If you're not already familiar with the concept of Basic Life Support, it's the idea that we learn the DRSABC framework so that we can draw on it immediately in case of an emergency. We check for Danger, assess Response, Send for help, assess Airway, Breathing and Circulation and start CPR if needed. In healthcare especially, this framework is like second nature. We use this framework to jog our mind in times of high stress to make sure we know where to start and where to go next.
This innate 'muscle memory' of a process to guide us through high stress times is helpful as we don't tend to "learn to swim when we're drowning". That is, times of stress or crisis are difficult times to learn new skills.
Self care is no different.
It is often difficult to begin and learn new self care skills when we are on the verge of burnout.
Yet so many of us are guilty of doing just that, waiting until we are under immense stress or difficulty before we recognise the need to "take better care of ourselves".
It is for this reason that I developed the 'Basic Life Support Self Care' model of proactive, authentic and holistic self care practices in 2020. Drawing on the familiarity we have in the healthcare environment with systems and protocols to drive memory recall and of the widespread awareness of the DRSABC acronym, I developed a set of simple & actionable self care practices to help guide others in their execution. From mindfulness to self awareness, breath work and self compassion, the framework is a useful reminder for everyone to use in their day-to-day lives in order to take better care of themselves.
The below was originally published on The Healers Health Collective website on 7th September, 2020.
We must start looking at Self Care in the same way we look at our yearly CPR training-
We all know it, we need some time when our nervous systems aren’t primed and thinking about work. Yet in reality (and private practice) it can be difficult to do. One part of this is removing ourselves from the environment so we can put some physical distance between ourselves and our work stressors to allow our nervous system to down regulate. The bigger issue however is many of us are unable to place any psychological distance between ourselves and our work even if we’re not there, the ‘tiger’ comes home with us every day.
What does this mean on a systemic level? It means that staffing is done with contingency plans for sick and compassionate leave. We used to think that this was impossible to do, but COVID-19 is showing us that when there is no other option, we can get creative & find a way. None of us are indispensable in this system. It also means that workplace structure integrates and prioritises self care education and practice to be as important as the core clinical competency of Basic Life Support.
Perhaps more importantly than this however is the personal level- how each of us feels when we find we need to take some time or focus away from work in order to practice self care. How many of us have been home sick in bed and still be genuinely feeling like we should be at work? We can change the system all we want, but until each and every one of us has the self awareness to truely believe our own right to practice self care how we see fit and not how others tell us we should practice it, nothing will change.
I really want to emphasise that stress is normal, our bodies are designed to respond to it. Too often we are told that to be resilient is simply to be able to shoulder the burden of stress without faltering. But this amazing system is also designed to switch off in order to reset. It’s the return to normal after a stress response that is an often unrecognised part of the definition of resilience.
Resilience represents the amount of disturbance that can be absorbed by a system before the system changes or loses its normal function, or the time taken to return to a stable state, within the normal operation range following the disturbance
Permanent resilience isn’t designed to be a part of the stress response. We need to be able to give ourselves some down time, both physically and psychologically, to allow for the elastic recoil. To make space for resilience.
When we exist in a state of default thinking, everything we encounter is allowed to move unfiltered through to our amygdala (the 'stress centre' of our brain) to start the finely tuned cascade of events that is our stress response. The switch is permanently left 'on' for this amazing system with no down time to return to a stable state. Collapse is a frequent but not altogether unexpected consequence.
For both creating psychological space between work and ourselves as well as being able to filter out what information actually makes it through to our brain to start the cascade of our stress response, mindfulness is an immensely powerful tool. Mindfulness helps us to notice things without judgement. It helps to hone our awareness and ability to process stimuli so that we're not constantly bombarding our amgdala with otherwise innocuous information. Like the goalie who isn't paying attention, the mind in default mode is letting a lot through to the net that it needn't be. So the control we have over this process is right at the beginning, with the noticing.
For those of us who have become used to ‘healing’ others, it can be very easy to lose the ability to allow ourselves to be helped. While we as humans thrive on connection, to ask for help and to be helped, takes a huge amount of humility and vulnerability. So many of us in the health and healing professions struggle to do it, we struggle to let go of the urge to ‘fix’ things ourselves.
So, why do we find it so difficult? There was no course at university that removed the fleshy vulnerability of humanity from us. Perhaps we need reminding, that in order to be truely self aware we must know that we will all give and receive assistance in this lifetime?
Somehow we’ve come to equate success with not needing anyone…
I have a phrase I use often in my work- “you don’t learn to swim when you’re drowning”. Likewise, it can often be very difficult to know and find the support you need at a time in your life when you need it most. In the same way you don’t want to be rummaging around in the drug room for the Adrenaline mid cardiac arrest, holistic self care is about building and maintaining a support network everyday, not just on the ones when you need to use it.
Self awareness is an interesting concept. Most of us think we know who we are. But if I asked you to describe yourself in one sentence- not referring to your job, family or where you live- how would you do it?
Awareness is very different to thinking. You don’t need to think of your foot being attached to your ankle, it is just there and you’re aware of it. Self awareness by the same token is not something you need to ponder or think about. It’s the innate sense of knowing who you are and what you need.
When we exist in a state of constant arousal, it can be difficult to pin point exactly what it might be that is making us feel bad at any given time. So many of us are guilty of filling any down time that we have with a variety of distractions that take us away from this innate self awareness. Social media, alcohol and other drugs, busyness, even exercise when used in excess can all be ways that we are unconsciously taking our attention away from our sense of selves. It can be a difficult thing to develop true self awareness. When we are confronted with aspects of ourselves that we perhaps wish were different, it is much easier to distract ourselves away from this than it is to look inwardly with compassion and a desire to change. However, our ability to know what we need and be able to practice self care in a truely authentic way, depends on our ability to practice self compassion without judgement.
Paradoxically, it takes time to become what we already are.
The path to self awareness is not one that we can take for granted, it is an attribute that takes daily work. We must be willing to be introspective, spend some time in solitude and contemplation, as well as talking openly with those around us about our struggles in a compassionate way.
Very few things have the capacity to change how we feel so profoundly as how we breathe. The practice of pranayama in yoga is entirely devoted to the breath due to the fundamental importance it has in our health. Over twenty-three thousand times a day we fill our lungs with air, every single day of our lives. The sheer consistency of this process means that even small changes and benefits are amplified significantly.
There are plenty of breathing practices aimed to help calm our bodies and our breath. As with all breathing practices, they will have a paradoxical effect on our nervous system (excitatory) if the breath is unnaturally prolonged. So we are much better to aim for consistency with gentle expansion over time than forcing the breath in any one exercise. One simple practice to master is that of ‘box breathing’. Simply, we breathe in for 4 seconds (or whatever length of time you feel comfortable doing), hold for 4 seconds (or what ever length of time you have inhaled for), breathe out for 4 seconds, hold for 4 seconds. This process is repeated for a few minutes with careful attention that you are not forcing the breath. Gently prolonging our exhalation over time and within our comfort level can further enhance this exercise. When practised daily, breathing practices have the potential to gradually improve our cardiovascular fitness and parasympathetic tone, an important factor in down regulating our stress responses.
Most of the worlds wisdom traditions tell us that when we can look to ourselves with compassion, we can then extend that compassion to others more readily. Practicing self compassion is one of the most fundamental aspects of self care.
True self compassion comes from viewing ourselves with curiosity rather than judgement. When we perceive our failings, we approach gently just as we do with a timid puppy, bringing a tone of guidance rather than retribution. Eckhart Tolle talks in his book ‘The Power of Now’ about the concept of the Ego and the True Self. Our Ego’s are fragile, turbulent guard dogs that exist to prevent our True Self from coming to harm. It is only when we have compassion for our Ego’s that we are able to thank them for trying to protect us, lovingly strapping them into the back seat to allow our True Self to take over. Our True Selves on the other hand are the calm beneath the deep ocean, that we find through a process of reflection, self awareness and self compassion. When we can do this, we are finally freed from the reactionary lives full of indecision, searching and regret that so many of us lead. Self compassion is the key to setting ourselves free and unlocking the very best parts of us to then offer to the world.
There is no one in this world more worthy of your kindness than you.