the big one) a case going wrong as ‘devastating’? Well, how’s about being stuck in traffic is a ‘nuisance’, spilling your coffee is a ‘niggle’ and an unsuccessful case is a ‘disappointment’!

     His words made me think.

    If we make the effort to ensure that our internal monologue is helpful and constructive,(or at least non-damaging), then that’s one less person bringing us down, and also our external words will be helpful and constructive for others.

    Internal monologue

    Psychologists reckon that only about 1 in 10 of us don’t have a chatter going on in our head for most of the day. It might be a list of things to do, an email we’re composing, a conversation we want to have or wished we’d had anything.

    What a fantastic opportunity, therefore, this is to speak kindly to ourselves and to choose our language carefully.

    I rarely swear out loud. But internally, when I drop and smash something, or inadvertently lock myself out of the house, or spill tea on my laptop, my internal monologue is the stuff of nightmares.

    However, if my friend does the same, or if my kid break plates or the cat spills a pint of water on my electronics, I use calm, reassuring words and tone of voice, because it’s a simple mistake and they may be distressed already.

    So why the disparity?

    We’ve talked before about treating yourself as you would treat a friend. A helpful practice is to choose the words for our internal monologue as carefully as we would choose words for a friend or our child. Before long, it becomes a habit, so choosing helpful words and phrases for our external voice becomes something we do automatically. As a massive added benefit, the less internal self-flagellation we practice, the better our self-esteem and confidence.

    External words to self

    There’s little benefit from being attentive to our use of language towards others and congratulating ourselves on our kindness if we call ourselves an ‘idiot’ out loud for forgetting something or if we swear at ourselves when we drop coffee on the carpet. More damaging than the coffee stain on the carpet is the effect it has on our kids and loved ones to hear us berate ourselves if we do it out loud. How can they have healthy self-esteem and feel unjudged if their role model is cursing their own simple mistakes?

    External words to others

    If you have high levels of Emotional Intelligence, what you say can be profoundly powerful to those around you and to yourself.

    Emotional intelligence has five key elements: self-awareness, self-regulation, motivation, empathy, and social skills.

    We should ideally be putting all of these into practice each and every time we open our mouths.

    With practice, you can run through all these in a few milliseconds.

    Self-awareness: how do I feel?

    Self-regulation: Am I going to speak to myself or to someone else reactively or after some thought?

    Motivation: What do I want to achieve out of this situation?

    Empathy: Am I aware of how the other person feels? What type of language will resonate with them? Cognitive empathy is, after all, all about using the language of the other person rather than our own.

    Social skills: What tone and volume do I need to use in order to achieve my goal? Is my body language going to reflect what I want to say and how I want to say it?

    Let’s take a (potentially unhelpful) everyday situation and apply Emotional Intelligent use of language to it.

    So, driving to work in London traffic, can be many different things to different people. For some, it’s a daily, boring, time-wasting source of stress which always takes longer than expected. For others, it’s a chilled alternative to the tube, with music or guided meditation playing, a good coffee sitting in the holder, and a chance to take deep, mask-free breaths.

    Someone cuts in front of me from the lane that was for turning right only, then stop while they catch up on their phone.

    Self-awareness: I feel angry? Enraged? Vengeful? Non-plussed? Amused?

    (or can I take it to the next level and say, “Thank you,” to this driver “for helping me to exercise my patience”? Seriously, every time I try this, I smile).

    No emotion is right or wrong. You don’t need to justify why you are feeling it. The exercise is to notice the emotion and put a name on it rather than be carried away by it.

    Self-regulation: I could swear internally or externally. I can sit on the horn. I can tailgate that driver for the next mile. I can shrug. I can smile. I can use any words reactively ranging from “bloody idiot” to “meh, Whatever”.

    “Between action and reaction, there is a space. In that space lies our freedom to choose”

    – Hans Selye

    Motivation: here’s the thing.  I do want to get to work as smoothly and as quickly as possible (and probably in as stress-free a way as possible).

    So, in my experience, shouting and tailgating rarely result in a driver like that moving faster for me or letting me go in front of them because they can sense that I’m in a hurry.

    Also, while it may feel that expressing anger and rage will make the stress go away, basic physiology tells us that that’s a fallacy.

    So, our internal monologue can be littered with expletives. Try it and monitor your heart rate.

    Or you can really thank them for helping you to exercise your patience, notice the breath, lower your shoulders and see if you can lower your heart rate through deep breaths alone.

    In reality, if you get to your destination one car length slower than intended, that’s probably “just fine”. Your stress levels are going to be way more significant than the time at the end of the journey.

    Empathy: Cognitive empathy, we know, is about communication. Whereas emotional empathy is about relating to how the other person is feeling. So, tailgating this individual will resonate with them because that’s the language they speak, and will effectively communicate that you’re up for this game of caffeine-fueled aggression.

    The converse is also true: by not engaging, and not communicating via words or otherwise, your goal of getting to work in a chilled state is more likely to happen. Using your internal monologue of “no problem”, “meh”, “thank you” etc. can help you to achieve this state.

    Social skills:

    Body language is not just for the benefit of the onlooker.

    It goes without saying that aggressive gestures out the window are unhelpful. Also unhelpful is colorful internal monologue describing the characteristics of this driver

    A quick body scan where you sit up straight, lower your shoulders, relax your face and jaw, and breathe, calms you while communicating to road hogs that your intentions are different from theirs. An inner monologue of “yeah, okay, whatever” might fit the bill.

    “But if thought corrupts language, language can also corrupt thought.”

    – George Orwell

  3. Re-Entry Anxiety Post COVID

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    ACT or Acceptance and Commitment Therapy is a form of psychotherapy that invites people to open up to unpleasant feelings, and learn not to overreact to them, and not avoid situations where they are invoked.

    So, what’s the point of knowing that? You may ask.

    Well, the restrictions of the last 12 months have been gruelling for many of us. The loneliness and anxiety felt by the halting of our usual basic liberties have caused a tsunami of mental health concerns. Unfortunately, many of the same people who have been suffering the most with these restrictions and finally succumbed to (or accepted) them, are now experiencing anxiety during the transition from social isolation to a packed diary again (the re-entry phase).

    We worked so hard at accepting that it is what it is, taking one mindful day at a time. We focussed on only the present moment rather than worrying about, or even planning for, the future. We got used to not planning anything to avoid the feelings of disappointment when plans were cancelled.

    We re-programmed ourselves to enjoy this cosy bubble of the home where every day is Groundhog Day, and the diary is empty. So now, we’re throwing the doors wide open and rushing back to normality as fast as the statistics will allow. All good right? Not necessarily.

    ACT is widely used by therapists for the anxiety that cancer survivors experience on re-entry. Cancer survivors may experience an uncertainty about the meaning and purpose of their lives following cancer, triggering anxiety. Additionally, they may worry: ‘Does this symptom mean that my cancer is back?’, ‘How can I live knowing that my cancer might return?’, and ‘Now that treatment is over, why I am not back to normal?’ Fear of cancer recurrence figures prominently, yet the focus of anxiety extends beyond just that.

    Moreover, anxiety often persists for a decade or more after cancer treatment, representing the largest mental health difference between long-term cancer survivors and community controls.

    Firstly, very, importantly, I do NOT equate restrictions on our freedom in any way, shape or form with having cancer.

    Nor do I think that the wonderful liberation unfolding for us over these next few months is like returning to normal life after surviving cancer.

    That’s especially true because, while a person is enduring the godawful process of cancer treatment, the rest of the world is going on about their usual business without them ‘as if nothing untoward is happening’.

    Covid and lockdown have affected every human on earth and so is a completely different scenario.

    What I AM saying though is that we can learn from the re-entry anxiety cancer survivors experience as we begin to understand the there-antianxiety, we are feeling on coming out of lockdown.

    Many may question the meaning and purpose of their lives after covid following this chance to stop, pause and re-evaluate.  Others may have no choice but to pursue other career paths due to redundancy. Each triggering anxiety.

    We may worry that this cough or headache is the start of a covid infection. We may continue to worry about our aged or susceptible loved ones developing the disease despite vaccinations.

    We may wonder how, now that life is returning to normal, why we don’t feel normal.

    And we might judge ourselves as ‘wrong’ for feeling all of the above.

    We have discussed Acceptance before.

    Acceptance is, in a nutshell, allowing ourselves to feel any emotion we are feeling non-judgmentally. One at a time so you can identify what that emotion is, give it a name, feel the physical effects of that emotion, look it in the eye and notice that it’s present. That’s the opposite of shutting those feelings in a box only for them to come back another day and grab us unawares.

    Commitment is like deciding what we want to do as a result of each emotion we are feeling. Internally, that might be deciding to live with it and even ‘befriend’ it. Alternatively, it may be deciding to let it go for now or for longer. Neither is ‘right’ nor ‘wrong’.  Externally we may decide on physical actionsE.g., do I want to shout? Do I want to convey a loud sigh? Do I want to run away? Do I want to just not reply to messages?do I want to make plans to go to the pub and then cancel at the last minute because I just can’t face it?

    Making these decisions consciously is helpful because it means that each reaction is not just us running on autopilot, it’s us being self-regulated. The spin-off of good self-regulation is happier, more content people with positive interactions with others.

    ACT promotes forms of coping that predict positive psychosocial outcomes among cancer survivors: actively accepting cancer-related distress, reducing cancer-related avoidance, clarifying personal values, and committing to meaningful behavioural change.

    ACT allows for, rather than minimizes, the distress of cancer and fear of recurrence—an approach that may authentically validate the fears of re-entry phase survivors, many of whom live with the real possibility of relapse and early mortality. Thus, ACT may help cancer survivors increase their capacity to live meaningfully and effectively even with persistent side effects and uncertainty about the future.

    I, for one, am in awe of cancer survivors who show any indication that they are accepting of these anxieties. Often, society and even the closest of family members, are so joyful for the cancer survivor when they come to the end of their treatment and are given a clean bill of health, that the survivor themselves feels totally alienated from those they feel closest to. At a venue where I counsel cancer survivors and cancer patients, time and time again I hear that the survivor with the discharge note from their oncologist emerges from the rigorous schedule of years of appointments. The champagne corks are popping, balloons are everywhere, and the survivor feels more alone than ever. Their family is celebrating but their support network has just evaporated as they are discharged from the only group of people who can truly understand how they feel. Some clients have said that they would choose to not be in remission or cured of their cancer rather than face this re-entry.

    Being aware that the jaw-dropping strength of cancer survivors getting back to normality is far greater than the strength we will need to get back to the pub is respectful and, perhaps, not something we had thought of before now.

    Telling yourself that there are people far worse off than you who have cancer or who have had loved ones die due to covid, while it is of course very true and not to be trivialised, rarely helps to relieve anxiety.

    Self-shaming is of benefit to no one.

    Some of us may have an underlying worry that, just as we get used to going to the pub again, it will all be ‘taken ‘from us. It may be the fear of disappointment that stops us from booking a holiday even though we’re allowed to do so.

    Accepting this plethora of feelings and identifying them one by one is a start.

    Giving ourselves permission to feel these emotions is helpful.

    Knowing that there are vast numbers of people feeling exactly as we are helping because we realise that it’s the nature of being human in 2021.

  4. Is perfectionism decreasing your worth?

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    Being non-judgmental liberates us from the habit of hiding behind self-depreciation, instead of acknowledging our errors, facing them and all the emotions they give rise to, and allowing ourselves to feel the shame, embarrassment, and agony in all its foolishness so that we can move on.

    Striving to be the best vet, nurse, person you can be is always an asset to the practice of your friends and loved ones, right?

    Not necessarily so.

    When striving to be great is accompanied by a yearning to be better than we realistically can be, it’s a perfect storm that can lead us down to the destructive circle of yearning, being disappointed, self-judgment, self-flagellation, trying harder, more disappointment, more harsh judgment, loneliness, and desperation.

    Now I’m not saying we should stop trying to be the best we can be. Not at all.

    But so many of my psychotherapy clients who are self-declared recovering perfectionists, find that swapping the above cycle for a less judgmental one, means that they have the headspace to focus more clearly on tasks at work, thus leading to better outcomes for their patients, colleagues, and ultimately their clients and their pets.

    Ironically, accepting less than perfection can improve their quality of work.

    Have you ever been with someone who constantly puts themselves down, listing their own faults, errors, and inabilities in an effort to convince their audience that they are worthless?

    Or have you ever been that person?

    And have you ever been in the company of someone who accepts that they aren’t infallible, who owns their imperfections and makes sure those imperfections don’t impact their patients, colleagues, or friends?

    Who would you rather be with? Who would you rather be?

    For me, I feel more confident in my colleague’s ability to handle a case if they realize their limitations and ask for help rather than forging ahead when the risk of errors is high.

    And when something goes wrong with a case, again a colleague who takes ownership of the complication and deals with it, with or without help from others to me, is way more valuable than a colleague who self flagellates out loud, listing their incompetencies and being eloquent about how rubbish they are.

    Being non-judgmental liberates us from the habit of hiding behind self-depreciation, instead of acknowledging our errors, facing them and all the emotions they give rise to, and allowing ourselves to feel the shame, embarrassment and agony in all its fulness so that we can move on.

    So how do we manage to not beat ourselves up when faced with a complication at work or when faced with what we see as a flaw in our general makeup?

    Being ambitious and always wanting to do better are qualities we want in our vets and nurses. As surgeons, we are encouraged to criticize our work and learn reflectively every time we operate. What 5 things could I have done better on this fracture repair? Even if we are super happy with our repair and we know that the outcome is likely to be a comfortable leg and a rapid return to normal function, developing a healthy habit of self-assessment does so much for us as surgeons and as people outside of work.

    So, what’s the difference between self-assessment and being judgmental?

    It may seem subtle, nuanced, or even nonexistent until examined more closely.

    Jon Kabat-Zinn defines mindfulness as “the awareness that arises from paying attention, on purpose, in the present moment and non-judgmentally”. 

    Non-judgmentally broadly means not putting any thought or emotion into a “good” category or a “bad” category. Rather than just noticing it, accepting it, and allowing ourselves to feel it.

    Non- judgment isn’t always about judging people or things they have done or their characteristics. Nor is it about judging ourselves. It’s about relieving ourselves of the need to place things into boxes. So, situations, thoughts, emotions, people even the weather can just be.

    Have you ever heard the saying that there’s no such thing as bad weather only unsuitable clothes? Well, that’s a bit contradictory because while we’re saying hooray, we don’t judge the weather as good or bad, but sadly we are saying that wellies are great, and sandals are substandard. It’s a bit patronizing.

    An easy starter for this is a simple mini-meditation on non-judgment.

    So, sitting comfortably, eyes open or shut, take ten normal breaths, noticing only the movement of the breath in and out of the nose.

    If a thought comes into your head during this time, gently push it aside for now.

    Then, during your body scan which we have practiced in previous articles, try to notice any discomforts. For example, you may have an itchy scalp or an aching joint. You might be sitting not quite comfortable enough. Maybe you would rather change your posture.

    Then, without scratching the itch or moving the uncomfortable position, try to notice the physical feelings associated with it.

    Name the physical sensations. It might be “itchy”, “irritated”, “painful” etc.

    Allow them to be, without doing anything to relieve the discomfort or annoyance. Focus on the discomfort wholeheartedly. It doesn’t need to be perfect.

    That is acceptance of discomfort.

    You can open your eyes and try to notice the relief of not having to correct the imperfections.

    A mini-meditation for when we have failed is harder.

    Instead of feeling just the physical discomforts, we feel the emotional pain of failing.

    Many emotions come to mind: shame, embarrassment, self-doubt, loneliness, desperation.

    We may tend towards affiliation, where the potential outcomes of our error become enormous in our mind and tend towards only the worst possible scenario as a definite reality.

    Physically we might feel nauseous, weak, faint. Or we might have palpitations, a sinking feeling in our chest, or a lurching stomach. We’ve all been there.

    The challenge of this meditation is to allow these feelings to be present one by one in the forefront of your mind for as long as you can hold them there. It’s difficult when our natural reaction is to push these hideous feelings away.

    It has been shown time and time again that naming these feelings whether it’s the feeling of nausea or the emotion of shame, that looking them in the eye and allowing yourself to feel them at their fullest, defuses their hold on you, thus enabling you to get on with your life.

    It is so important to pull your mind away from trying to justify why you feel any of these feelings. Therein lies the non-judgment part. It doesn’t matter if you should or shouldn’t feel a feeling. The point I that you do feel it and that’s it.

    Now is not the time for yearning for the error to not have happened. It has happened.

    So, when we’re being non-judgmental of the emotions we’re feeling as a result of not being perfect, we are indeed noticing them, allowing ourselves to feel them, and accepting that they exist.

    We aren’t justifying whether these feelings should or shouldn’t exist. We aren’t defending to anyone why we’re feeling what we’re feeling.

    We’re just noticing each emotion one by one, looking it n the eyes and giving it a name. Recognizing that the plethora of feelings can indeed be sorted into an orderly queue of individual emotions and dealt with and accepted. Like the mass of cables behind the TV. When untangled, it’s a great deal easier to organize them.

    Isn’t it telling that when we make a mistake in our profession, it’s called “committing an error”?

    Similar to committing murder or committing suicide or committing a crime.

    Dealing with errors as a team that runs Morbidity and Mortality rounds is a fantastic way to learn how to accept imperfections and mistakes. Like a mini-meditation but as a group of fallible beings. M and M rounds, when run intelligently, are an opportunity to say out loud that something went wrong, and we did it. Then it’s out in the open. These rounds aren’t about blaming anyone, we all know who did what. It’s about accepting that we make errors and that there are outcomes from these errors. We talk about the near misses and the deaths that we didn’t prevent. We feel sick to the core when talking about it. The physical feelings and the feelings of shame are a given. We feel them as a team. We discuss how to prevent various mistakes from happening again, put more protocols in place, and ironically, we come away from these meetings even more bonded as a team and more at peace with the fact that we made those mistakes, they make us feel hideous and that life.

  5. The nature of Impermanence, attachment, and positive psychology.

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    “Nothing is permanent— not even our troubles.”

    –  Charlie Chaplin

    Impermanence is constant change, and it’s woven into the very fabric of our existence. Moments come and they go. Years go by. Kids grow up too fast. Holidays take ages to arrive and seemingly minutes to pass. Time flies when you’re having fun. The breath you took five minutes ago is long gone.

    Intellectually, we understand that our pet will be born, age, and die, that a car will break down, that the traffic jam will eventually move. Our work is to move that understanding from our intellect and nestle it deep in our hearts. But how does that benefit us? Sounds miserable, right?

    There’s a beauty to impermanence. You know, in Japan, people flock to the hillsides to see the spring blossoming of cherry blossoms. The festival is over after a few days as are the blooms. Tiny blue flax flowers in North America last for just a day. Glastonbury is amazing. But it has to end because it’s impossible to party that ardij

    Impermanence isn’t a good or a bad thing. It’s just a fact. We rely on constant change; we rely on impermanence.

    Ancient trees will burn in great forests so new ones can be born. Evil dictatorships crumble. 

    Winter days can be cold, wet, and dark. Some people love winter. Others of us prefer sunshine, long warm evenings and swimming in the sea. How many Winters have you seen pass and give way to Spring and Summer? We need Winters to be impermanent

    So how does really understanding impermanence benefit our wellbeing?

    If you’re having a great day, enjoy it to its fullest, it won’t last.

    And if your day is feeling like a disaster, hang in there, it won’t last.

    No matter how long that ops list is. It will eventually all get done. That’s also the nature of impermanence.

    If you’re dreading the root canal treatment you’re having next week, have faith that that day will come. And it will go. And the root canal procedure will be done.

    So, how can I claim that Impermanence is a path to fulfillment and an antidote to regret? Accepting the nature of impermanence is a key Buddhist teaching. It also leads neatly into relinquishing attachments which, according to Buddhist teachings, are one cause of suffering.

    Impermanence versus attachment

    So, if I can accept that I am impermanent, as is my cat, my job, this good or bad day, my holiday, then I can hold myself back from becoming so attached to the necessity of it being permanent that I can relax a little. Instead of fearing and dreading the end of my holiday, I can enjoy it even more mindfully and embrace every tiny joyous thing about it even though I know that it will pass.

    With time, I can accept that everything, even all humans on earth including me are fleeting in some way. That is acceptance and letting go of my attachment and desperate need. And that’s ok.

    Attachment :

    According to Buddhism, attachment is the root of suffering, and it is usually the reason why impermanence is difficult to fathom for many people. Rationally accepting that everyone and everything is temporary is a refreshing concept, and whether you want to believe it or not, it’s true.

    Positive Psychology :

    While clinical psychology has largely focused on diagnosing and treating mental illness and diseases, positive psychology is concerned with cultivating positive well-being, which is very different from merely eliminating negative mental states.

    We already know that external factors don’t determine one’s happiness. Certainly, positive external factors compound and complement one’s overall contentment, but internal factors are required to achieve an authentically joyous life. True happiness comes from within.

    So, although a fortnight in the Maldives would be fantastic right now, it would come, and then it would be over. i.e., impermanent. Then you are still the same person (although a bit more rested), left with your mental state which only you can cultivate

    It is also important to understand that grasping for positive thoughts, emotions, and occurrences in life is not what positive psychology suggests. If you accept the notion of impermanence but still attempt to force happiness and joy into your life, you are missing the point.

    This quote from Paul T.P. Wong (2007), a positive psychologist sums up the concept of impermanence and attachment :

    “Craving for happiness necessarily causes us to fear or reject anything that causes unhappiness or pain.

    Attachment to possession and achievement invariably leads to disappointment and disillusionment because everything is impermanent.

    Thus, the positive psychology of pursuing positive experiences and avoiding negative experiences is counterproductive, because the very focus on happiness contains the seed of unhappiness and suffering.

    Failure to embrace life’s experience in its entirety is at the root of suffering.” References: Wong, Paul T.P. (2007). Chinese Positive PsychologyInternational Network on Personal Meaning. Retrieved from http://www.meaning.ca/archives/archive/art_Chinese-PP_P_Wong.htm

  6. Staying mindful in a pandemic

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    What can we learn from our patients and our pets during the pandemic?

    Have you noticed how so many people have got a new puppy, a kitten, or a pair of guinea pigs since the pandemic started? While this raises many questions about morals and ethics, it also shows how the human-animal bond can be a lifeline during difficult times.

    Looking at the ever-increasing number of puppy-poodle crosses among my friends and coming through the door at work, I can be either judgemental about pet breeding, grumpy about the fact that work is busier than ever and I’m suffocating behind this mask-visor combo, or I can choose to celebrate the human-animal bond which has helped me as a pet owner and many others to cope with potentially over­whelming emotions related to the pandemic. It’s a choice.

    During mindfulness meditations, we can consciously train our brain to notice things, such as how a puppy has brought joy to a locked-down family, how the lack of traffic noise gives us a chance to hear more birdsongs than ever, or how concentrating on a good coffee makes its aroma, taste, and temperature so much more prominent than normal.

    You can choose to rejoice in the good things about increas­ing pet ownership while also being aware of the drawbacks. It is about noticing both, and then choosing which one has the most influence on you. I can see how pets can have a pro­foundly positive effect on us during difficult times. With that in mind, what can we learn from our patients and our pets?

    The importance of a good routine

    When we were kids, most of us had routines provided for us. We had a wake-up time, school time, dinner time, and bedtime. These routines kept us on a productive path.

    The pandemic has caused us to have amounts of time to fill that we probably aren’t used to having.

    The pandemic has caused us to have amounts of time to fill that we probably aren’t used to having. And yet, for a lot of it, we are running on autopilot like news-jaded zombies. At the other extreme are very productive people learning new jam-making skills while teaching their kids to crochet their own wall hangings in five different languages. But this is a global pandemic, not a productivity contest. Somewhere in the middle are the dogs and cats: super chilled bundles of joy who love a routine of walkies – food – nap – repeat.

    We can learn from our pets in many ways, and one way is by having an easy routine to add a bit of structure to the days when our default mode is to doom scroll endlessly through the news and social media. A simple routine (eg mindful meditation – mindful shower – slow coffee) can bring some normality to an incredibly abnormal situation.

    Feel what I need to feel when I need to feel it

    This pandemic is impacting more than just our physical health, it is taxing our mental health as well. Fear is at an extremely high level. The non-stop media coverage and pro­longed uncertainty can lead to intense feelings of stress, anx­iety, and depression. Now more than ever, it’s essential for us to create awareness of our feelings and to learn to manage them. With animals it’s easy: hunger, eat, done. Separation anxiety, owner returns, done. We, however, need to put a lot more effort into “notice, feel, let go” of difficult emotions.

    We need to take time out to sit, breathe, and allow our­selves to feel what we feel. It’s hard to know what we’re feeling when it’s jumbled up in our minds like a bundle of intertwined wires behind the TV. The very simple act of untangling those wires and sorting them out is so satisfying. As is the act of identifying our feelings, one at a time, and giving each one a name. By naming them, we are identifying each feeling and allowing ourselves to feel it. It’s not weak to feel overwhelmed. It’s not selfish to feel sad when others may be worse off. It’s not shameful to feel joy mid pandemic. Feeling overwhelmed doesn’t stop you from feeling happy to stroke the guinea pigs, play with the kittens or walk the dog.

    You are allowed to feel all of those emotions. You need to give yourself permission to feel each of those feelings, all the while recognizing each individual feeling and emotion separately, rather than as a plethora of intertwined emo­tions causing anxiety.

    How to truly be present

    Just as animals can teach us to let go of difficult emotions, they can also show us how to be truly present. What dog is yearning for life to return to the way it was pre-COVID while they’re out for a walk? The simplicity of their minds allows them to notice the present moment wholeheartedly.

    When times are hard, it’s impossible to be anywhere else other than totally consumed in the moment of awful grief and desolation. So, when times are pleasant enough, or even really gorgeous, why does it take such effort to remain in that moment and glean all the happiness possible out of it to provide future resilience? It just does. Because we have hard-wired ourselves to ignore things that don’t need “fixing”. It takes training to change. It takes practice. And it’s so incredibly rewarding.

    So, if we are going to achieve anything during this pan­demic, maybe it could be to (1) develop a simple routine; (2) allow ourselves the time to feel what we feel, and (3) be totally present in the moment we’re in. Because the past has passed and cannot be changed or undone, and the future is overwhelmingly uncertain.

  7. Self-compassion is more than just self-care

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    When we are truly self-compassionate, we relate to our feelings in an accepting manner to defuse their hold on us.

    A pandemic has enveloped the world, changing the way we live so dramatically and chipping away at our inner strength bit by bit until we were left anxious and on a rollercoaster of emotions aptly named the COVID-coaster. It’s difficult to maintain the inner strength we have spent so long cultivating right now.

    It is often said to “treat yourself the way you would want others to treat you” – so, how would you treat a friend who is struggling, and how can you extend that effort towards yourself? Do you find yourself gagging for a coffee and then, when you get it, slugging it down while typing your notes frantically? Do you run yourself a bath and then spend your time in it scrolling through your long list of emails? Do you wonder why, if you are exercising self-care by making yourself a coffee and running a bath, you’re not feeling the benefits of it?

    Ask yourself this. If a friend were struggling, anxious, and exhausted, would you place a cup of coffee in their hand and then walk away, job done? Would you sit them in a comfortable seat and then scroll through your emails, ignoring them? No, of course, you wouldn’t. So why do we do this to ourselves?

    How would you treat a friend who is struggling, and how can you extend that effort towards yourself?

    Why do we pay so little attention to ourselves and think that the material external aspects of self-care are enough to “fix” us? Why does looking after ourselves and offering loving-kindness to ourselves end up on the long list of chores we really don’t have time for? So, we half-heartedly do it to “get it done”.

    Self-care is so important if we are to maintain a stable mindset during challenging times. This pandemic has presented us with a unique set of challenges, the like of which we’ve never seen before and hopefully will never experience again. You may have children, colleagues, and clients all depending on you to help them and it’s difficult not to experience emotional fatigue.

    This state of sympathetic overdrive coupled with the knowledge that there is really no easy way out of this can send us on a downward spiral into a state where we are no good to anyone.

    Taking time out to stabilize and recharge is essential if we are to survive. Ironically keeping our heads just above water by running a bath and hoping that’ll be enough, for now, is simply not enough.

    The three elements of self-compassion

    Mindfulness

    Mindfulness helps with self-awareness in a balanced way. As we know, mindfulness is focusing on the present moment on purpose, as if your life depended on it. And yet, focusing on the present moment, when it’s nothing short of horrific, seems counterproductive. However, avoiding feeling what you’re feeling, in order to feel it a bit less, will allow those emotions to grow into something truly unmanageable before they come back to haunt you at a later time. So, we need to deal with them as they happen.

    It’s easy to ruminate and to get lost in the drama especially when the current situation is so overwhelming. Mindfulness helps us to relate to what we are feeling in an accepting manner. For example, “I feel anxious that the mental health fallout of this pandemic will be too enormous for me to bear.”

    Rather than analyzing the anxiety and the origins of the anxiety, instead of justifying it, instead of judging it, simply accepting that anxiety is the thing I’m feeling, and allowing myself to feel it, can defuse the hold that it has on me.

    Have you ever noticed that, sometimes, when you talk about what’s upsetting you to a friend, they immediately begin a sentence with “well at least” or “never mind” or even “it could be worse”?

    This is a genuine effort by a kind friend to help you. But active listening doesn’t respond with unhelpful comments. Active listening means being there in the moment with your friend, silently understanding, pausing to digest what they’ve said, relating on a deep level to what they’re expressing. True empathy doesn’t sweep your friend’s uncomfortable feelings under the carpet in an effort to jolly them up. No, we pause, reflect, and share the load by staying quiet.

    True empathy doesn’t sweep your friend’s uncomfortable feeling under the carpet

    So, can you do that with yourself? When you make yourself that coffee or run that bath for yourself, can you then spare yourself the time to just be there with yourself at that moment? Like you would with a friend in need? Truly listening instead of scrolling through your messages. Accepting and understanding that it hurts. Taking the time to just be and to breathe.

    A sense of common humanity

    By that, I mean taking some solace from the fact that we are not alone in our experiences and feelings. This awful suffering is part of the human experience. We have horrific pandemics every 100 years or less. This is the norm for humans. I’m not saying that it doesn’t hurt. It does. Enormously. But knowing that we are not alone, understandably eases the added anxiety associated with loneliness. And loneliness is rife at the moment due to social distancing and isolation. Repeatedly saying in your head “this shouldn’t be happening” is a judgment that is rarely helpful.

    Loving-kindness towards yourself

    What does this mean? We need to cultivate a strong motivation to relieve our suffering. It’s vitally important. You can make it OK for you. You can make it better than OK for you.

    But it needs to be deeper than just physical well-being if it’s going to weather the long storm we have ahead of us in the post-pandemic phase. It needs to be hand-on-heart meditations and more.

    A mini-meditation for vets and vet nurses during times of anxiety

    Hold your right hand on your heart as if to say to yourself “I’m here for you.” Like a close friend offering comfort. Close your eyes. Taking normal breaths, concentrate only on the in-breath for a while. Imagine you are breathing in strength, loving kindness, and calm. Imagine it as a valve mechanism and the in-breaths “inflate” the inner well-being. Every in-breath adds to the strength, love, and calm inside you. Feel the solace growing inside of you.

    When you feel a calm, warm sensation within, when you are fully “inflated”, stay focused on it for as long as is comfortable.

  8. Coping with anxiety during the pandemic

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    Acceptance of the anxiety we feel, rather than trying to push it away, goes a long way to defusing it and reducing its hold over you.

    The uncertainty and fear are palpable on the way to work, at work, traveling home from work, even in the (possible) safety of our own homes.

    We have to socially distance ourselves while examining a patient being held by a colleague, manage our clients’ fears and anxieties and manage our own fears and anxieties about our families while being professional at all times.

    It’s crowded where some of our work, and so difficult to stay 2m apart.

    The shame we feel for using public transport to get to work adds to the anxiety, clutching onto a letter stating that we work as a vet in an emergency hospital as if it were the only thing keeping us safe.

    The moral dilemma adds to the stress. Each and every one of us has to stay at home, protect the NHS and save lives. But here we are getting public transport to work feeling like we alone are responsible for this pandemic perpetuating.

    And when we get to work, circumstances such as a lack of surgical disinfectant, shortage of face masks and gloves, postponement of prophylactic treatments, and the inability to help our clients with their concerns all add to the “moral injury”.

    Moral injury is what can leave us with long-term psychological scars if we allow it to.

    The feeling that we cannot perform as well as we should and that our patients and clients will inevitably suffer is hard to come to terms with.

    We have handed our ventilators over to the NHS. Whether you think that’s morally right or wrong, it follows that some of our patients may die as a result and we won’t be able to feel or to say that we did everything we could do.

    These moral injuries, injuries to our ethics, can have long-lasting negative psychological effects. Sir Simon Wessely, professor of psychological medicine at the Institute of Psychiatry, King’s College London, says the moral injury is “where you know you didn’t do everything you could have done”. It makes us feel angry, it makes us feel guilty and it makes us feel ashamed.

    Sir Simon Wessely, professor of psychological medicine at the Institute of Psychiatry, King’s College London, says moral injury is “where you know you didn’t do everything you could have done”

    Fear of the unknown causes more anxiety and we constantly have to improvise. Then the advice changes again.

    Previously, many of us learned to leave work at work. Then we would leave the hospital and manage to have a life outside of work and in our homes where we would recharge. This pandemic changes all of that. It’s everywhere. There is no life outside of work that is free from COVID-19. And home is where we may be spreading the virus we picked up on the tube.

    So what can we do?

    We’re already washing our hands, social distancing, and self-isolating.

    We’re clapping on our doorsteps and sending the NHS hospitals enough sweets through Amazon to make sure the dental profession flourishes after the pandemic.

    Clear leadership, communication, and an acceptance that the situation may result in decisions that would not normally be best practices are needed.

    We can draw up new and temporary protocols for this time. These protocols need to be agreed upon by us as a team otherwise they will harm our mental well-being further. When you’re tired and anxious and afraid, it’s nearly impossible to implement protocols you don’t agree with. So, more than ever, we need to be team-leading from within.

    The emotionally intelligent team leader will facilitate this, coordinate the decision-making processes and produce clear instructions for the team made by the team.

    Good leadership enables teams to support each other.

    We’ve talked before about the three types of empathy and how highly functioning teams have all three running at full throttle. So, we need each other. We need the social interactions we normally take for granted. We need the hugs which are banned. We need to be with each other in the moment when cases are going well and when cases are failing.

    Acceptance of anxiety

    This is not the time to flood the practice with professional counselors. To be anxious is normal. To be afraid is a given. To feel shame is expected. Where else can we find cognitive empathy other than among our colleagues? From there, the emotional empathy will grow, and we can truly be there in the moment accepting the fact that although this pandemic will pass, for now, it’s not OK.

  9. Talking techniques to cope with stress

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    20 Feb 2019

    THE 2017 VETERINARY EDUCATION FOR TOMORROW (VET) Festival celebrated a record turnout this year, opening its gates to over 1,400 delegates. The 36 speakers, chosen by Professor Noel Fitzpatrick, educated and enthused delegates in the themed tents for two days at Loseley Park, Guildford. On Friday, the CPD tents were full to the brim with delegates all through the day, not just by people seeking refuge during the morning’s torrential rain. Wellness was the theme for this third event and a whole stream was dedicated to the topic. Dr. Laura Woodward, a veterinary surgeon, and therapeutic counselor attracted a large crowd to her talks on mindfulness, emotional intelligence, and coping with stress in the veterinary workplace. Dr. Woodward opened by explaining the need for counseling in the veterinary profession – a profession where the suicide rate is four times that of the general public, and a high percentage of individuals often seriously consider quitting for good.

    Mindfulness

    Dr. Woodward reiterated that we need to get rid of the “blame culture” and work more as a team; we need to be more open about the issues we face, and more support must be made available to veterinary professionals. She highlighted the benefits of mindfulness, a stress-reducing exercise described by its father, Jon Kabat- Zinn, as “paying attention on purpose in the present moment, as if your life depends on it”. Mindfulness can be practiced in several different ways to help you work more efficiently and save time in the long term. The first means is through formal meditation; for example, meditating for an hour, movement meditations (like yoga), or group exchanges. Dr. Woodward is more of an advocate for informal meditation. “Any activity can be mindful if you focus on it in a mindful way,” she said. Suggestions included playing mindful tennis, doing mindful poem-reading, or even trying your hand at mindful tooth-brushing.
    The point is that you take a few minutes out of your day to remove all work distractions and focus wholly on the activity at hand. These shorter, simpler mindfulness exercises are more realistic for people in the veterinary profession; they can be performed in just a few minutes, or even achieved while undertaking necessary tasks like washing and cleaning. Mindfulness takes practice and staying focused even for five minutes is harder than you might think;
    Dr. Woodward suggests starting with shorter periods – a minute or two – and working your way up to longer, more regular mindful practice. 

    Emotional intelligence

    Being emotionally intelligent in the workplace can help reduce feelings of stress and anxiety on a personal level as well as helping to maintain a relaxed work environment for those around you. Dr. Woodward quoted the pioneering endocrinologist Hans Selye:
    “It’s not stress that kills us, it’s our reaction to it.” She described five key components to emotional intelligence:

    1. Self-awareness – being aware of how you feel in a particular moment and knowing how you would feel in different situations; knowing your strengths and your limitations.
    2. Self-regulation – controlling your emotions and not allowing yourself to be reactionary.
    3. Motivation – thinking about what you can achieve from a situation and how you can achieve it.
    4. Empathy – seeing things from another person’s perspective.
    5. Social skills – tolerating your own weaknesses and those of other people; being compassionate, resilient, and actively listening to others. 

    CBT to cope 

    Dr. Woodward’s final talk focused on cognitive behavioral therapy (CBT) – another method to cope with stress in the workplace. This technique is about changing the way you view a situation so you can change the way you feel about it and react to it. CBT isn’t about suppressing your feelings, Dr. Woodward says, but is about stopping you from “awfulizing” them. Using CBT should help a person to put things in proportion; it can be used to rationalize anxieties and work to overcome them. There are several steps to
    overcoming anxiety (like a fear of failure in performing a certain surgical procedure). Firstly, Dr. Woodward recommends disputing the irrational belief by “doing your homework” – in other words, looking to see how likely it really is that the bad situation
    you’re envisaging is going to be the outcome. It is also suggested that you change your language to put a positive spin on your thoughts (think “I will do it, but I’ll do it with a more experienced surgeon on call in case of any problems”). Roleplay, Dr. Woodward says, is a great exercise for reducing anxiety; take yourself to a quiet place and work through the whole situation, from start
    to finish, in your head. Think about what you would do if the worse were to happen and make sure that when you enter the real situation, you have everything to hand to deal with it efficiently.
    Perform shame-attacking exercises – know that you are not a terrible person and it’s OK to be cautious; the very fact that you’re thinking about these CBT methods means that you are being proactive and trying to tackle the issue. Again, think about your motivation – why do you want to overcome the anxiety? What benefits will you get from being able to perform that procedure confidently? Try to desensitize yourself to the situation – don’t just do it once, keep agreeing to do the activity you are anxious about, perhaps with somebody on hand to help. Skills training and assertiveness training can also be beneficial. Dr. Woodward recommends signing up to some relevant CPD to help you better understand the situation and strengthen your knowledge. Once you
    have successfully come through the situation, think that you can deal with it and you have overcome the anxieties. The more you practice these exercises, the more efficient you will be at tackling your ever-growing to-do list. Paradoxically, taking the time to
    not think about work will help you to function more efficiently and work through the list more swiftly, leading ultimately to a less stressful workday and a happier workplace.

  10. MINDFULNESS FOR BUSY PEOPLE

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    Can you spare a minute?
    Can you spare 5 minutes?
    If I said you could change your life if you could spare 5 minutes every day would you do it?
    5-minute mini meditations are for people who genuinely are too busy for anything more. We have ridiculously busy lives. As vets we multitask in our sleep.
    Maybe we go to yoga once a week which is a formal way to practice mindfulness and that’s great. However, what about the other days?
    Everyone’s talking about mindfulness for a reason. The benefits are immediate and multiple. It costs nothing. You can do it anywhere, in any clothes, at any time.

    What is it?
    John Kabat-Zinn says, mindfulness is “Paying attention, on purpose, to the present moment, non- judgementally, as if your life depended on it”.
    The simple (note, I never said “easy”) act of pinpoint concentrating on the here and now, can have such profound effects on our psyche that it can be a very powerful tool for each of us, whether distressed or having the time of our lives.

    How do I do it?
    Mindfulness can be anything from taking a moment to appreciate a beautiful view, to taking a few deep breaths, to mini meditations, to full meditation in cross-legged posture for an hour or more every day.
    No act is better or worse than the others. What matters is that you choose what works for you.
    Have you ever felt a bit overwhelmed to such a degree that you wish you could step off the rapidly revolving world for a few moments for a break and then step back on?
    Yoga, Pilates even tennis can be “escapism” from the rollercoaster of life where we concentrate on our bodies, posture, breathing etc. This can be a form of escapism, and, is useful for those of us who find it difficult to concentrate on “nothingness”. We may need a “thing” to concentrate on to keep us in the present moment.

    But while mindfulness is another way of freeing oneself from automatic and unhelpful ways of thinking, it is NOT a method of avoiding our emotions or escapism.

    Mini meditations are a calming, anxiety-relieving strategy which we can do at any time of the day.
    While mini meditations are a good place to start, they are essentially “fire brigade treatment” for those of us who are experiencing a difficult time in our lives; a “band aid” until we make the time to use mindfulness more deeply.
    There are literally thousands of meditation apps out there to download, however proceed with caution. I would suggest instead disappearing to a place for 5 minutes without your phone, sit and focus on nothing other than your breathing for 5 minutes. Toilet cubicles are an obvious place in a busy veterinary hospital. Closing your eyes while on the tube is another. Walking to work concentrating on only your feet is another. It’s much harder than you would think to maintain this clarity of concentration for a full 5 minutes.

    Deeper meditation is easier than you would think. Start with “Guided mindfulness “sitting meditation” by Kabat-Zinn from You Tube where you can learn how to get into that deeper state of consciousness.

    Then learn to do it by yourself. Posture is important.
    Focus entirely on the present moment, your breathing, clear your mind of all thoughts which are trying to get your attention. Gently push them to one side. Push the past to the left and the future to your right and concentrate fully on the here and now.
    Once your mind is clear, then reintroduce and observe your emotions, in a direct and open manner one at a time. Face it, give it a description and a name. Be non- judgemental. No thought or emotion is right or wrong. Just accept it as the emotion it is. This is difficult. Once analysed, decide how much you want to hang onto or let go of that emotion. Then gently push that emotion aside. This is where you are powerful. Because you can literally choose the degree to which you feel that emotion from now on. If it is anger, you may wish to feel it less. If it is joy, you may wish to grow it so that it fills your mind for the day and makes you the person your colleagues want to work with.
    Enjoy. All feedback welcome www.laurawoodward.co.uk