When we know athletes are about to have a tricky time; a training camp they need to go on with team mates they dislike, a really hard period of training focusing on a skill they are currently weak in, the biggest competition of their year that is fuelled with pressure, we often discuss how they can suck it up. We all know we can cope with tough stuff for a few days or weeks. It helps to put the period in context and see light at the end of the tunnel.

But we are now two weeks into the COVID-19 lockdown. And while every athlete knows they can cope with three weeks of something (as the original period was given from the Prime Minister) we mostly know it will be longer. But none of us know how much longer. It is that uncertainty that is so tricky to deal with. The novelty of isolation has worn off and we’ve probably tried lots of things to keep us busy, entertained and fit but now is the time to ensure we have some coping strategies and routines in place to keep us mentally fit.

I chatted to Chartered Counselling Psychologist, Dr Natalie Raiher, from The Practice at 322 in West Hampstead (where I sometimes also see athletes in clinic). She is still seeing her regular clients for video sessions but is also volunteering using her skills to support NHS staff. We talked about how she is helping all these people deal with this period. She offered some great advice that will be valuable for athletes and performers both now and when things return to normality.

What are the main worries you are finding people have about Coronavirus?

“The worries tend to vary depending on what part of their lives has been impacted the most. People whose businesses have had a sudden downturn, such as those in travel or hospitality or those who are in debt, their main worry is money and livelihood and what to do. For some people it is the loneliness if they live alone or are estranged from loved ones, some people it is the chaos and the lack of access to their usual coping resources like sport or hanging out with their favourite people. We are used to having support structures in place but they just don’t exist in the same way right now.”

It is changing at all?

“The profile of worry does seem to be changing as the virus is getting more virulent. In the beginning people were worried about lockdown and food and trying to organise things. Now people are more worried about their own health and more emphatically worried about others; their health and how they are coping.”

How are people coping?

Some aren’t. We are seeing a rise in domestic and child abuse statistics – people are finding it very hard to function in small places under stress. Substance abuse is going up too with people reaching for unhealthy coping mechanisms. When I work with people we use a coping mechanism pyramid [I’ve added a picture of one here – it was created by Dr Alice Boyes – http://www.aliceboyes.com] – the behaviours at the top are ones you use sparingly and those are the bottom are those you can use liberally. All coping mechanisms serve a purpose but there can be a fine line between healthier ones and unhealthier ones. You don’t want to take away the coping mechanism they have but we do want more alternatives for people.”

“We must remember most of the worries and anxieties people are experiencing right now are completely normal. From a mental health perspective it is entirely appropriate not to feel great right now. Lots of people have lost jobs and structures so it is fine not to be feeling ok. Some people have responded to this by fleeing from the reality of this using denial and this is a solid way of coping but it can come under many guises. So some people have developed things like over-productivity or OCD. They are denying what is happening, which is perfectly understandable – it is bloody scary. It is perfectly normal to be grieving our normal lives and feel the loss around it. It is ok to feel the fear.”

Athletes are often used to high levels of routine and structure in their lives. How can they cope without this?

“Even if you are someone who likes the freedom not to be too structured, during times like this everybody needs some structure. The degree is dependent on personality. Some people need a lot of structure to feel safe – others need less. But everybody needs some type of routine as it regulates our limbic system and things like our appetite and body clock. Routine can be quite soothing and a gentle structure is beneficial.”

“For athletes used to a high level of structure in their training to go to none is very distressing so they need to find gentle structure in their day. It can be unique to each athlete but a few elements which create a routine will help them.”

Many of the coping techniques that athletes rely upon; such as exercise or focusing on a goal are either not possible now or only possible a different way. Are there any good coping mechanisms you can suggest athletes could try instead? 

1. Focus on function. Again this will be personalised but you can think about the function of what each thing in your normal routine does for you. What is the function of yoga class, or work or taking the train? When you drill down into this then you can write your own prescription to replicate that function within the constraints of your life right now. Whatever you get out of that activity that is a good way to translate it. Replicating the same function within our new constraints.
2. Stay goal driven. Keep the idea of being goal driven but focus on the soft skills which will help your performance down the line, such as learning to tolerate pressure or stress better. If you can use this time to practice tolerating higher levels of anxiety and uncertainty or using a different approach to unhelpful thoughts then that you will have developed some really positive cognitive skills that will help you in the future.

Are there any specific cognitive skills that athletes could work on? 

“Meditation is really good. We know from neuro-imaging that meditation turns off the fear part of our brain. When there is over-activation in our fear brain we can turn the volume down when we meditate. Meditation also turns up the impact on the self-soothing centres of our brain so cortisol [our stress chemical] release goes down and we are better able to reflect and to be present. Apps like Calm and Headspace can help these.”

If we are used to being very active, always in and out of home and often at work or the gym what should we look out for to spot if our mental health might be becoming fragile?

“It is completely to be expected that everyone’s mental health will be a bit wobbly right now. Angry, moody, feeling helplessness is completely normal when everything has changed in the way it has.  But if these feelings persist and don’t vary throughout day or they start to get in the way of you functioning then you need to keep an eye on yourself and ask for help. If you find yourself starting to use unhealthy coping mechanisms such as gambling, drugs or withdrawing from others these are also signs need to seek help.”

We realise that being anxious or feeling some grief during this period is a very natural and rational response – but that doesn’t mean we can’t try to feel better. Have you found any ‘pick me up’ techniques which are helping people when they are having a down moment? 

“Yes. We follow a two pronged approach.

Firstly, we have to feel our feelings. It is like digesting food. If we don’t do it then it gets stuck and we get panic attacks and will have angry outbursts or become obsessive about things. So if you are feeling down acknowledge that feeling and only then focus on comforting yourself. Some people will make a ‘coping card’ with a message to themselves or a quote that they love. They can keep it with them – or have a photo of it on their phone and look at it when they need comfort or strength.

The second prong (if it is anxiety you are feeling) is to use a grounding technique which can use your five senses and pull your body down.

Another second prong (if it is low mood you are feeling) is to focus on ACE. This stands for Accomplishment, Connectedness and Enjoyment.

• Accomplishment – When our mood drops over a period of time we withdraw so we need to increase our sense of accomplishment. These can be any small tasks; baking a cake, having a shower, something on our to do list.
• Connectedness – when we withdraw the only way to come out of it is to get back to connecting with other people. We have to force ourselves to connect with another person – even if that is a text or a phone call to someone else that day.
• Enjoyment – This is the biggy in this is many people are depriving themselves of enjoyment and pleasure. People are getting on with the task at hand but not factoring in any pleasure and that really effects our mood so got to look for some enjoyment and pleasure in the day – this is your prescription for better mental health.”