Overcoming Anxiety Following COVID-19

By Kimberly Cairns / 04 Aug 2020

Psychologist Kimberly Cairns considers the impact and influence of stress related to the global pandemic on the aesthetic workplace

At the beginning of the pandemic the World Health Organization documented that the coronavirus global health crisis is generating stress at an unprecedented level.1 So as restrictions ease and the aesthetics specialty looks to re-open, it is important to consider how this could affect you, your staff and your patients.

Anxiety through lockdown

One emotion that has become conventional in COVID-19 dialogue is anxiety. Anxiety is defined as a particular worry about the future and includes what may or may not happen. This fear for the future is a natural reaction to our environments or circumstances and is to be expected at this time of uncertainty. However, experiencing prolonged restlessness, uneasiness or dread can be signals of a developing anxiety condition.2

If this apprehension becomes constant, overwhelming or disproportionate then it may start to cause disruption to daily life. Intense, negative or limiting beliefs that affect your ability to focus, rest, eat, or live your life as fully as you want to, can all be signs of an anxiety disorder.3 Unhealthy patterns of behaviour may form with any level of anxiety.

The UK Mental Health Foundation charity (MHF) has conducted a UK-wide, long-term study of more than 4,000 adult exploring how the pandemic is affecting people’s mental health.4 Comparing results from mid-March (before lockdown) and currently up to July 9, five waves of data have been collected which are helping us identify the complex and divergence of stressors that the aesthetics community may face.5

The MHF states that the extent of coping well is improving amongst the population as a whole. Reports of anxiety have fallen from 62% to 53%, the proportion of people having panicked has gone down from 22% to 13%, and the proportion of people reporting financial concerns as a result of the pandemic has decreased from 42% in mid-March to 29% at the end of May.6

It appears certain groups of people are at greater risk of experiencing poor and, in some cases, deteriorating mental health. In particular, it was reported that 59% of single parents, 63% of young people aged 25-34, and 62% of women described having been anxious/worried compared to the overall adult population.6

The following groups were identified to be more at risk of having higher issues compared to the general population:

Single parents: higher risk of anxiety, feeling more lonely, more hopeless, not coping well and higher proportion of reporting financial concerns compared to the general population.

Individuals with children: higher proportion of parents with young children aged 5-16 reported greater financial difficulties than the general population, which can induce anxiety.

Young people: those aged 18-24 are more at risk of feeling lonely and more hopeless. Adults aged 25-34 also reported to feel more hopeless and also reported greater financial difficulties than the general population.

Those with health conditions: a higher proportion of people with long-term health conditions said they were not coping well compared to the population overall.

A pertinent factor to the mental health crisis which is persistent and likely to increase is specifically financial inequality and the devastating link to mental health outcomes.7-10 The black, Asian and minority ethnic (BAME) community (a term covering a wide ranging group of people with diverse needs, given that different ethnic groups have different experiences of mental health problems which reflect their culture and context) have been widely reported to be suffering disproportionately, along with having an increased risk of COVID-19.6-8 This has further implications to those communities that face societal and individual challenges which can affect their access to healthcare.12,13

What does this mean for clinics?

Identifying those at higher risk of being affected by anxiety and other disturbances due to COVID-19 allows the potential to respond in the most appropriate way and construct useful adjustments in the clinic. When doing this, consider your entire aesthetic community; the workforce and the patients, including their usual support systems, to acknowledge those discrete co-morbidities and unintended factors that will inflate the ‘emotional load’ as individuals reintegrate back to the clinic and/or seek cosmetic treatments.

Fear and anxiety may well be the most common emotional responses most of us will feel ahead of, and during, the easing of lockdown restrictions. Acknowledging this as a reasonable expectation of our emotional response system is an important first step of self and ‘other’ compassion. We must accept that the pandemic has dramatically changed the aesthetic landscape as we return to something we haven’t been doing for a while or had in a while, and in new circumstances. Each person re-entering the clinic or ending any period of isolation, whether they have been exposed to COVID-19 or not, is going to feel different about it.

This might present in the clinic as a diverse and complex assortment of emotions including tiredness, irritability, decreased concentration excitement, fear of own health, fear of another’s health, financial fears, loneliness, boredom, anger, guilt, sadness, relief, complicated and interrupted grief.2,14

All of which may be embedded in the experiences associated with a deterioration of a pre-existing health condition (including mental health), weight gain, increased smoking and alcohol use, the increased prevalence of repetitive behaviours (for example, handwashing and exercise), which is a significant feature to the comorbidity of Obsessive Compulsive Disorder in relation to Body Dysmorphic Disorder.2

Fear and anxiety may well be the most common emotions most of us will feel ahead of the ease of lockdown restrictions

Patient considerations

For our patients, lockdown may have been relatively quiet, isolated, reflective and educated, or equally frantic, disturbed and unfulfilled. Coming back into the clinic for the first time, just driving through the traffic or using public transport, might lead to an overwhelmed presentation when they arrive. Coupled with the fact that due to restrictions we have undergone immense variations to our usual routine, which include deviations to our diet, exercise and, generally, our movement overall.

There is a growing body of research suggesting that we are relating to our appearance differently, and that something has changed in our bodies and potentially our body image through lockdown.15 We must be vigilant to this change as it presents in our clinics. It is likely to become evident in the way in which patients seek or talk about their perceived appearance concerns at booking, consultation, treatment and follow up, and we must give time to allow the patient to explore these changes throughout their patient journey should the need arise. It is imperative that we consider the patient narrative and reframe with a non-judgemental narrative. For demonstration I will use an example patient concern and alternative practitioner responses for you to reflect on and consider which response is more appropriate and why:

Patient: ‘I’ve been sat doing nothing for months, I’ve put on weight, feel awful and I need to sort it all out’

Practitioner response A: I know, so many of us feel like that too, we have this device that would do it for you.

Practitioner response B: It sounds like this time has reduced your activity significantly and left you with unwanted weight gain.

It is important that we do not unintentionally inflate, collude, or become unknowingly predatory to exploit vulnerabilities that patients may bring to us as lockdown eases. Whilst the long-term impact of coronavirus and the way in which we relate to our appearance is unknown, we need to use the data available with suitable caution to protect the at-risk groups amongst us to becoming more vulnerable. The influential Bioethics Nuffield Report demonstrates the contextual ethical complexities of the aesthetics specialty which we should all be familiar with to safeguard and improve liabilities.16 Critical ethical considerations have also been highlighted in the Brunton rapid review, commissioned as part of the Keogh report in 2013, that addressed the specific question ‘What factors are associated with requesting and undergoing cosmetic interventions?’.17 It was concluded with a strong association (amongst other characteristics including dieting, smoking, alcohol use, higher stress, medicated sleep and nervous conditions) that those seeking aesthetics had suffered inter-partner violence, more commonly known as domestic abuse.17Although this publication was in the absence of COVID-19, the Met Police reported that domestic violence arrests have increased to nearly 10% above that in same period last year,18,19 which motivated the UK Government to launch its own dedicated advice for those in abusive situations during COVID-19.20

We must therefore carefully manage the psychological risk and benefit from accessing aesthetic treatments, especially when attempting to relieve or pursue an emotional target underpinned within the motivation for treatment, as we have to accept the potential rise of inter-partner violence that will be present, perhaps silently in our own clinics.

The more prepared aesthetic practitioners are, the less concerned they will be

Team considerations: promoting positive mental health

Providing safe personal care for others requires a compassionate approach. We know the complexities noted above suggest it may take longer for some to adjust to necessary workplace changes. It is imperative that staff feel they are adequately supported with both physical and psychological personal protective equipment (PPE), prior to having patient contact. If the practitioner is lacking insight to their own needs, this will disturb the patient experience and will have negative consequences to your business as a whole. Look out for warning signs: if a practitioner’s usual ability to relate to others is diminishing, providing additional support is a must. Looking out for lateness, absenteeism and presenteeism. Taking time to reintegrate is key, go at the right pace for your business and your team. Avoidance is anxiety’s best friend, meaning that building our exposure to tolerate emotional discomfort will provide a resilient antidote to anxiety.21

This is important to the safe use of PPE, specifically face masks that can mimic the physical sensations (shallow breathing, shortness of breath, headache dizziness, increased heart rate, nausea or dry mouth) of a panic attack and replicate or exacerbate and anxious presentation.3 You may wish to commit experimental time to the use of PPE in training days, or even offer home-care packages for staff. Encouraging employees to engage in a scripted or guided relaxation/ meditation or breathing exercise to separate, diffuse or combat any possible negative consequences with the use of PPE could also help. There are a number of free resources available, with a summary accessible via The Free Mindfulness Project.22

Clinics making space for experiential time and reintegration will be adopting a growth mindset, where accountability prospers, and blame diminishes. Now is a great time to make subtle changes to your practices to allow your values to penetrate deeper into the culture and experience of work to improve for all.23 Vulnerabilities have many faces, and it can be extremely challenging to demonstrate leadership in uncertainty.

Encouraging safe, trusted and approachable spaces to talk is crucial. Just one recommendation is having dedicated ‘worry time’.24 This can counteract the effects of a toxic culture or unhelpful COVID-19 conversation in the workplace, which can be destabilising to both the practitioner and the patient. This may seem counterintuitive, however making an allowance for this at work and signposting staff to this designated time promotes opportunities for mental curiosity and flexibility. Emotional regulation and healthy strategies of coping can then become built into a cohesive and collective attitude at work which will provide a corporate construct for a demonstrable impact working against the COVID-19 mental health consequence. You may also consider appointing a mental health champion(s) in your workplace. This can be done through a reputable external training provider and has great contributes to your expanded CPD profiles and workplace opportunity.

The DBK experience is a leading provider of prosocial transformational corporate workshops that can certify your employees as confident mental health first aiders.25 KLNIK wellness also offers an inclusive (specialist integrated approach to aesthetics) authentic model of corporate wellness based on the 5 Rings of Wellness; an accessible effective concept curated alongside Rebecca Adlington OBE.26

Hosting regular mental health days or wellness days with or without a professional will bring about healthy collective coping systems to strengthen your practitioners. This is also an opportunity for you to demonstrate your corporate values. Planning selfcare is particularly important within the healthcare sectors. Wellbeing days can include a plethora of activities. Just one example is sharing hobbies; taking a field trip for a long country walk or bike ride, sharing a streamed yoga session, baking, or practising origami are just a few example. This can have a minimal financial overhead and encourages the opportunity to explore coping behaviours and conversation together. Delegating activity choices throughout your team deepens active coping further and adds an opportunity for autonomous leadership. With dependable and authentic commitment, such wellbeing opportunities provide an abundant employee wellbeing service that embrace understanding and diversity.

Team considerations: role adjustments

Protocols that include self-monitoring are challenging. Furthermore, virus monitoring in others will be demanding. Cultivating a culture of adaptation and growth will support the confidence with protocol adherence, and pressures of health screening as an additional job role. For practitioners and clinic owners alike, reconnecting with your values of working are essential steps to uphold your own moral code of how you run your clinic.

Promoting inclusive COVID-secure reporting will give a more realistic and useful picture of how effective your COVID-19 controls are, which can be discussed at weekly staff meetings. Having weekly designated staff time can also inspire adaptation and positive change. This can create a platform to deliberately celebrate small wins (and big wins), while inspiring practitioners to keep a note of what they are achieving in a shared group forum gives another opportunity to notice and reward behaviours in others, and an occasion to improve confidence. Reconnecting and adjusting in this way can lead to improved job satisfaction, confidence and quality of life.23 With the incorporation of a daily mindful workplace task, this can enhance the notion further. Purposefully signal a clear boundary at the start or end of the working day or shift or break time. Introducing a physical activity in break and lunches or simply putting on/off your name badge, face shield, mask or apron, even your ‘work shoes’ or handwashing beyond the superficial, mundane or resented ‘things to do’ can help transition yourself from a professional or personal space healthily.

Start by allowing yourself to be curious with the physical sensations of this task, knowing and thanking yourself that in doing this you are acting in accordance to your values and supporting the things that are important to you. Extending this gratitude to your colleagues and your patients too, as for each new procedural or compliant task they undertake, they too are looking after you, and your loved ones, enhancing the experience of connection to your values. The more prepared aesthetic practitioners are, the less concerned they will be.

Summary

With our return to the workplace it is essential to acknowledge that everyone reacts to stress differently; this is not a reflection of strength nor courage, but complex individual characteristics. We must not accept that we have all been in ‘the same boat’ – we have each been fighting the storm of the sea within our own individual boat, and continue to sail a very distinctive sea.


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