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COVID19

2020-03-14 18:13:14

So COVID19. What do we know, and how could we use hypnosis? Coronavirus is a rapidly evolving pandemic, and it is highly possible some of this information may be out of date by the time the blog is published. NHS England will always have up to date information and guidance on their blog, and this is generally considered to be a good overview. There’s lots of medical social media response, with a coronavirus podcast from LSHTM being one of the most regular. The virus is a nasty little bug that infects people, in a similar way to flu. It causes a cough, and a temperature. It doesn't cause a runny nose. It doesn't symptomatically affect children (probably), but they can be asymptomatic carriers. More on kids here. 

About 99% of cases are mild and self limiting, but in some cases, it causes severe respiratory compromise with a really nasty pneumonia. Many patients recover, quickly, but increasing numbers need advanced intensive care, with about 1% needing ECMO. That’s a rate of 99% not needing ECMO. Numbers needing intensive care are predicted to be so high that we might not be able to cope. Although they're only about 5% of cases, 5% of a pandemic is a lot.

 

 

We get our numbers predictions from Italy. We're about two weeks behind them, and so far, all our case numbers are following theirs exactly. We've employed similar public health measures to them, so it is very likely the spread will be the same.

 

 

So what does this mean for you as a hypnosis practitioner? Should you go to work? Should you cancel clinics? With the peak number of cases currently anticipated to be in May, that’s a long time not to work. But it might be worth considering!  Whatever you do, here's some "medical" considerations, and some hypnosis considerations. As we said at the beginning, coronavirus is evolving, and our hypnotic thoughts around it will also expand and evolve. I wonder what your hypnotic strategy looks like.

We’re proud that BSCAH has proactively prioritised the health and wellbeing of their members and the communities around them. To safeguard this, we have cancelled some meetings and educational events already. We’re not sorry for doing this. We are sorry for the disruption it may have caused.

1.        Don't infect yourself, or your patients

Employ vigorous infection control practice, whether you're in a hospital or not. Use the five moments for hand hygiene - and if in doubt, wash your hands.

 

 

Once your hands have been washed, I wonder how much you can not touch your face. Try to touch the inside of your pockets instead (is that hypnotically avoiding enough?).

 

 

Regularly clean everything you touch - your phone, your pen, the door handles, your ID badge...and your phone, your surfaces. Coronavirus remaining on surfaces is likely to have decreased by 72 hours – if you count how many times you touch your chair in a day, then multiply by three – that’s how many times you’ve probably infected yourself.

 

 

 

 

Wash your hands again before eating.

Blue -1

Encourage your patients to wash their hands regularly. They need to wash their hands for at least 20 seconds using soap. You can design some awesome posters based on songs and common prose to go up in your toilets.

Then avoid contact. Most patients understand if you don't shake their hand, but instead, maybe think about a footshake. This hasn't caught on yet as far as I can tell, but it looks much more fun than fist bumps!

Don't get too close to your patients. Corona is mostly droplet spread, so if you don't get too close, hopefully you won't be infected. Coronaviruses have also been detected in blood, faeces and urine. I've read somewhere (but now can't find the reference) that you should stay 2m away from patients to reduce spread. 

Don't let symptomatic patients into your consulting room! A travel history is unlikely to be helpful anymore, but a sneezing patient will certainly be less than helpful. If they do sneeze, encourage good hygiene, catch it, bin it, kill it. Then they (and you) should clean your hands. 

Blue -3

This poster highlights some transmission routes.

Follow your work place’s advice about wearing PPE, remembering that supplies are finite. If you’re going to wear masks you need to practice donning and doffing. Masks will act in your defence and prevent you touching your face, as your body’s immune system works to protect you too, and using the mask will remind your body to heal itself.

To help you and your colleagues feel really comfortable when wearing masks, I wonder how much 7/11 breathing will help. I wonder how much more relaxed you will feel with every breath you take through the mask, knowing that your body is working with the mask to protect you, and help you to only listen to positive suggestions.

These measures are effective at minimising risk, but can never eliminate it.

2.      Provide Psychological Support

The world is incredibly anxious about this - one of the defining features of a pandemic is the fear associated with it. As clinicians who use hypnosis, we’re all experts at introducing calmness, and reframing strategies. Identifying that peaking too soon is a good idea.

 

 

The WHO also has some helpful leaflets. It’s worth making sure everyone who may be stressed thinks about their coping strategies now – I’m biased, but have a look at this blog for tips.

StressChildren -stress

Happily survival is 99% in most people and even in elderly with co-morbity it may be 90%  in some series. If a person has decided they’re not in the 99%, who put them in that group? Remind them, and re-frame. We don't know until we know. Remember the "law of pessimistic interpretation".

Staff are going to start suffering moral injury from seeing demand massively outweigh supply. Even if you don't offer any formal therapy, providing a safe listening ear, and support for your colleagues may well be very useful. Those that aren't affected will still feel as bad as if they weren't there - as we've seen in many major incidents, and even every day life. Even sending a packet of biscuits to your ITU / ED/ Acute medicine/ lab (the specialties likely to be swamped) staff will be really helpful.

As the WHO points out, being kind will be support enough.

Be -kind -to -supportBe -kind -to -address -stigma

 

 

There will also be many people needing support around “Allow Natural Death” or DNA CPR decisions. Training around  communicating this is being improved to prevent many relatives feeling like it was their decision to allow death. It is possible these discussions may be briefer than ever before, due to immense pressures. Make sure you know what your loved ones would want – although it’s ultimately a medical decision, it’s good to think about it. There’s a fabulous BMJ letter with some good phrases to use, and a good Twitter thread with some top tips, and some great posters you could consider putting up in your waiting room. 

 

 

 

3.        Control existing disease and modify risk factors

Anything you can do hypnotically to control a patient's pre-existing disease, minimising their likelihood of needing admission to hospital for their co-morbidity, or reducing the impact of the disease will be useful. If covid19 hits a well controlled asthmatic, one suspects the impact will be minimal. If covid19 hits a brittle asthmatic, the impact will be significant. Smoking cessation - is it ever too late to stop? Hypertension - could stopping drug therapy be useful

4.      Build Up Immunity

If you're sleep deprived and malnourished then you're probably more susceptible to infections than you might otherwise be. 

 

 

Do what you can to prevent that. A little suggestion for every hypnosis patient can't go amiss. Laughter can enhance immunity. There's lots of evidence that reducing stress, and direct hypnotic suggestion can improve immunity.

If this script:
"This means that the defending soldiers of your protective system are too combative...They fight everything that comes by. That is why your nose is running. Tell them to set up a sentry to watch for the approach of the real enemies. The small pollen ins innocent, there is no need to fight against it."
helps reduce hayfever, I suggest it could be easily modified to increase the vigilance or number of the "sentries", any I wonder if an infection would be asymptomatic!

5.      Positive Suggestion on ITU

If you end up treating any patient whilst they are sedated and on ITU, there is lots of evidence that hypnosis can still help.  Here's a script from "Beyond the Words":

"As your body becomes strong enough you are more and more able to breathe on your own. You can just feel how interesting it is to take a deep breath with your own muscles. You can feel your chest moving with every breath, you can follow the natural way of the air moving in and out. You will know exactly when it is time for a deeper breath or coughing to make your breathing the most effective. Every minute you spend with breathing on your own makes it easier, minute by minute, hour by hour, day by day...you will notice that breathing is a natural process, your muscles move more and more automatically...Now everything is settled around you, you can give your attention to your inner processes. You can find the most pleasant places in your body, the feelings of peace and calmness...Just let it feel, let it happen... "

We know that hypnosis can improve rates of surgical wound healing - maybe it can help lung healing too?

 But why wait until they're in ITU? Start at the beginning – maybe adapt the famous Kansas experiment:

"The worst is over. We are taking you to the hospital. Everything is being made ready. Let your body concentrate on repairing itself and feeling secure. Let your heart, your blood vessels, everything bring themselves into a state of preserving your life. Bleed just enough to cleanse the wound, and let the blood vessels close down so that your life is preserved. Your body weight, your body heat, everything, is being maintained. Things are being made ready at the hospital for you. We're getting there as quickly and safely as possible. You are now in a safe position. The worst is over." In the randomised groups, if this script was used, survival was better.

or maybe

"Are you familiar with mental imagery and how it can redirect biochemical processes? Whilst we're waiting for the treatment to work, we can enhance the healing process, and help your body respond to the treatment. Close your eyes and as you do, notice the immediate increase in comfort. Now, just allow that feeling of increased comfort to increase even more. As it does, notice you are beginning to relax the muscles around your abdomen a little more, and that this also increases the sense of comfort. Good.

Now I want you to imagine that a crew of special miniature workers are going down into your lungs to fix the problems that are causing you discomfort. See them going down to fix a sort of protective seal that is in need of repair, and is allowing the wrong stuff to be in the lungs. What sort of tools do you think they could use? "

I don’t think hypnosis has the only answer to slowing down the curve on this pandemic, but every single one of us has the power to infect hundreds of people with coronavirus. But we also have the power to inspire hundreds of people with positive suggestion, and careful communicating. If anyone manages to set up an RCT in their environment, I’ll be impressed! Let me know how you get on, and pop yourself firmly in the survival group.

For further positive coronavirus blogs, have a look at Action for Happiness.

And finally:

Finally as panic doesn’t work

Serenity prayer:

God, grant me the serenity to accept the things I cannot change,.........( corona virus is here)

Courage to change the things I can, ........( wash and avoid close contact)

And wisdom to know the difference.

 

 



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