Mindfulness: Strategies to implement targeted self-care

Abstract

For many, the COVID-19 pandemic felt overwhelming and stressful due to longer work hours and caring for self and others. More people experienced anxiety, fear, anger, sadness, and helplessness. Self-care is important. It enables anyone to maintain their physical, emotional, mental, spiritual, and social health. Practicing mindfulness when implementing self-care can include a holistic approach that focuses on five areas: Physical, Emotional, Mental, Spiritual and Social (PEMSS). The mindfulness approach helps with properly implementing applicable, direct self-care from any of these areas. Approaching self-care from any of these five areas can be helpful in eradicating the challenges of identifying self-care behaviors that are effective for maintaining personal and professional well-being in the face of the unique demands of work. Mindfulness self-care can help identify untargeted self-care patterns and blocks to implementing targeted self-care as well as how to develop intentional, targeted self-care.

1. The challenges of self-care during a pandemic

For many, the COVID-19 pandemic felt overwhelming and stressful due to longer work hours and caring for self and others. More people experienced fear, anger, sadness, and helplessness.¹ Physically, many were feeling an increase of headaches, muscle tension or aches and pain, fatigue, digestive problems (upset stomach/nausea, gas, diarrhea and/or constipation), insomnia, low testosterone, or irregular menstrual cycles (absent or painful).² Emotionally, many felt exhausted, worn-out, overextended, drained, detached, and cynical or negative attitudes towards work.³ Mentally, many were experiencing anxiety, depression, or memory deficits, to name a few.¹ There was also an increase of excessive alcohol consumption.¹ Many were stressed prior to the COVID-19 pandemic and found it hard to adjust and practice proper self-care.

Self-care is important as it enables anyone to maintain their physical, emotional, mental, spiritual, and social health. In an online survey of 2051 U S. adults aged 18 years or older, 46% Americans reported struggling to find ways to maintain their physical, mental, and spiritual health during the pandemic.⁴ Moreover, 30% of Americans reported a lack of energy, 29% reported difficulty sleeping or exercising less, and 47% reported feelings of social isolation.⁴ Most (64%) reported being focused on their mental health now more than ever and 44% desired more guidance and support for practicing self-care during the pandemic.⁴

With the higher demand to work from home due to the pandemic, many people experienced burnout and virtual meeting fatigue.⁵ In May 2019, burnout was included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon according to the World Health Organization.⁶ It has not yet been classified as a medical condition. Some American insurance companies may be reluctant to recognize burnout as a clinical diagnosis, partially due to concerns about a flood of requests for disability coverage; also, the lack of an official diagnosis of burnout limits access to treatment, disability coverage, and workplace accommodations.⁷ The rate of burnout among those employed in the health care field tends to be reported in the moderate to high levels and it is believed that the burnout risk in health care is higher than in the general working population.⁷

2. Defining burnout

Burnout is defined in ICD-11 as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed”.⁶ It is characterized by three dimensions⁶.

• 1.Feelings of energy depletion or exhaustion
• 2.Increased mental distance from one's job, or feelings of negativism or cynicism related to one's job
• 3.Reduced professional efficacy

Although burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life,⁶ there are a variety of burnout triggers so different symptoms require different solutions. Maslach and Leiter⁸ identified six areas of burnout.

• 1.Workload (too much work, not enough resources)
• 2.Control (micromanagement, lack of influence, accountability without power)
• 3.Reward (not enough pay, acknowledgment, or satisfaction)
• 4.Community (isolation, conflict, disrespect)
• 5.Fairness (discrimination, favoritism)
• 6.Values (ethical conflicts, meaningless tasks)

Over the past several decades, psychologists have focused more attention on the importance of self-care for preventing negative consequences of work stress and promoting positive outcomes such as optimal professional functioning and enhanced well-being.⁹ Self-care is always suggested for handling an overwhelming workplace load that leads to energy depletion, exhaustion, reduced professional efficacy or increased cynicism.¹⁰ In general, establishing professional boundaries has been recommended to healthcare providers as a mitigator of work-related emotional distress.^{11 , 12} However, relying solely on self-protection strategies can also strain well-being over the long-term.^{13 , 14}

3. Defining self-care

Self-care is undeniably important, yet defining and particularly identifying critical aspects of it, continues to be challenging, however, this does not have to be difficult when using the appropriate assessment tool. Generally, self-care involves engaging behaviors or activities that promote health and well-being to feel better physically and emotionally. However, humans are more than that their physical bodies. The mindfulness approach to targeted self-care must include asking yourself what you need physically, emotionally, mentally, spiritually, or socially and following through on the honest answer.

4. Mindfulness and the evidence

Practicing mindfulness when implementing self-care can include a holistic approach that focuses on five areas: Physical, Emotional, Mental, Spiritual and Social. The mindfulness approach helps with properly implement applicable, direct self-care in any of these areas. Approaching self-care from one of the five aspects of wellbeing can help eradicate potential challenges in identifying effective self-care behaviors to maintain personal and professional quality of life in the face of work demands. Mindfulness self-care can help identify untargeted self-care patterns and blocks to implementing targeted self-care as well as how to develop intentional, targeted self-care.

For example, mindfulness techniques have been cited in the literature as effective tools for reducing stress and anxiety in undergraduate nursing students.^{15 , 16} Mindfulness is moment to moment awareness.¹⁷ One can be mindful at any time and while doing any activity; however, the pandemic may have forced people to operate on auto pilot. To be fully present means that one is completely in the moment without distraction, and practicing mindfulness is one tool to bring presence to targeted self-care.

Mindfulness interventions are associated with a range of cognitive, psychological, and physical health benefits.¹⁸ Providing mindfulness interventions as a means of preventing or mediating stress and burnout can serve as a strategy on which to focus and possibly enhance self-care and wellness.¹⁹ The positive impact of infusing mindfulness-based stress reduction includes introducing the concept of mindfulness and practical methods for self-care.¹⁹ Cashwell et al.²⁰ also suggested that mindfulness practice may be beneficial for enhancing an individual's capacity for attention and concentration, strengthening ability to accept the present moment, possessing a greater self-awareness and compassion, and increasing one's capacity for self-regulation.

Mindfulness skills have shown to be effective in increasing relaxation and coping skills when faced with stressful situations.²¹ Mindfulness practice gently counters the mind's inherent need to evaluate experiences as positive or negative.²² Instead, the mind begins to observe experiences with an attitude of curiosity, suspended judgment, and without worry of the future or regret of the past.²²

5. Instructions and recommendations for use

Self-care varies and looks differently person to person. Approaching it from a PEMSS approach, the following questions are used to assess the targeted areas for burnout and where to implement self-care:

Physically: (1) Am I eating healthy for me? (2) Am I moving/exercising regularly? (3) Am I getting enough sleep?

Emotionally: (1) Have I done something nice for myself today/this week? (2) Have I told someone I love, “I love you” today/this week? (3) Have I practiced self-compassion today/this week?

Mentally: (1) Am I practicing negative self-talk now/this week? (2) Am I engaging in negativity with others? (3) Am I finding it hard to stop ruminating?

Spiritually: (1) Did I practice gratitude today? (2) Did I engage in a spiritual/religious practice today? (3) Did I help someone else in need today?

Socially: (1) Did I reach out to family/friends today? (2) Did I take time to do nothing today for 15–20 min? (3) Did I set a healthy boundary with social media today?

6. Strategies that promote practice

Strategies for success may require a few minutes to do the following.

• •Assess the areas where burnout is rooted, pause and be present.
• •Make a commitment to check in with self routinely.
• •Avoid practicing untargeted self-care patterns disguised as maintenance activities (pedicure, manicure, a bubble bath, binge watching TV, or mindlessly scrolling on social media)

It is common to fall back into not practicing self-care at all. As soon as this is recognized, develop a realistic plan to get back on track with self-care. Other potential barriers can be.

• •Feeling guilty for taking a break
• •Practicing self-care in general
• •Lack of time management skills
• •Poor boundaries with self and others
• •Poor flexibility

Implementing regular self-care is the best way to manage symptoms of burnout, reduce stress, and anxiety. Understanding how stress is experienced in day-to-day functioning can lead to enhanced awareness and the ability to implement targeted self-care. For targeting areas of burnout and where to implement self-care from a PEMSS approach, the following can be considered:

Physically: (1) Have sex regularly with self or a partner. (2) Relax the body by routinely by unplugging from social media or work. (3) Eat healthy food. (4) Move/exercise regularly.

Emotionally: (1) Watch a funny movie. (2) Tell yourself you're amazing. (3) Engage in a new hobby.

Mentally: (1) Paint, draw, sing, garden. (2) Journal, go to therapy, receive/ask for help. (3) Relax, listen to music, or read a book.

Spiritually: (1) Meditate, pray, forgive yourself or others. (2) Volunteer. (3) Spend time in nature, watch a sunset/sunrise.

Socially: (1) Take a staycation or cook with a friend or loved one. (3) Take breaks from work. (3) Spend time with family, learn to say “no” or “yes.” Learn how to say “no” to the things that will drain you and “yes” to the things that replenish you. For example, saying “no” to family dinner that may trigger you during the holidays and instead saying “yes” to spending time with friends.

Setting self-boundaries. Self-boundaries reinforce self-love and self-respect to a physically, emotionally, mentally, spiritually, and socially healthier self. Stick to a schedule and not work past set working hours. Decide to not be around people who are hurtful or stressful.

Setting a daily routine. Create a daily/weekly schedule that also includes a calendar of activities that allows connections with others in some way. Create a sleeping and eating schedule. Before rising out of bed, take a couple of minutes to think about daily goals to achieve. Take mini-breaks and pause between each task.

Turning off. When working from home, it can be easy to work more, however turn off the phone &/or computer at the end of the workday. Set boundaries with employer, acknowledging work will be there tomorrow.

Shutting down. Take a couple of minutes to practice some deep breathing and think about a time that felt deeply relaxed or peaceful to re-experience those feelings. Soothing music, burning candles, or using a diffuser filled with essential oil can sooth several senses while also practicing deep breathing. No electronics - this is a time to reset and restore.

Creating positive experiences. Human connection sustains life and without it, people can begin to feel not human. The 2021 World Happiness Report found that people who experienced an increase in connectedness with others during the pandemic had.

• 1.Greater life satisfaction
• 2.More resilience
• 3.Better mental health

According to the 2021 Word Happiness report, human connection also decreases health risks and improves physical well-being and longevity²³. Strong social connections strengthen the immune system and increase your chances of a longer life by 50%²⁴. Schedule time with family, friends, and associates. The synchronicity and rhythms with others are an instant mood booster.

Being cautious, not fearful. Practicing mindfulness involves living in the present moment day after day. Avoid overconsumption of news coverage and social media. Too much negativity can take a toll on the psyche. Don't hesitate to seek therapy during difficult times.

Sitting with it. Avoid rushing to numb an uncomfortable feeling or emotion. It is okay to be angry, disappointed, anxious, or depressed as it is a normal response to stress and burnout. Feel alive by checking-in with yourself to identify how you are feeling and be honest. Notice where these feelings show up in the body.

7. Resources for continued exploration and/or guided practice

Self-care can be implemented immediately. It does not have to take a lot of time or money. Self-care can be used to immediately reduce or alleviate stress, anxiety, or other symptoms of burnout. There are several resources that can be used readily to begin mindfulness self-care. Some of these resources are books and videos.

• 1.The A-to-Z Self-Care Handbook for Social Workers and Other Helping Professionals. By Grise-Owens, E. From A (awareness) to Z (ZZZZ--sleep), the editors and contributors use a simple A-to-Z framework to outline strategies to help you build a self-care plan with specific goals and ways to reach them realistically. Questions for reflection and additional resource lists help you to dig deeper in your self-care journey.
• 2.The Resilient Practitioner: Burnout and Compassion Fatigue Prevention and Self-Care Strategies for the Helping Professions. 3rd Ed. By Skovholt, T.M. & Trotter-Mathison, M. The Resilient Practitioner, 3rd edition gives students and practitioners the tools they need to create their own personal balance between caring for themselves and caring for others. This new edition includes a new chapter on resiliency, an updated self-care action plan, self-reflection exercises in each chapter, and a revised resiliency inventory for practitioners.
• 3.Self-Care for the Healthcare Professional: How to Gain confidence, Take Control & Have a Balanced and Successful Career. By Tietz, K. (2017).

You will find ways to bring the “care” back to your profession in healthcare. The author provides you real world examples, as well as strategies to implement, to beat back burnout, overcome feelings of imposter syndrome, address incivility in the workplace, and much more.

• 4.Targeted Self-Care: Redefining Your Approach to Healthy Living.

Dr. Holly Sawyer, PhD, LPC, NCC, CAADC, SAP presents a visual explaining targeted self-care. It provides an in-depth look at mindfulness, self-care, and burnout. https://youtu.be/sHF_40Lw7Xc.

• 5.Mindfulness and Self-Care for Burnout Prevention.

Dr. Dawn-Elise Snipes, PhD, LPC-MHSP identifies signs and causes of burnout. She also explores techniques for burnout prevention. https://www.youtube.com/watch?v=SF2YrfodjIA.

• 6.Strategies for Self-Care and Mindfulness.

Nadine Channaoui, MS, CGC is a licensed genetic counselor that discusses how to locate resources relevant to self-care planning. She also identifies multiple forms of self-care, collective-care and mindfulness. https://www.youtube.com/watch?v=wVWEq98QB-U.

8. Key takeaways

• •Check-in and ask questions to assess for specific area(s) to target and implement mindfulness self-care.
• •Often, self-care is implemented in areas that don't recharge or rejuvenate.
• •Untargeted self-care can impact relationships and overall health.
• •Setting boundaries is key.