How to improve your resilience and avoid burnout during the 'uncertain times' we live in
Physiotherapist Chrissie Mowbray and GP Karen Forshaw have joined forces to form Resilient Practice, which offers training courses and a range of materials to help healthcare professionals cope with stress and become more resilient. Here Chrissie and Karen offer PhysioUpdate readers a 10-point programme that will help you to enhance your mental and physical wellbeing.
There is no doubt that physiotherapists are at greater risk of burnout than the general population, especially following the pandemic. Private practitioners have played an essential part in maintaining patient health and in easing pressure on NHS services. During lockdown, practitioners have had to close clinics and, on opening, work under rigid Covid-19 guidelines while managing the uncertainty of reduced numbers, late cancellations, and an unpredictable future.
NHS staff have been redeployed during the pandemic, working in stressful and unfamiliar environments. Moving forwards, both private and NHS physiotherapists will increasingly be dealing with patients affected by long Covid, which has both physical and psychological components.
Before the onset of the pandemic, in 2019, the Chartered Society of Physiotherapy (CSP) published the results of a survey, titled Pinpoint the Pressure. This revealed that that physiotherapy staff were experiencing high levels of work-related stress with one member in five considering leaving their current jobs.
In the same year, the NHS staff survey showed that a majority (59 per cent) of physiotherapy staff stated that their morale has deteriorated with the highest ranked cause (74 per cent) being stress. The September 2019 NHS Digital survey reported that 25 per cent of registered physiotherapists’ sickness absences were directly attributed to stress.
We fully agree with the CSP’s call for the workforce to be strengthened to reduce burnout. The system needs to change, but the fact is that people are suffering with burnout right now. We need to foster resilience in our staff so that they can continue in their roles without irreversible negative impact on their mental wellbeing. Additionally, we know that challenging the system requires a certain skillset. The fact is that resilient practitioners are the ones best suited to lobby for change. They are the ones whose wellbeing will not suffer as a result.
As we campaign for reform, we also need to take responsibility for our own mental wellbeing.
When we connect with nature, we are happier. There is much research that demonstrates this. Go outside when you can and, when you are not able to go outside, bring nature inside to you [Chrissie Mowbray and Karen Forshaw]
Thriving or surviving
The first thing to do is overcome resistance to the idea of self-care, something that is often seen as indulgent and surplus requirement but is the difference between thriving and surviving. Most people think of self-care as good food and entertainment and the odd spa day. Self-care is, in fact, about learning to set healthy boundaries, to manage conflict, to observe and choose our responses, to say ‘no’, to achieve balance, to compartmentalise and to appreciate the difference between compassion and empathy. Without these skills we put our wellbeing at stake every day.
The best way to make personal wellbeing a priority is with a toolkit of evidence-based skills and techniques to draw on.
As resilience trainers and authors of a book on this topic, titled How to Rise: A complete resilience manual and published by Sheldon Press, we offer our top 10 tips for maintaining good mental health:
Stay Active: This benefits our physical and mental health, boosting mood and reducing stress. It improves sleep and cognitive function. Find ways to exercise that you enjoy that can be easily woven into your routine.
Hydrate: A 2018 study showed that when water intake is less than 1.8 litres the body is inadequately hydrated  This impairs cognition and causes headaches. Commit to keeping your total daily water intake to more than 1.8 litres.
Practise gratitude: Habitually acknowledging the positive creates chemical changes which lead to feelings of happiness. This improves our behaviour and its outcomes, creating harmony. We often complain about adverse situations, but gratefully acknowledging the lessons will always improve our mindset.
Challenge distorted thinking: Thoughts, feelings, and behaviours are linked in the cognitive behavioural cycle. When we engage in distorted thinking, we drive negative cycles. Examples include catastrophising, mind reading and making negative assumptions. Recognising and challenging these patterns leads to positive changes.
Reframe negative core beliefs: Our core belief systems create the unique lens through which we view the world. Negative core beliefs generate negative thoughts, feelings, and behaviours. Reframing them results in positive outcomes.
Sleep: Poor sleep habits adversely affect wellbeing. Commit to a good bedtime ritual and consider meditation and visualisation exercises for encouraging sleep.
Practise mindfulness: Mindfulness frees us from imagining a fearful future and ruminating about the past. Practise giving your energy fully to the present moment reducing stress and improving performance.
Practise meditation: This ancient practice leads to a calm mind. It encourages down-regulation of the stress response and improves mental health. A recent study showed that meditating daily for 15 minutes had a similar effect on mood as a day of holiday .
Breathe: One exercise for reducing stress is diaphragmatic breathing. It stimulates the vagal nerve activating the parasympathetic nervous system and the relaxation response.
Connect with nature: When we connect with nature, we are happier. There is much research that demonstrates this. Go outside when you can or, when you are not able to go outside, bring nature inside to you.
For more information about resilience and wellbeing and for free tools and audio meditations, visit: www.resilientpractice.co.uk
For resources for one-to-one help to combat the effects of burnout, visit: www.practitionerhealth.nhs.uk
To find out more about Chrissie's practice, including hypnotherapy and psychotherapy, visit: www.belllanephsyiotherapy.co.uk
 Armstrong LE, Johnson EC. Water Intake, Water Balance, and the Elusive Daily Water Requirement. Nutrients. 2018 Dec 5;10(12):1928.
 Christopher J May, Brian D Ostafin and Evelien Snippe (2020) The relative impact of 15-minutes of meditation compared to a day of vacation in daily life: An exploratory analysis, The Journal of Positive Psychology, 15:2, 278-284
Chrissie Mowbray is a physiotherapist, psychotherapist and hypnotherapist, who is trained in cognitive behaviour therapy and neuro-linguistic programming. Dr Karen Forshaw is a GP and a GP trainer and appraiser.
Together they run Resilient Practice and are based in Yorkshire. Chrissie and Karen run courses for a range of organisations, including the Royal College of General Practitioners and Health Education England. For further information, email: firstname.lastname@example.orgAuthor: Chrissie Mowbray and Karen Forshaw