In Mindcast

Sarah Appleton – The Psychological Impact of ‘Coming Home’

Dr Sarah Appleton is a Clinical Psychologist working in Employee Health for Central London Community Healthcare NHS Foundation Trust. Sarah explores the experience of returning to ‘business as usual’ following participation in a crisis response such as COVID-19, and helps us prepare to navigate this next period of uncertainty.

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The past few months have been a whirlwind; a time that has flown by whilst feeling protracted, life changing and leaving us struggling to remember what “pre-COVID-19” life looked like. You may have worked longer, harder hours than you ever thought possible. You may have been redeployed to a new role, moving even further away from “normal” life. You may have been told to “watch and wait”, bouncing between feelings of guilt that you “should be doing more” and anxiety as you anticipated the threat of redeployment.

Whilst our individual experiences may look different, we are united by two common themes: 1.We have all, for an uncertain period of time, had to say goodbye to our “normal” professional roles and 2. We have all been living in a high threat environment.  

So, as talk turns to establishing a “new normal” and re-opening services, I wanted to spend time thinking about what it’s like to “come home” from the experiences we have had.

Whilst our understanding of the psychological impact of COVID-19 on NHS staff is still emerging, we can begin to anticipate some of the likely psychological responses (and possible avenues for psychological support) from other areas of literature.

For example, research into the experience of humanitarian aid workers highlights how difficult it can be for them to return home from the experiences that they have had.

Humanitarian aid workers will often return home feeling emotionally and physically exhausted (following a prolonged period of time in a “high threat” state). Research highlights the experience of “vicarious traumatisation”, or the belief that one’s self (i.e. an individual’s hope or meaning) has inherently changed following exposure to a trauma environment. They have seen things that they can’t unsee, and are now acutely aware of how cruel Mother Nature and mankind can be.

Adjusting back to an old but now unfamiliar environment can contribute to a complex mixture of emotions including guilt, anxiety, anger and loneliness. It may also leave an individual longing for what they left behind, wanting to return to those that understood the challenges they faced.

Importantly, research further documents how difficult it can be for aid workers to seek support on their return either viewing this as “weak” or neglecting their own distress because “other people have it worse”.

Whilst the experience of NHS staff working in the COVID-19 pandemic and humanitarian aid workers cannot be directly compared, there are a number of similarities that may be able to inform psychological support moving forward. Importantly, research highlights the value of preparing staff for returning home (including debriefing and reintegration sessions), psychological assessment and psychoeducation.

Preparing to Come Home: Key Questions

With that in mind, I invite you to consider the following questions as you navigate this next period of uncertainty (it might help to get a pen and paper and write your answers down):

  • What am I coming home from?

Take a moment of gentle reflection, gently breathing as you do this. What impact did COVID-19 have upon your job role? What other challenges did COVID-19 bring? What difficult emotions have you had to navigate over the past few months? Try to offer yourself a sense of kindness and compassion as you reflect back upon some of the challenges you have faced.

Now turn reflection to your strengths, again gently breathing as you do this. How did you manage to navigate this time of difficulty? What helped you to cope? What did you say to yourself? Who else helped to support you?

  • What am I coming home to?

This may include reflection on what your new working role or environment looks like. Acknowledge that this may have changed, and that this may create new anxieties.

If you notice yourself getting overwhelmed by difficult thoughts or feelings, it may help to practice a grounding technique such as ACE.

  • What am I bringing home with me?

Continuing with your gentle breathing, try to think about what you are bringing home with you. This could be difficult emotions such as stress or anxiety about the future.  This could be feelings of guilt if you think you “have not done enough” , or a sense of sadness for a team that you are no longer working with.

You could also be returning home with positive emotions. What adventures did you have? How did you help and feel worthwhile?

Take a moment to notice what emotions are showing up for you. Gently acknowledge these, without judgement. As you gently explore these emotions, try to offer yourself the same kindness and compassion that you would to someone that you care deeply about.

  • What do I need to help me move forward?

Whilst this can sometimes be a difficult question to answer, try to focus on labelling the main emotion that you are struggling with. What might help you to best navigate this? What has helped you to manage this emotional response in the past? This might include seeking support from those around you, prioritising self-care, or problem solving areas of difficulty.

For additional ideas on how to best manage difficult emotions please visit the resources page on this website.

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