Protecting your mind amid crisis

Exhale, emptying your lungs of air. Now imagine drawing a box with your finger in the air. Inhale to a count of four while drawing the left side of the box from bottom to top, allowing your lungs to fill up with air. Hold that breath to keep the air in your lungs for another 4 seconds while you draw the top of the box with your finger from left to right. As you draw the right side of the box, exhale, emptying your lungs, while counting to four. Now hold your breath to keep your lungs empty for another 4 seconds as you complete the bottom of the box, closing it with your finger from right to left.

Box breathing is just one of eight quick and easy interventions designed specifically out of concern for the mental health of frontline workers during the current pandemic and made freely accessible on the new NHS in Mind platform. Box breathing relieves stress, but can also heighten performance and concentration. These mental exercises on NHS in Mind are meant to help switch off the fight-or-flight response of our bodies when we experience fear, anxiety and stress—feelings that are likely in excess for frontline workers coping with COVID-19. The creators of the NHS in Mind platform highlight that the ‘threat’ state of ‘fight or flight’ narrows our attention and sends more blood to our mucles, preparing us to either fight or ‘take flight’/run away—but also, turns off ‘non-essential’ functions as our instincts take over, one of these functions being the ‘thinking brain’. Being able to think rationally on the job is of course integral to providing competent care, as well as to remaining safe, for example, in terms of following correct procedures regarding personal protective equipment.

Frontline paramedics and other health professionals, as well as students, academics and retirees who have stepped up to help manage the demand and keep the public safe are at an increased risk of work-related stress and anxiety. This is coupled with the additional challenges of having to distance from friends and relatives who may serve as support networks, avoid social gatherings and group hobbies, which may usually help with stress management, working long hours where getting enough rest may be difficult, avoiding frequent shopping which can make it more challenging to eat nutritious food, and gym facilities being closed, making it slightly more difficult to engage in physical exercise, all of which are extremely important for your mental health. As well as difficult ethical decision-making and the loss of patients, many of you may have experienced the loss of colleague(s). Taking time to recognise the toll all of this may be taking on you, as well as renewing yourself, has never been more important.

NHS in Mind provides invaluable techniques to experiment with, as you may discover that short breathing exercises may bring you back to centre throughout your shift. One of my personal favourite resources is the Calm app for mindfulness meditation, and of course there are many others such as Headspace approved by the NHS. Remaining in contact with loved ones digitally may also help, and it is worth remembering that Samaritans can be contacted on 116 123 or via email at

In the current issue of the Journal of Paramedic Practice, we provide important information about COVID-19 (p. 179 and 193), but we also look at mindfulness activity and whether it can improve the occupational health of paramedics (p. 186). Mental Health Awareness Week takes place 18–24 May 2020. You are out protecting our bodies, but who is protecting your mind?

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