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Put On Your Oxygen Mask First: You Can't Help Others if You Don't Help Yourself
Stress, anxiety, depression, burnout, post-COVID anxiety…


It will take years to unpack how badly the pandemic damaged our collective mental health. But what we know now is no one is immune. Healthcare providers, grocery store workers, executives, stay-at-home parents, food service workers: We’re all suffering in some way. In 2019, 10.8% of adults in the United States reported symptoms of anxiety or depression. By December 2020, that number had skyrocketed to 42.4%.

If you’ve been feeling anxious or depressed, you are not alone.

I’ve always considered myself resilient: able to adapt to whatever life threw my way. I also consider myself lucky. Throughout the pandemic, I have had a full-time job; can work from home; “successfully” manage the education of 8-, 9-, and 10-year-olds; and can afford grocery delivery to my doorstep. Since I’m no longer a bedside clinician, I’ve escaped the risks and heartbreak of being on the front lines. Given the circumstances, my life is good.

And yet, it happened anyway.

I was driving on I-440 around Raleigh, North Carolina, fueled up on coffee, navigating traffic, listening to the radio, pondering everything I needed to get done, and my ears suddenly became blocked. I was sweating but felt cold. My arms were tingly, and my heart was racing. I knew what was wrong with me—I was having a panic attack. I became terrified I would cause an accident.

Why now? Why me?

In retrospect, it was clear. Like so many of us, I was under a tremendous amount of stress. But hey, some of us thrive under stress, right? Well, we do until we don’t.

It took me an extra three hours to reach my destination, and until now I’ve shared my experience with very few people. I didn’t want to be seen as weak, ineffective, lesser, or incapable. Even when almost half the population is struggling with mental health, my first instinct was to feel like I needed to suck it up and deal with this on my own. But we need to start talking about our struggles so we can start to heal.

After several months and a lot of self-care, I’m feeling better. But what does self-care really look like?

You don’t need to devote hours each day or book a spa appointment.
Even taking a few minutes each day can help.

You can google this topic and get a list of 50 things to try. What works for you might not work for someone else. But the most important thing is to try something. Here are my top three I practice every day.

  1. It’s all about the breathing — l don’t like a lot of fancy breathing techniques, but two help when I am feeling anxious or need to refocus.

    The first goes like this: Inhale through your nose for a count of five seconds, hold for three seconds, exhale through the nose for a count of five, hold for three. Repeat at least twice.

    The second is alternate nostril breathing: After exhaling, hold your right nostril closed and take a long deep breath (about 5–8 seconds) through your left nostril, then exhale slowly through the left nostril. Now, close the left nostril and take a long deep inhalation through your right nostril, then exhale slowly through the right nostril. Repeat this cycle for several minutes.

    The key to both techniques is controlling and slowing down your breathing, which in turn lowers your heart rate and decreases stress. People with breathing problems, like asthma or chronic obstructive pulmonary disease (COPD), should discuss with their physician first.

  2. Meditation for Relaxation — There are many ways to meditate, and I encourage you to find one that works for you. Some people need complete quiet; some people need mantras. If you’re like me and prefer music, there are literally thousands of options with a quick YouTube search. Here is my regular go-to for a quick 20 minutes.

    My technique is straightforward. I turn on my music, get into a comfortable sitting position, close my eyes, and start with one of the two breathing techniques listed above. Then I continue with long, slow inhalations and long, slow exhalations. With each exhalation I release tension, starting with the crown of my head and working my way all the way down to my feet. I pay particular attention to my jaw and shoulders because I tend to carry tension in those spots.

    Two quick relaxation hacks when time is limited: The first you can do right now. Unclench your jaw and let your tongue float free (instead of resting it on the roof of your mouth). That’s it.

    The second takes practice ahead of time. Each time you begin to meditate for relaxation, inhale an earthy, grounding, or relaxing scent at the beginning of your practice. Many people like lavender, but use what works for you. Your body will begin to associate this scent with relaxation and eventually just smelling it will calm you. Carry the scent with you to inhale when pressed for time.

  3. Mindfulness — This is very different than meditation for relaxation and some people find it easier. Both have their place. Johns Hopkins shares a good overview on the practice and its benefits.

    Do you know what happens to many people after they experience a panic attack? They associate whatever they were doing during the attack with their anxiety and worry doing the same activity will trigger another attack, which may become a self-fulling prophecy. (Imagine the dilemma when that happens to be driving.)

    Mindfulness can help break this cycle. For me, it was checking in with my body and accepting how I felt instead of fighting it. It was also noticing how tightly I was gripping the wheel, whether I was clenching my jaw, and if my shoulders were tight, then loosening that grip, unclenching my jaw, and relaxing my shoulders. It’s a lot of self-talk, but it works.

    Mindfulness can also be practiced when doing repetitive tasks, like washing dishes, folding clothes, or walking. Bring your full attention to the task at hand and honor the present moment. When clinicians learn to do this, it not only benefits their personal life, but it can also benefit their daily work. The Institute for Healthcare Improvement shares an excellent podcast on mindfulness and patient safety.

Finally, if you are fortunate enough to have access to both physical and mental healthcare, use it. Make sure you schedule any routine or preventative care you might have missed during the pandemic. If your mental health is having a negative impact on your daily life, seek help.

Take the time to make sure you are OK. I know I’m not alone. Neither are you.                             

About this blog

Regina Hoffman serves as the  executive director of Pennsylvania’s Patient Safety Authority and editor-in-chief of Patient Safety, its award-winning journal.  Ms. Hoffman was recognized by Becker’s Hospital Review as one of the top 50 experts leading patient safety in both 2018 and 2020. This blog serves as a source for her to share her insights in patient safety and leadership with Pennsylvania’s healthcare leaders.


***​ The views and opinions expressed at or through this blog are the opinions of the author alone and may not reflect the opinions or positions of the Patient Safety Authority or the Commonwealth of Pennsylvania, nor do these views represent in any way medical or legal advice. ​ 

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