In a world full of uncertainties, how do we stop ourselves from being overcome with fear and anxiety?
In this episode, The Joyful Doctor, Caroline Walker, joins us to share the negative and positive effects of worrying. She also gives us useful tips and techniques on managing anxiety so that our mental health and wellbeing can thrive.
As a psychiatrist and expert on doctors’ wellbeing, she’s also been burnt-out and overwhelmed by the pressures of working in medicine. Growing tired of seeing her colleagues succumb to the constant pressures of work, she founded The Joyful Doctor to support more doctors and provide them with the help that they need. She also provides keynote speeches and talks to break the stigma with mental health and offer empathy and support for doctors.
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Dr Caroline Walker: I might get in my car today. I might crash my car. That’s why I put my seatbelt on. Actually, having a little moment to worry about, “Oh, put my seatbelt on, okay. I put my seatbelt on. Carry on.” The worry doesn’t continue. It doesn’t ruin my day. It doesn’t stop me from doing anything. It doesn’t make me feel particularly anxious.
That’s okay. That’s a kind of useful worrying thought. If I did my seatbelt off, set off, and then I spent the entire journey worrying about, “Oh, I might crash my car.” I’m going to be feeling pretty awful, pretty stressed out, and it’s going to make me perversely, slightly an unsafer driver — potentially more likely to have an accident.
Dr Rachel Morris: In this episode of You Are Not A Frog, we’re talking about worry and anxiety, particularly rational worry and anxiety. You know the phrases, ‘Don’t worry, it’ll probably never happen.’ Or, ‘It’s not like anyone’s going to die.’ But what do we do when bad things may well happen, or people’s lives and livelihoods are genuinely at risk? How do we stop ourselves becoming overwhelmed with anxiety then?
To explore this, we’re joined by psychiatrist and therapist, Dr Caroline Walker — The Joyful Doctor, to talk about how to stop ourselves feeling overwhelmed with worry even in the midst of worrying times. Even though we might not be able to control what’s going on in the world, or even just our families or workplaces right now, one thing we do have more control over is how we deal with ourselves when we start feeling anxious or dwelling on unhelpful thoughts even if they may be very rational.
We can also stay focused on the present where everything is okay at the moment. We talk about how worry can be helpful when it spurs us into action. But when it’s overplayed, it can cause us to stress and actually make the bad things more likely to happen as we can’t think straight or perform as well when we’re in our sympathetic fight, flight or freeze zone. Which are some simple techniques you can use to reduce your anxiety which you can use anywhere even in difficult times?
Listen to this episode if you want to find out why we need to be more gazelle. Which emotions your anxiety may be masking, and why this matters? And how to get yourself out of the vicious cycle of rumination and worry?
Welcome to You Are Not A Frog, the podcast for doctors and other busy professionals who want to beat burnout and work happier. I’m Dr Rachel Morris. I’m a GP, now working as a coach, speaker, and specialist in teaching resilience. Even before the coronavirus crisis, we were facing unprecedented levels of burnout. We have been described as frogs in a pan of slowly boiling water. We hardly noticed the extra-long days becoming the norm and have got used to feeling stressed and exhausted.
Let’s face it, frogs generally only have two options: stay in the pan and be boiled alive or jump out of the pan and leave. But you are not a frog. And that’s where this podcast comes in. It is possible to craft your working life so that you can thrive even in difficult circumstances. And if you’re happier at work, you will simply do a better job. In this podcast, I’ll be inviting you inside the minds of friends, colleagues, and experts — all who have an interesting take on this. So that together, we can take back control and love what we do again.
If you’re a doctor who’s feeling strung out and overwhelmed right now, and you want to find balance in your life, beat burnout, and work happier, but find it almost impossible to find the time to make this happen. Then let us help make it easier for you. Dr Caroline Walker and I started the Permission to Thrive online CPD membership for doctors a year ago giving overwhelmed doctors the tools they need to thrive in their work and lives. It’s a wonderful community to be part of and we’re continuing this year with brand new content and loads more suggestions, coaching tips and resources to help you thrive, not just survive at work.
We run monthly webinars with accompanying CPD coaching workbooks so that you can kill two birds with one stone, invest in yourself, and claim CPD time. If you can’t make the live webinars, you can access the recordings in our online resources centre, as well as other bonus content. If you want to find out more, then do sign up to a free webinar called How To Give Yourself Permission To Thrive on Wednesday, the 19th of January at 8 pm.
If you sign up and can’t make it, we’ll send you a recording. We’d love you to join us. Just sign up through the link in the show notes.
Hello and welcome to another episode of the You Are Not A Frog podcast. I’m delighted to have with me again, Dr Caroline Walker. Hi, Caroline. How you doing?
Caroline: Hi, Rachel. I’m well, thank you. It’s lovely to see you. Thanks for having me back.
Rachel: You’re very welcome. Caroline is a friend of the podcast. We have had her on several times before. We’ve done lots of podcasts together all Around COVID, all around our reactions to COVID. Caroline works as The Joyful Doctor. Can you tell us a little bit about who you are and what you do?
Caroline: I am a doctor by background. I’m a psychiatrist and a therapist, and I specialise in the mental health and well-being of doctors and other healthcare professionals. I am setting up The Joyful Doctor, which is not for profit organization a few years back now. Everything we do just helps to improve the well-being of doctors and high-stress caring professionals.
It’s just a joy to come on, and to be working with you again, Rachel, to help reach some doctors and healthcare professionals out there who might be struggling a bit at the moment because it is quite a challenging time.
Rachel: It is a difficult time, isn’t it? And we’re just sort of in the thick of Omicron and everything that that that brings us. The reason why we’re doing this episode is Caroline and I run a community — a CPD community for doctors called Permission to Thrive where we do a webinar once a month. In a recent webinar, we were looking at worry and anxiety. Actually, there were lots of things I thought would be really good to talk about on the podcast.
I think with everything that’s going on in the world, there’s a lot of worry and anxiety around. Some of the worry and anxiety techniques are just to sort of minimise what might happen, and that will help your worry. That sort of got us thinking, ‘Well, what is the worst that might happen? How do you stop yourself worrying when actually things are bad?’
Yet, we know with COVID at the moment, the numbers are baked in because of the amount of cases that we’ve got. Also, over the last few years, things have got worse than we probably could have imagined. In some time, there are actually things that have got worse than we imagined. Lots of times, I know that people use a technique of you know, ‘Well, let’s think about it. It’s not like anyone’s going to die, is it?’
Actually, when you apply that to healthcare, well you can’t say that anymore, and you can’t minimise the impact of stuff. When you got lots of worries and anxieties, it feels actually it’s almost right to do that. However, we can’t live in a state of being crippled by anxiety. I am getting lots of emails from people, through listeners who are saying about how worried and anxious they’re feeling right now, and is there anything we can do to help them? What would we suggest?
I’ve got questions myself around it. Caroline, I’d love you to share some of your wisdom. I think we’re going to talk about some of those things that we did talk about in the Permission to Thrive webinar which I think had been helpful for people. First of all, can I ask you? Are we abnormal when we’re feeling anxious and worried, and ruminating? Or is it just something that everybody does?
Caroline: See. We all worry. We all ruminate particularly when there’s lots of stuff going on like there is at the moment. I mean, it’s extraordinary, isn’t it? We’ve had two years of the pandemic. It’s the middle of winter. Winter is always a tough time in healthcare. Always lots and lots of staff shortages, secondary absences, and it’s just that bit worse at the moment as well. There’s a lot going on for people. A lot of uncertainties still about what’s going to come in the years ahead.
I think, no. It’s a completely normal part of being a human being to get worrying thoughts and to feel anxious. What becomes problematic is when those sorts start to take over, they start to get in the way of your day-to-day life, they start to stop you being able to enjoy things and get on with things and still be productive.
It’s about drawing that distinction between normalising, ‘It’s absolutely fine to worry and get anxious.’ But when is that becoming problematic? When is that becoming more of an issue for you, something that you might need to do something about?
Rachel: What I have noticed is that a lot of people get very anxious about being anxious.
Rachel: That, then exacerbates their anxiety.
Caroline: We call that meta-worry — worry about worrying. It’s really, really common. It does just wind things up, and up, and up. Again, like normal worries and anxieties, it can be helped with some simple steps, techniques, and strategies. If those aren’t working for you, again, seeking out some help and support to get some treatment around anxiety can be really, really helpful too.
Rachel: Interesting. I’ve never heard of meta-worry before. That makes a lot of sense. Before we go on to talk about tips, and techniques, and strategies to help with our worry, is there any time where worry is actually helpful?
Caroline: Definitely. Absolutely. I mean, I think often when we’ve got a problem that needs solving, we might need to think about it, and think about ways around it. Worry tends to kind of activate us. It gets us out of a state of apathy and lack of motivation into a state of, ‘I’m going to do something about this.’ We might be worried about an exam coming up — we might sit down and do a revision time, we might sit down and actually do some revision.
If you’re worried about how you’re going to get ready for going on holiday — you might actually get your suitcases at the loft and start packing. Actually, worrying itself is not the enemy. It’s not a bad thing. A little bit of like, ‘That thing needs to be doing. Okay, I should probably do that.’ It’s very helpful, actually. Sometimes, we genuinely have some real problems that it’s completely normal and natural to be worried about.
If you’ve got a loved one who is ill, or something serious going on in your life. Maybe a relationship is in difficulty. Sometimes, worry alerts us to a genuine issue that we actually need to pay attention to and spend some time thinking about. I think, though, that’s the difference between that, and when worry gets us all hyped up and anxious about things that aren’t real or haven’t happened yet.
Like we did with the beginning of the pandemic, Rachel, you and I both shared when it first came along. We were watching the 24-hour News Cycle. Within minutes, we’ve gone from thinking, ‘Oh, my God! I might get COVID’, to imagining our own funerals, how our families were going to cope without us. Worry can kind of get out of hand quite quickly if we’re not mindful around it.
Rachel: I think the key to stopping worrying when the worst might happen is that second phrase you said. No, the first one is, ‘When it might not happen, fine. Let’s not worry about stuff that might not happen.’ But actually, it’s that hasn’t happened yet. Yet, it might happen, but it hasn’t happened yet. That’s the mindset we find it really difficult to get into. When you think about it, there’s loads of things that are going to happen in life that haven’t happened yet.
Caroline: I might get in my car today. I might crash my car. That’s why I put my seatbelt on. Actually, having a little moment to worry about, “Oh, put my seatbelt on, okay. I put my seatbelt on. Carry on.” The worry doesn’t continue. It doesn’t ruin my day. It doesn’t stop me from doing anything. It doesn’t make me feel particularly anxious.
That’s okay. That’s a kind of useful worrying thought. If I did my seatbelt, set off, and then I spent the entire journey worrying about, “Oh, I might crash my car.” I’m going to be feeling pretty awful, pretty stressed out, and it’s going to make me perversely, slightly an unsafer driver — potentially more likely to have an accident.
I think it’s about — it’s okay to predict what might be about to happen. Ultimately, worry and anxiety keep us safe. I mean, it’s just our brain’s way of trying to predict that something bad may or may not happen, how will we deal with that? But I think it’s about going, ‘Okay. I’ve made a little plan for if that happens. Now, I’m going to let go of whether it happens or not because there’s nothing we can do to control that.’ Respect your zone of power.
There’s relatively little in life that we do have control over. We can bring it back and focus on what we do have control over, then we’re going to feel much more relaxed.
Rachel: That’s a really good tip. Actually, number one tip is use the zone of power. People that have not heard about this inner power before, it’s simple. If you get a sheet of paper, draw a circle in the middle, that’s your zone of power. Everything in the surface things you can control, and then everything outside the circle is things that you can’t control.
When you start worrying, probably one of the first things you can do is literally draw that zone of power, ‘What am I in control of here? What could I do? What can I do?’ Do that. Then, everything outside that circle, like you said, things that we have absolutely no control over. It means the weather — being one thing.
There’s almost no point in worrying about the weather. Well, I guess there is you could worry about the weather. You’re not going to change the weather, but you could change what you wear. Actually, you’ve got an umbrella, right?
Caroline: Actually, there’s a difference between worrying about something and caring about it. I think it’s okay to be to wish it was sunny when it’s raining. It’s okay to care whether the weather is nice or not. Because the difference is you caring about it and worrying about it. I think, sometimes, we can acknowledge to ourselves, ‘This terrible thing is going on, right?’
We’ve got this awful pandemic. We’ve got staff shortages — there’s too much work, we’re under-resourced, people are tired, anxious, uncertain about the future — all of that is real, and it’s okay to feel a bit scared, a bit sad, any of those emotions that might be coming up for you. They’re all okay. Acknowledge them. Allow a bit of space for them.
Sometimes, I find we worry and get anxious when actually there’s another emotion going on that we’re not paying attention to. I think at the moment, we’re still grieving a lot, we’re still quite sad about the loss of the life we were living — the loss of our security and our ability to make plans, and trust that they were going to happen.
Now, I’ve had lots of conversations this week with doctors and healthcare workers who maybe got a holiday coming up, and they’re still not quite sure if it’s going to go ahead or not. We’ve never had to live like that really before in our society. Some societies have. But we’ve been very fortunate, haven’t we?
To live a life where things have been pretty predictable, relatively secure — and that still isn’t the case. I think that leaves us feeling a bit unsettled, at least to me quite sad. Those are difficult emotions to sit with. Actually, it can sometimes be easier to then get worried because worry is like an active emotion, right? Kind of get to juice up, it gets us active that we can do something about it.
We think we can do something about it. Often, as we’ve just alluded to, we can’t because it’s not in our control.
Rachel: That’s so helpful. Yes, it’s a lot easier for us to admit to being worried about something than to be sad. I think anger is very like that as well. I think, sometimes, if I feel undervalued, or unappreciated or unloved, and I feel sad about that. I’ll feel angry. It will come out as anger, not sadness because sadness shows a lot of vulnerability, doesn’t it?
Caroline: Well, maybe if we’re a bit embarrassed, or a little bit ashamed about something — like I get this around my parenting quite a lot. If I’ve missed something or not noticed something, and then it’s pointed out to me, I’m like, ‘Oh, cringe.’ So, I start to worry and get anxious.
As I said, it’s an easier emotion. I know it’s an unpleasant emotion to be anxious and worried, but it’s that it’s slightly easier I think than some of the others. Sometimes, it’s worth thinking, ‘Is there something else going on here that I’m not allowing myself to feel or to pay attention to?’
Rachel: That’s really helpful that there’s a difference between caring and worrying because I do struggle with this idea of — and we teach this, don’t we? That everything outside your centre path — you’ve just got to accept. It’s really hard to accept it, and I think I’ve always thought that accepting it is just dismissing it, not caring. Actually, it’s not that is you can deeply care about it but —
Caroline: Absolutely. You can care about climate change, but also have an acceptance around the limits — around how much impact you might personally have around it. This is something I learned in my addiction recovery, actually — my own personal recovery around addictions. But we can care about the outcome of something but still let go of it.
If I ask somebody to do something for me, I can care about whether they say ‘yes’ or ‘no’. But ultimately, it’s not my responsibility whether they say ‘yes’ or ‘no’, or not. It’s not in my control whether they say ‘yes’ or ‘no’, or not. If they say ‘yes’, brilliant. I’m going to be happy. If they say ‘no’, I’m going to be disappointed or sad or angry — or those other emotions will come up.
We can still care about stuff, but let go of the outcome.
Rachel: That’s so important because as you were saying with the driving — if you were driving along, you would care… You care about the fact you’re going to have an accident or not. Nobody wants to have an accident. But if you’re worried about it, conversely, the worry does the exact opposite of what it should say that.
The bit of worry to start off with helpful — seatbelt goes on. But the more you worry, the more anxious you get, you go into your fight, flight or freeze zone, you’ve got adrenaline racing around you in your sympathetic zone. You can’t think straight, you’re much more likely to crash.
Caroline: This is where — something like a worry tree that can be very helpful. This is where you might ask yourself a simple question like, ‘Is this a real problem? Yes or No?’ If it’s a real problem, great. You go down the problem-solving route. If I get in my car, I say, ‘Oh, I might crash my car. Is that a real problem?’ Yes, I might crash my car. What can I do about that? I’ll put my seatbelt on. Okay, I’ve taken action. I’ve kind of addressed the worry.
If the answer is, ‘Is this a real problem?’ ‘No, it’s not a real problem.’ Then, you’re looking at other techniques like worry time — that can be quite helpful. That’s where you would set aside a time of the day or time in the week when you’re going to specifically worry about things. It might sound a bit strange and a bit silly, but it really does work for a lot of people.
What that does is, it acknowledges, ‘This is something I want to worry about. It is worrying to me. It means something to me. I do want to give it some time and attention, but I don’t want to let it take over my day. So, I’m going to plan it say, six o’clock tonight for 20 minutes. That’s my worry time. That’s what I’m going to think about.’
Then, when you get to six o’clock, you can worry as much as you like for those 20 minutes. Often, what happens when you get there is actually you’re not that worried about it anymore. Sometimes, you are, but you’ve got your 20 minutes for your time. It hasn’t ruined your whole day. It just manages your worries.
This is one of those techniques, which says, ‘Worrying is normal. Let’s accept it’s going to happen. Let’s kind of take a little bit of control and manage it — manage how we’re going to worry.’
Rachel: I think that worry time technique is really helpful. I’ve used that myself. I found that it’s more helpful for those long-term chronic worries. If you’re going through a complaints process, or somebody with a GMC, so that’s going to be going on for a couple of years. Or you’ve got worries around one of your children — there’s something that they’re going through because those worries are just constantly with you and putting those times into like, ‘Well, I will worry about it.’
Then, and I do find that, then you get to that, you think, ‘Well, actually, I don’t need to worry about it now. I’ll come back the next day.’ That is really helpful.
Caroline: Well, you might get a totally different perspective on it at a different time of day, or something will have changed between when you were not going to worry about it, and then that helped you to move on with it. It’s a helpful strategy. It doesn’t work for everybody but definitely, worth giving a try if you’re someone that struggles with repeated worries.
Rachel: I think you can adapt that for the middle of the night as well. Lots of people keep a notepad by their bedside. If they wake up in the middle of the night — like the middle of the night is pretty much the worst time to do worry times. They don’t even go there. It’s like — we have a Sunday night rule in our family.
We’re not allowed to have any discussions about relationships or anything on a Sunday night because I’m awful on a Sunday night. I’m like, ‘Well, this terrible.’ It’s just Sunday night. So, nothing deep. Just watch something silly on telly on a Sunday night, that’s fine. It’s like that at three in the morning.
Do not schedule your worry at 3 am. If you can write it on a pad next to your bed, say, ‘I am going to worry about this, but tomorrow afternoon.’ And nine times out of ten, you’ll get smart and you think, ‘What was I thinking of?’ I heard a podcast from someone, actually. She was a gastroenterologist, and she’d looked at the gut-brain connection, and she talks about stress.
She said — often, she wakes at three in the morning, and she’s trained herself to think not, ‘What’s bothering me? What am I worried about?’ But, ‘What if I eat him that’s causing me to feel a bit anxious and worried?’ Because often, a cup of peppermint tea makes her feel a lot better — it settles her gut down, and suddenly she’s not worried anymore. We often feel anxious, and then our brains look around for the thing that’s making us feel anxious.
Caroline: That’s a great example of something we call ‘attentional refocusing’. Basically, just trying to switch your attention on to something else that’s more helpful. You can do that in lots of ways. You could have your favourite teddy bear next to you that you decide to give a good hug to, and look at, and talk to. You could think through, ‘What was the best thing that happened to me today? Or if it was a really bad day, ‘What’s the best thing that happened to me last year?’
Basically just switching — deliberately asking your brain to focus on something else because essentially, all worry is a type of thinking, isn’t it? If we can switch to a different type of thinking, we’re going to feel less worried. Asking your brain different questions, ‘What went well today?’ ‘What am I looking forward to?’ Those sorts of things can also be quite helpful.
Then, there’s always the lovely effort — I won’t use the full swear word version for the podcast — but if you’ve got something that’s just going right around your head, try visualising it. Just taking it out of your head, or literally write it on a piece of paper, crumple it up, and put it in the ‘f– it’ bucket. At least, you put it in the bin. Some thoughts and worries are just not worth our time, and ‘f— it’. That can be quite powerful.
Rachel: There is something very powerful about that. I think one of our very, very first guests on the podcast was John C. Parkin who has written a book called F**k It. Such a nice man, it was such a good episode. People might want to go back and listen to that. In fact, I’m rereading his book at the moment because I’m thinking, ‘How does “F**k It” work after pandemic?’ Obviously, that book was written quite a few years ago. But it’s exactly like — you said earlier, and he says in the book — it doesn’t mean we don’t care about these issues.
Caroline: Yes, and the more I work with anxious doctors and healthcare professionals, and the more I get to know my own anxiety, the more I believe that there is often something else going on for us. When we’re particularly anxious, there’s often another emotion or another thing going on in our lives that we’re not quite paying attention to.
I think at the moment, we will try not to feel anxious about something that is going to make us feel anxious. There’s this massive pandemic — there’s a lot of uncertainty, there’s a lot of risks, there’s a lot of overwhelm.
Actually, I think it’s really normal to be a bit worried about that. Maybe, we’re not paying so much attention to the other emotions that it’s bringing up for us — the sadness, the loss, the anger. Because they’re not emotions that we’re typically used to sharing publicly, are they? We don’t often see many examples of people role modelling how to do anger in a healthy way, or how to be sad in a healthy way that isn’t uncomfortable for the people around you.
I think it’s about allowing yourself to just check-in. Is there other stuff that’s going on here too? What am I feeling sad about right now? What my maybe angry about right now? Just paying attention to those things as well probably have a really good knock-on impact on your level of worry and anxiety.
Rachel: Something happened with one of my children the other day. I just felt dreadful about it. I remembered what we’ve been talking about with this whole ‘let yourself feel the emotion’, and I was really sad. I was really sad about it. I sat there and I said, ‘Right, I’m going to let myself feel sad. I felt really sad.
Then, I was reading the F**k It book, and I was like, ‘Okay. Well, f– it.’ Because there is literally — I’d done everything I can do. I was feeling sad, and I can’t do anything about the outcome, and just — it doesn’t stop me feeling sad, but I don’t… I think before, I’ve been trying to get rid of that sadness feeling, doing everything to get rid of that sadness, like hidden —
Caroline: That just makes it last longer. The thing about feelings is they all pass. Nobody has ever had a feeling that’s lasted forever. They always pass — always, always, always. If we can learn to just invite them in and say, ‘Hello, I noticed you’re there.’ And notice, ‘I’m feeling sad today.’ Or, ‘I’m really angry today.’ Or, ‘I’m feeling this today.’ It’s okay. It’s not going to kill me. It’s not going to do any major lasting damage. Not comfortable, but that’s okay.
Then actually, if we name what the actual feelings are a bit more accurately, I think it gives us a chance to soothe ourselves. Like you said, if you’re sad, you’re going to next up — sad. You might have a cry, you might have a nice cup of tea with a friend, you might give — during that hug from your partner, or you might wrap up in a cosy blanket and watch a sad movie.
That’s going to be more useful to you than sitting there worrying for an hour and a half — over and over scrolling on Google or trying to find the answer to the problem. If you’re angry, if you can get that out in a healthy way, you can punch a pillow or write an angry letter that you don’t send — that kind of thing.
You can get that anger out, that’s going to be much more effective way of managing your feelings and helping them to pass more quickly than again, spending an hour and a half worrying and scrolling on Facebook.
Rachel: Do you think that part of the problem is that as doctors and other professionals, we are used to being able to fix stuff? Then, when we can’t fix stuff, it really irks us, but our brains are still in there, ‘Well, I can fix this if I just think about it and worry about it for long enough.’
Caroline: I think we are still sold the myth that things are fixable when they’re not. It’s very difficult when we come across things that aren’t fixable — things that just have to be sat with or answers that we might never get to the bottom of. I think we find it very, very difficult not to be able to fix things. It’s natural to want to be able to fix them. Of course, we don’t want to sit there and be sad, or be angry, or be this or that.
I was talking to somebody that day actually about how often it is as doctors, we’re the ones that the friend comes to us and tells us a problem. Our first response usually is to try to help isn’t it? Try to give a solution, or to say, ‘Have you tried this? Or have you tried that?’ That’s when it’s all about coaching and the difference there if you work with a coach, and how they won’t necessarily offer you solutions. So, how do you come up with your own?
That’s quite a hard thing to do as a doctor because we’re used to kind of stepping it out with the protocol or follow steps ABC — if A plus B, then you do D, or whatever. We work — that our brains work in that way. Actually, we’re not often taught how to just sit with something, to just be okay that actually, it’s rubbish right now. It’s a bit sad, or it’s a bit uncertain.
I was thinking at this time of the year especially, it’s very much like a planning time of year, isn’t it? It’s January. Everybody thinks about their New Year’s resolutions, ‘How many we get fit? How I get on top of my finances? How we’re going to change my job — finally get my life sorted?’
Actually, how hard it is to resist that and to just be like, ‘No, actually not going to entertain the idea I might make any changes. I might just be, actually. Just feel one feeling, go about my day-to-day life, feel what comes up, and not try to change it.’ Really rare that we’re given that role modelling or that permission to do that.
Rachel: I think it is getting a little bit more in the zeitgeist — that that sort of thing about self-acceptance and stuff. I talked about this in pretty much every podcast at the moment — the book Four Thousand Weeks by Oliver Burkeman.
Caroline: I just finished it because you recommended it to me. I loved it. So good.
Rachel: Wasn’t it good? For me, the guy who used to be — well, he’s a productivity time management guru has now realised that the only way to do it is to accept that we’re never going to get everything done that we want to get done, and just go ‘that’s it’, really.
Caroline: And really prioritise, actually, what is the most important — this is what the pandemic did for us, isn’t it? Gave us permission to stop and go, ‘Oh, crikey. We are mortal. We can’t do everything. We can’t take everything for granted. Maybe, what is most important?’ Instead of a week-free — which we’re going to talk about that, I think, in our next webinar with the Permission to Thrive.
I can’t wait to do that because I think more and more for me, like goal setting and thinking about the life I want — it’s more about, ‘How can I live that life today?’ Not necessarily always focussed in on this time next year, or five years time, or 10 years time. But how can we make the most of our precious time that we have today?
Rachel: It’s living a good life, even when things aren’t perfect even when there are things to worry about. I think one of the things that’s interesting — we’re talking here about how you stop worrying when the worst might happen. Actually, even when the worst might happen, I think there are still lots of very unhelpful stories that we’re telling ourselves which makes the worry worse.
We talk a lot about being gazelle, don’t we? Be more gazelle… And this concept, it was taught to me by a good friend of mine, Elena, who’s a mindfulness teacher, and she said, ‘Alright, you’ve just got to be more gazelle. When a gazelle is eating grass, and the lion comes along, it runs away, doesn’t it? Then, when the lion is gone, what does the gazelle do? Back to eating the grass.
That wouldn’t be me. If that was me, I’d be like, ‘Oh, my gosh! Did you see the lion? Look at his hair! What if it comes back tonight? It’s my babies? What am I going to do? And I’ve got that presentation tomorrow. If I don’t sleep well, it’s going to go bad. If it goes badly, I’ll lose my job.’ Then, we’re constantly pre-living stuff that absolutely hasn’t happened. Even if it might be true, we’re experiencing the pain of it in the present even though it’s in the future.
There’s a lovely quote by Mark Twain. I’m sure I’ve talked about this on the podcast before, ‘I’m an old man. I’ve known many troubles, but most of them never happen.’ We’re suffering now for something that may or may not happen in the future purely because of the stories we’re telling ourselves in our head which then puts us into that adrenaline warrior zone as if it actually happened.
Caroline: But we’re not gazelles, aren’t we? We have these annoying brains that click in with those extra worrying thoughts: the worrying about ‘what-ifs’, worrying about the future, things — like you said — that hasn’t happened yet. If we can catch that, we can realise that’s what we’re doing, then we have a choice. We can actually choose, ‘Am I going to continue to keep worrying about this thing that hasn’t happened yet? Or am I going to kind of focus on what I do know is true?
Actually, the lion is gone. I’m safe. I’m okay. I can sit down and enjoy my meal. I think this speaks to why it’s so hard as doctors and nurses, and healthcare professionals to stop the breaks. Because actually, when we stop for a break, I think our minds are still going at 150 million miles an hour in threat mode so much. It’s really hard for us to switch straight back down into a relaxed parasympathetic mode where our thoughts are more calm. It’s really, really hard.
It’s like that time and you turn off the fan, and it just keeps spinning for a bit before it slows down slowly. It’s like that. You take a five-minute break, you might just be starting to slow your thoughts down when you’re back up into the threat zone again, or you might spend your whole five-minute break. or go to the, you’re sitting there almost jittering — unable to relax.
It’s really important that we start to practice being more gazelle — practice a lot, getting our brains into that relaxed state. You can do that with simple, simple small exercises like breathing exercises, mindfulness exercises — just starting very, very small. A couple of seconds at a time, a couple of deep breaths at a time, but just training your body and your brain to switch between on and off mode between sympathetic and parasympathetic mode.
If you can start to do that in your time off a bit more when it’s bit easier, it will start to feed through into your working time as well.
Rachel: That’s really important. We always talk about the ‘pause’ button as well, don’t we? When you have been triggered, like the gazelle and the lion say — you run away. Because then, it sort of stops. Often, we then, in our ‘fight, flight or freeze zone’, react really badly to stuff and make mistakes and do things we regret. Dr Steve Peters calls that your inner chimp isn’t hearing — the Chimp Paradox — because of the stories we’re telling ourselves.
I think we’ve noticed that there are lots of stories that doctors and other professionals tend to tell themselves. There are the stories, ‘Like if I don’t do this, if somebody might die, there might be a big mistake.’ In this case, you obviously need to take action. But there are other stories that cause a lot of worry and anxiety. Things like, ‘I’m not good enough. They’ll think badly of me. I should… I ought… If I don’t, who will?’ Or, ‘I have to…’
I think it’s those types of stories that cause as much distress, and maybe even more than those other types of big, big stories, would you say in your work that you do when you see with people?
Caroline: Absolutely. I mean, 80—90% of the stuff we worry about isn’t actual real worry. We go back to the worry tree, most of it isn’t ‘real life, right now’ problems. Most of it is ‘what-if’, and it’s threats to things like our sensor self, our security or fear of judgment from others — those sorts of things. They rise amongst doctors, and then nurses and healthcare professionals. We want to be thought well of, we want to be appreciated, we want to do a good job, and the thought of doing anything less than that is really, really hard for us.
It is very easy for us to mind-read and get it wrong — to assume that someone thinks badly of us, or to catastrophise the worst day ever or the worst outcome ever. I think the key again, is if you can catch it happening, then you’ve got a choice. You can press ‘pause’. I’d always start there. Start trying to have a little bit more mindful about the story that’s going on in your head, and use that phrase. I mean, that phrase has turned my life around, Rachel. I don’t know about you, but —
It’s Brené Brown, I think, that first talked about it in her book — Daring Greatly, or one of her first books around a sort of vulnerability and shame. She talks about, ‘Use the words, “The story in my head is… That’s it’s not ‘I am a useless mother’, it’s ‘the story in my head is I’m a useless mother.’ It just decentres from it a little bit, makes it something that might not be true that you can start to just gently challenge.
Essentially, you mentioned about the ‘making mistakes and people dying’ because you showed me something I found quite helpful was that quote from the lady in Australia, was it? Who said about, ‘We will make mistakes — I will make mistakes.’
Rachel: ‘I’m going to make mistakes. Some of them will be serious.’ Dr Annalene Weston
Caroline: Because that I think it’s really important that we don’t go the other way, and say, ‘No, you’re not going to make mistakes. No one’s gonna die. It’s absolutely fine. Everything’s going to be fine. It’s going to be perfect.’ We don’t know that,do we? I mean, if we’re very lucky, it might be that way.
But we know, in life, there will be good and bad things that happen. Actually, having something that acknowledges, ‘I might make mistakes, actually. Some of them are going to be serious.’ Generally, I’m doing alright. I’m doing an okay job. Most of the time, I’m helping people. Most the time, I’m getting things right. Remembering what we are doing well, what is going well.
Rachel: In my experience, the mistakes and stuff that we worry about the most never happened. Actually, it’s the stuff that you don’t worry about comes in, hits you sideways. Side note, a bit of a silly story:
But I was in an exercise class — one of these hit classes on Monday evening. They’re just coming to the end of this nine-minute hit — that high-intensity thing on a treadmill. I fell off the treadmill. It was awful. I was just putting it down to walking having been sprinting, I just misstepped. I grabbed hold of it. The treadmill shoots me to the back of it.
I was hodling on for dear life because if I let go, it was kind of like fling me across the room. The bloke next to me grabbed my arm. The other women on their sides go, “Ah!”, the treadmill wouldn’t stop. I skinned my knees. Just awful. Now, if you’d asked me, what would I worry about during those classes, it’s probably hurting my back. I would never — falling off the treadmill. This is a really simple, silly example.
Caroline: I’d say true. There is truth there. It is true of being a doctor, you worry about making mistakes. But we end up making the mistake we didn’t see coming. We end up with our parenting, messing up our kids in a way we didn’t see coming. We spend all this time trying not to, and actually the mistakes —
What percentage of mistakes did we see coming? Yes, some. Looking back with hindsight, there are some warning signs. Most of us are practising as safely as we can, aren’t we? Most of us are doing the best we possibly can to reduce risk, and to not make mistakes. It’s really important that we don’t lose sight of that, that we remember that we’re good people trying to help others doing a good job.
The thing about worrying that I hate the most is it takes us away from that. It takes our attention. It takes our time. It fills our day with negativity, and it may take our eyes off the ball. Just look at all those nursing outside, and all of you listening to this now, you’re doing a phenomenal job. You really are doing an extraordinarily good job. We’re incredibly grateful to every single one of you.
Rachel: Totally. It’s really interesting when you said ‘most mistakes you can’t predict’ because I think I can predict the mistakes. The mistakes that I make is when I am in my warrior zone, that ‘fight, flight or freeze’ zone, that sympathetic zone when your amygdala kicks in, and we call that ‘being backed into the corner’.
That’s why the ‘pause’ button is so important, and those techniques to get yourself out and check the story in your head because if you go into situations knowing that you are in that zone, you are more likely to encounter issues which is why…
Why are we talking about this because it’s really important, not just for people to feel better, but actually be to be effective as a professional, and have good relationships, and practice safely.
Caroline: I’m feeling a little bit better because right now and there’s enough going on that’s tough, isn’t there? It would be nice if we could just be a bit kinder to ourselves, just feel a bit more relaxed and recognise all the good things we’re doing.
Rachel: We talked about loads and loads of different things, Caroline. If I was to pin you down to your three top tips for how to stop worrying when there is a lot to worry about, what would they be? Out of everything you’ve said, what do you tend to find is the most effective for your clients and doctors and people?
Caroline: For me as well, right? I think number one, I remind myself that worrying is completely normal, and it’s okay. Not all worrying is bad. Because sometimes, that just takes the sting out of it. It’s like, ‘Okay, I’ll worry about that for a little bit, and problem-solve it, and move on.’
Number two, I think it’s about noticing it. Starting to notice those stories in your head. If you can start to notice when you’re getting into that worried state, when you’re getting stuck in it, then you have a choice. Then, I’d say press ‘pause’.
Number three, because there’s a million and one things you can do once you’ve done all those things. But unless you can actually notice you’re doing it, press ‘pause’ and give yourself the opportunity to change how you’re thinking, or what you’re about to do. You can’t really do anything. Worry is normal. Try and notice storytelling stuff in your head, and press ‘pause’.
Rachel: I think the things that I find helpful as well is A: stay within your zone of power. Literally, what can you control? What can’t you control? Then, take action within that zone of power. There was a book called The Happiness Trap by Russ Harris. He talks about choosing which thoughts you fuse with. For me, just identifying those thoughts I’ve got on distancing myself rather than saying, ‘I’m thinking this is… I’m noticing I’m having the thought that…’
It’s like identifying the story in your head, and then you can just let that thought go like a cloud. You don’t have to fuse with it. You could use maybe worry time to worry about that later if you want to.
Then, I really like the ‘f– it’ bucket thing. Actually, I’m just going to let that go. Does it really matter? Or even if it does matter, there’s nothing I can do about it. I’ll worry about it when the time comes to worry about it there, and just be really helpful as well.
We know that people are struggling at the moment, and it’s really normal to worry. Worrying about worrying can make things even worse. If anyone is really struggling, Caroline, where can people go to get some more help if they need it?
Caroline: If you’re trying a lot of these techniques, then they’re not really helping because but whatever reason, then please do seek out some professional support. You can speak with your GP. You get your doctor in England, Scotland. You can come to practitioner health. You can self-refer for mental health and treatment, and advice and support.
I think it’s just about talking to somebody. Just take that first step. This is a trusted somebody — a friend or family member. Just somebody — a colleague or even get in touch with Rachel and I if you’re not quite sure where you need signposting to. Then, please do get in contact with us. We’ll be happy to signpost you.
Rachel: Please do. Please get some help. Don’t struggle alone. I think it’s very brave to ask for help, so please do that. If anyone has any questions or queries or wants us to discuss certain topics on the podcast, do get in touch, do drop us an email. We can jump on again and record episodes about various different aspects of this because there’s a lot more to dig into.
Caroline and I are running a webinar on the 19th of January at eight o’clock. If anyone is interested all about how to give yourself permission to thrive, and we’ll be actually talking about in more detail about — those concepts that you mentioned earlier, Caroline — about actually a bit more self-compassion, a bit more self-acceptance which will just enable us to thrive right here where we are without having to change everything about our worlds. That’s really, really important.
If you’d like to join us, please do. The link there will be in the show notes.
Caroline, if people want to get hold of you, how can they contact you?
Caroline: They can contact me through the website, joyfuldoctor.com or email us on firstname.lastname@example.org. Happy to hear from you anytime.
Rachel: Great. All the links, the books, and things we’ve talked about are on the show notes. If you want to join us for the free webinar, do sign up. Caroline, we’ll have you back again soon, if that’s okay.
Caroline: I’d love to come back. Always. You know I’m a big Frog fan.
Rachel: Brilliant. Thank you so much, and we’ll speak soon. Bye, everyone.
Caroline: Thank you. Bye.
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