— Kasey Boehmer, Ph.D., is a health services researcher at Mayo Clinic
As a society amidst the COVID-19 pandemic, we continually hear of the struggle to embrace a “new normal.” For some, this new normal is at the front lines of health care. Clinicians caring for those with chronic illnesses are pivoting quickly to check in on patients through telehealth technology. Others are shifting their duties to identify and treat those acutely ill with the virus. In many other cases, those not in health care are still interacting with the public as they provide essential services like groceries, plumbing repair, or transportation services. However, the physical environment or other aspects of their work may have changed.
For those not in essential service categories, new normal likely includes a homebound reality that many have never experienced before. They, along with their housemates, are learning to work and attend school from home — or to occupy their time without formal employment. Many are facing these new realities with reduced or no income. People who live together have been thrust into 24-7 contact, while becoming physically distant from the other people in their social circles. None of these situations feel normal, but at least for right now, they are.
Regardless of what category you fall into, life has shifted rapidly in the past several weeks in a way that we could have scarcely imagined a year ago. This rapid shift has left people from all facets of life feeling completely overwhelmed. People are saying on telephone calls and on social media that they are struggling. I recently reflected in another blog post as to why this is occurring. Peoples’ capacity (i.e., their abilities and resources to respond to new work) is currently being challenged on all fronts. Now, as people are beginning to recognize the struggle, more are looking for coping strategies. Some lessons in coping may be found in a program developed at Mayo Clinic called “Capacity Coaching.” While Capacity Coaching was originally developed for patients living with multiple chronic conditions, this intervention’s underlying principles contain tools that are applicable to the overwhelming nature of what has become everyday life. I discuss a few of these principles below.
One principle of Capacity Coaching is that of achieving “workload-capacity” balance. Briefly, everyone has a set "workload" for which they are responsible. This includes paid employment, caregiving activities, volunteer work, household chores, general self-care, and for those living with chronic health conditions, doing what is necessary to maintain their health. When we consider our current situation amidst the pandemic, most of us have experienced changes on some or all of these fronts. The ability to accomplish and maintain a given level of work, or "workload," relies on our capacity. When workload exceeds capacity, people struggle to act.
Contributing to our capacity is our:
These are all in a state of upheaval right now. In the case of patients living with multiple long-term conditions, this workload-capacity balance affects their abilities to access and use healthcare and enact self-care, which in turn, affects their health outcomes. In the current situation, we might consider that this workload-capacity balance affects our abilities to manage uncertainty, care for ourselves and our loved ones, and continue our life’s goals and dreams. Ultimately, the ability to do those things will affect how we emerge from this pandemic.
Therefore, to remain healthy and resilient during these trying times, we must attend to our workload-capacity balance. To do so, we have limited options. We must: reduce workload, increase capacity, or do both.
A patient participating in a Capacity Coaching program would work through these activities with a coach during a long-term partnership. However, in the current situation, it is important to arm as many people as possible with ideas of how to cope.
Defining your workload
In order to define your workload, it is useful to conduct a brainstorming exercise to identify all the tasks that you are current doing — or feeling required to do. Consider paid or volunteer employment, managing unemployment if unemployed right now, caregiving activities, household chores, etc. Write down everything you’re doing on a daily or weekly basis.
For each task, note next to it if the activity feels “helpful,” “burdensome,” or “both.” It is important to note that these are simply reflections for your personal use. There is no judgement in saying something is burdensome.
In Capacity Coaching, we use the ICAN Discussion Aid, which provides a helpful visual, even for people without chronic conditions.
Once you have done this, some questions to consider:
Ultimately, removing or modifying workload that is burdensome right now — even if temporarily — can be helpful. For activities that feel burdensome, but cannot be removed, brainstorming how to break them down into smaller, more doable actions can also decrease workload while contributing to your own self-efficacy. Adding mindfulness around the activities that are enjoyable right now is another option to reduce one’s overall sense of workload.
Adding appreciation and inquiry
Another principle of Capacity Coaching — used to increase capacity — is that of Appreciative Inquiry. This is an approach that focuses first on appreciating the situation at hand, what is currently working well in that situation, and past learnings and strengths from similar situations. From that, you can work to envision what an ideal future looks like and co-create a plan for arriving there. After implementing the plan, assess what is working well, and what might need reevaluation.
While this process works best with the support of a coach or others, one can use the diagram and its associated questions to work through this process individually. Appreciation and Inquiry is intended to be a continual process of appreciating, designing, implementing, and evaluating experiments in one’s own life.
During this unprecedented time, it may be helpful to use appreciative inquiry on new and emerging situations to build one’s own capacity. For example, if in a situation where current demands are particularly stressful or overloaded, one might consider past instances where this has occurred independent of the pandemic.
In my own life, due to social distancing, I have switched to teleworking and simultaneously homeschooling a 7-year-old. I am constantly reflecting back on strategies I used previously when I was pursuing my graduate degrees fulltime, while working fulltime and adjusting to motherhood.
Thinking back in your own life for times of successful coping can help you learn and identify strengths that can be applied to working in the current situation. From what my colleagues and I have learned in developing Capacity Coaching, it is best to establish small-scale experiments of new ways of working and coping and evaluating those often, ideally weekly.
I hope that these tools we have used with our patients in Capacity Coaching are helpful to you and your family during this time. If you have questions about the content here or Capacity Coaching in general, please contact Dr. Kasey Boehmer at Boehmer.firstname.lastname@example.org.