Anxiety within the general population at present is running high, and understandably our renal dialysis community who are vulnerable and shielding may be experiencing distress as they continue to attend their renal dialysis centre or satellite unit for life saving dialysis treatments. You may be experiencing distress around your own safety and that of others; reduced staffing levels or additional unfamiliar staff present in units or the ward; initial fast pace of changing information and procedures; the triage system before entering units; dialysing in different units or areas to usual; asking yourself questions like how do I shield myself when family members are going out to work, and I am going to dialysis where other patients or front-line workers are not wearing masks or physical distancing?

Firstly let’s look to explain the response you may notice when anxiety is experienced. Anxiety manifests itself in three ways:

1. How we think and what we say
2. How we behave
3. How we physically respond

The fight/flight/freeze stress response is a coping strategy to protect ourselves from perceived danger. It is an automatic protective mechanism and not a conscious decision. However with pre-planning, self-soothing and attention to changes in our body we can exert some control over anxiety and limit the extent of our reaction.

How our brains work

The amygdala – an area of our brain responsible for fear, sends signals to the hypothalamus which in turn stimulates the autonomic nervous system (ANS) to release adrenaline and cortisol. The ANS consists of the sympathetic (SNS) and parasympathetic nervous systems (PNS). The SNS drives the fight-or-flight response, whilst the PNS drives the freezing response or puts the brake on.

Physical response: With the release of stress hormones we will notice an increase in heart rate, faster and shallow breathing, reduced pain perception, sweating, sharpened hearing and eyesight. Anxiety impairs our cognitive function especially our decision-making. When we are able to calm ourselves or self-soothe our cognition improves, allowing rational thought.

What you say to yourself, i.e. “self talk” – e.g. “what if”, “should have” “I must” all increase anxiety. FEAR – False Evidence Appearing Real. One way of challenging this thinking is to ask yourself – “what factual evidence do I have to support these thoughts?”.

Psychological response: Or fear response (present or imminent) is a learned response to situations or behaviour. It is learnt through repeated exposure and we can experience over stimulation or catastrophic thinking as a consequence. The more evidence/experience an individual and collectively we have that we can cope with these extremes of emotions will demonstrate we have control over our anxiety, not the reverse. Practising relaxation techniques or mindfulness is one way of reducing our emotional responses.

Behavioural response: In order to relieve anxiety symptoms we will often avoid the situation to prevent feelings of distress, in the short term relieving the anxiety but in the long term the issue or problem remains. Therefore helping to alter our thinking style from avoidant to despite the presence of anxiety I can cope with this situation – proving to the self there is another way of approaching this. Trying to fight or resist panic feelings will usually only aggravate it. Learning to observe and go with it instead of reacting to the physical symptoms is perhaps the most important behavioural shift to make. Often feelings of panic are merely a front for buried feelings of anger, frustration, grief or depression. Try to recognise symptoms of suppressed feelings by identifying what you are feeling and learn to express or communicate them to someone you trust are key coping strategies.

Suggestions to Cope during Covid 19 Pandemic

• Focus on the positive, what can be achieved, not what you can’t – for e.g. if someone doesn’t wear a mask in the unit – You can protect yourself with a mask, washing your hands regularly and asking the person to keep their distance in a polite and respectful manner
• Routine – Get dressed, don’t stay in night clothes. Plan out your day alternating between being active and relaxed; take regular breaks, keep nourished; ensure good quality sleep – go to bed and get up at the same time each day
• Exercise – we may have to be inventive if we are unable to access the outdoors, engage with tv shows, internet – you-tube or app’s; walking up and downstairs, walking around the garden for the equivalent of X steps or miles usually achieved daily, listening to uplifting music at the same time; or sitting in your chair doing arm or leg raises
• Limit contact with Covid-19 news updates or emails to once a day – view prime minister daily update, but not in the presence of children – try to shield them from worrying or distressing information in relation to the virus
• Practise self-care by listening to your body – what am I noticing now in this moment? Any tensions? Introduce or continue your practise of yoga, tai chi or Pilates, using online free classes, introduce mindfulness practise to your life by downloading an app or google.
• Socialise using the medium of phone calls, texting, facetime, skype, or online chat rooms – be inventive with socialising online; dress up for dinner as you would if you were going out to a restaurant – have some fun – laughter is the best medicine!
• Time out – meditation, journal writing; adult colouring books, puzzles – something that allows your brain to be active and to switch-off from worries
• Book worry time- 5, 10, 15 minutes a day; outside of this write down the worry for later and then “let it go”; use the process of – can I do anything about this issue? If yes, go and do it now; if I can’t now but I can address it tomorrow, then let it go for today and attend to when able; if answer is no – let it go; ask yourself – will any amount of worry time solve this or make it better? If the answer is no – let it go
• Letting it go – put the thought on a leaf; the leaf on a stream or river and watch it float off downstream until it is out of sight
• Learn something new – if you’ve always wanted to do X and never had the time; ensure you log this into your daily routine or downtime
• Take one hour, morning, day or week at a time
• Use of imagery – think of an imaginary calming place – in as much detail as possible using all of your senses – what you can see, hear, smell, taste, feel, sense; who would you want with you, or are you alone?; temperature of environment, and notice how you feel as you imagine this calming place
• Whilst communicating with loved ones, stop and consider before responding – is what I was going to say something positive, or something they will appreciate or find helpful? If, not – don’t say it; hold onto it and then find a way to let it go – maybe through breath – releasing tension as you exhale, or the leaf on a stream
• Think of something positive that can come out of this experience for you or your family.

If you are experiencing distress or you are noticing that your mood or behaviour is changing in a less positive manner please speak up, contact a friend or relative or professional counsellor or psychologist – let someone know that can provide a listening ear. At this time most professionals are offering appointments either online or via the telephone.

If you don’t have a specific renal professional in your unit, please contact Kidney Care UK.