After a brief discussion with one of the delivery guys in the dispensary, where we covered the apparent dire state of the world, he turned to me and summed it all up ‘There is a lot going on, for sure.’
Now that may be the understatement of the year, but it is increasingly how many of us are feeling right now. Work is changing, technology is developing, healthcare is shifting. The expectations of patients and customers are changing. Outside of our work situation, the cost of living, family responsibilities, social media, world events, and the constant flow of information all compete for our attention. Of course, change itself is nothing new, but what feels different is the volume, speed and relentlessness of it.
For those of us working in community pharmacy this is especially relevant. Pharmacy has always been a busy environment, but the demands on pharmacists and pharmacy teams continues to shift and evolve. At the same time, the customers walking through the doors are also navigating the same, rapidly changing world. Sometimes it feels like everyone is just about holding it together. From a wellbeing standpoint understanding our nervous system can help us understand why.
One of our brains most important tasks is extremely simple; to keep us alive. All day every day, mainly outside of our awareness, our brain and nervous system are constantly asking one fundamental question. ‘Am I safe enough?’
When the answer is yes, we are in what we can call ‘ready mode’. We feel steady and connected. We have full access to the part of our brain that allows us to think clearly, solve problems, communicate effectively, and connect with other people. We have a greater capability to be calm, creative and compassionate. Our internal message is essentially: ‘I’m okay. I can handle this.’
However, when our brain decides that we are ‘not safe enough’ it shifts into ‘protect mode’. This equates to our survival system, our stress response. The problem is that this mode evolved mainly to help us respond to acute threats and then recover. It wasn’t designed for overflowing inboxes, staff shortages, constant notifications, difficult conversations, financial worries, breaking news and an endless stream of change and uncertainty.
Our threats today do not disappear like a tiger over the horizon but can remain with us for days or weeks. As a result, our nervous system can spend longer amounts of time in protect mode.
Protect mode can show up in different ways for different people, depending on circumstances. Some of us become ‘revved up’. Everything becomes urgent. Our internal message is ‘I need to get this sorted now’. We become impatient, argumentative, anxious and frustrated. Our thought processes speed up and become louder. Small problems suddenly feel like big problems.
Other people ‘shut down’, with their overall outlook being ‘I just can’t deal with this now.’ We withdraw, disengage or go quiet. In these situations, we may respond with an ‘I’m fine’ when really we mean ‘I don’t have the capacity to deal with this at the moment’.
No doubt both scenarios will sound familiar, because we can see these responses in ourselves, and we also encounter them every day with patients and customers. A delayed prescription, an unavailable medicine or brand, or a misunderstanding that might usually be manageable can become the final straw for someone whose nervous system was already stretched before they even entered the pharmacy.
Of course, pharmacists and pharmacy staff aren’t immune. When our own capacity is depleted, our tolerance also reduces. The impatient customer feels even more irritating, a colleague’s mistake feels even more significant, and a simple request feels like one request too many.
Understanding this does not mean accepting inappropriate behaviour. Boundaries, as always, remain important. However, it can help us to approach things with a little more curiosity and compassion for the situation or individual. Sometimes the person in front of us isn’t being difficult, they may be revved up or shut down because they are simply struggling to cope with everything else going on in their world. And sometimes that person is us.
For me, the biggest learning while exploring the topic of nervous system regulation has been the sequence of that process. Like many people, I spent years trying to think my way out of stress: ‘Calm down. Stop worrying. Get a grip. It’ll be fine.’
The problem with this approach is that when we are in protect mode, the very parts of our brain we are asking to rationalise the situation may have less capacity available. As a result, thinking our way out of these situations rarely works.
Instead, we can try the following four simple steps; Notice, Soothe, Settle, Respond.
Tune in to what is happening by asking:
Use a somatic nudge, somatic simply referring to the body. Instead of immediately trying to change your thoughts, give your body a small signal that says, ‘I’m safe enough right now.’ That might mean slowing down and lengthening your exhale, feeling both feet firmly on the floor, gently tapping the body, humming, stretching, shaking out tension, or reassuring touch.
These aren’t about pretending the problem has disappeared but are simply small ways of helping the body move from protect mode and toward feeling calm and connected again.
Once the body has received reassurance we can introduce a brain nudge. This can take the form of self-compassionate words, changing perspective, or using a simple phrase such as ‘I can slow down, I can handle this. We will figure this out one step at a time.’
Now having shifted from protect mode to ready mode, we are in a better position to ask, ‘What does this situation actually need from me right now?’
The sequence is all important, body first, brain second. This can be readily accomplished using the four simple steps; Notice, Soothe, Settle, Respond.
We cannot slow the pace of change around us. Nor can we remove every difficult interaction from a busy pharmacy. What we can do is become better at recognising what is happening around us, and within us, then developing small, practical ways to respond appropriately. As we often find wellbeing isn’t about changing the world around us. More often than not it’s about giving our nervous system the support it needs to navigate the world a little better.
Séamus Ruane
Community Pharmacist and Positive Psychology Practitioner
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