Finding a Way Through Winter Low Mood

Winter can be a difficult time for many people. Shorter days, less light and increased pressures at work and home can affect mood, energy and motivation, making everyday life feel heavier and harder to manage.

In this episode, Dr Lee David speaks with Dr Helen Garr – Medical Director at NHS Practitioner Health – about finding a way through low mood in the winter months. They explore why winter often amplifies stress and emotional strain, and how expectations around productivity and “pushing on” can clash with what our bodies and minds really need at this time of year. 

The conversation looks at permission, balance and self-awareness, offering practical ways to check in with ourselves, recognise early signs of struggle and understand when extra support may be needed. Together, they reflect on the value of movement, light, connection and small, nourishing actions, as well as compassion, psychological safety and supportive relationships. 

 This is a thoughtful discussion about understanding winter low mood and finding realistic, compassionate ways to care for ourselves – and knowing when and how to reach out for support. 

Key moments

 00:00 Why winter can make low mood harder to manage
 02:10 NHS Practitioner Health and its role
 04:24 Hope, recovery and supporting healthcare professionals
 05:23 Psychological safety and workplace culture
 08:10 Being your “best self” under pressure
 10:57 Why winter amplifies emotional stress
 14:40 Permission, balance and expectations
 17:35 Checking in with yourself and noticing early signs
 25:18 Talking openly about hopelessness and suicidal thoughts
 28:21 The Choice Pause –  pace for positive action
 32:42 Support, connection and “your crew”
 43:42 Choice Space takeaway – simple steps to support winter mood 

About the guest

Dr Helen Garr is Medical Director of NHS Practitioner Health, a national service supporting Healthcare professionals with mental health and addiction difficulties.

She is a GP and recognised leader in wellbeing and mental health, with a background in psychology and nursing. Helen has worked extensively in student health at the University of Nottingham Health Service and continues to work in out-of-hours general practice.

She is a former Public Health England Clinical Champion for physical activity, a former Director of the British Society of Lifestyle Medicine, and currently serves as Wellbeing Lead for Nottinghamshire LMC. Helen is known for her engaging speaking style and commitment to compassionate leadership in healthcare.

Outside of work, Helen enjoys open water swimming (mainly in the summer), running half marathons (slowly) and walking her chocolate Labrador, Eileen.

About the host

Dr Lee David is a GP, CBT therapist and author specialising in mental health and wellbeing. Lee has written many books on CBT, mindfulness and teen wellbeing, and speaks regularly at conferences and in the media. Away from work she enjoys running, hiking, singing in a choir and spending time outdoors with her family. You can find Lee through her website and on Instagram, TikTok (@dr.lee.david), Facebook and LinkedIn.  You can find more about her books, wellbeing courses and therapy here:  https://linktr.ee/dr.lee.david 

Transcript

Helen Garr (00:00)
Top tips number one, move your body. So we do not feel like movement when winter comes. We just often want to hide under the duvet, stay in bed, move your legs. Your mind will follow.

The things that can make us feel better don't need to cost money. They don't need to take time. We just need to be intentional about them. And if you are struggling, please, please, please do not struggle alone. Please seek help. Practitioner Health is here - If you are a health or care professional. We are here to look after you and care for you and treat you.

Lee (00:44)
Welcome to the Choice Space podcast. I'm Dr Lee David, GP, CBT therapist and author. In today's episode, we're talking about finding a way through low mood in the winter months. Shorter days and less light can affect our mood, energy and motivation. And it can make everyday tasks and our routines just feel a bit harder to keep up.

We often keep going with work and our responsibilities, but some of the activities that usually support us, like movement, connection and time outdoors, can start to fall away. The new year can add extra pressure. We might expect ourselves to push forward or make changes at a time when our capacity is perhaps even lower. And when our expectations don't match what we're able to manage, it's easy to feel stuck.

or frustrated. This episode will explore how we can notice what's happening, make some helpful and realistic choices and knowing when to reach out for more support. I'm delighted today to be joined by Dr Helen Garr, Medical Director at NHS Practitioner Health.

She brings extensive experience in supporting people through challenging times in their lives. 

Helen, huge welcome. Could you start by introducing yourself and sharing a little about Practitioner Health and your role there?

Helen Garr (02:03)
Thank you for having me, so my name's Dr Helen Garr. I am a GP by background and prior to that, I was a nurse. Prior to that, I was a psychologist and I'm now the medical director of NHS Practitioner Health. So we are a national, confidential mental health and addiction treatment service for health and care workers in the NHS who face a barrier to seeking confidential care through local services. And we've seen almost 40,000 NHS staff, mainly doctors, other NHS staff as well, in the 17 years that we've been going. as you say, lots and lots of experience of the kind of challenges that people face both 
as healthcare workers, as humans and people going through life.

Lee (02:55)
I'm also one of the team within NHS Practitioner and really proud to be a part of a service which I think offers so much support to a group who really are under pressure, caring for others, working under pressure and IT'S challenging times isn't it Helen?

Helen Garr (03:10)
absolutely. regardless of where you're working right now, I see across the board just in life challenges are huge, we're all facing so many challenges just to get through daily life at the moment, but the NHS specifically, people are just facing enormous challenges in their day-to-day work and obviously that has knock-on effects on our mental health.

Whether you're a patient or whether you're working in healthcare, we all deserve the best care. So lot of what practitioner health is enable might be suffering with poor mental health or stress at work, for example, we enable people to get better and to work at their best so they can deliver the care that their patients deserve, but also that they deserve

Lee (03:56)
I think what's also really helpful to the really high numbers of health professionals who have been supported through the service. and there's real hope, isn't there, that people do recover and there are really positive outcomes.

Helen Garr (04:07)
absolutely, our outcomes blow me away. And as you said at the beginning, we're all so proud to work in this service and support our colleagues as well who come to us treatment and I often say we're credited not just saving lives, but saving careers. we keep people in work, but also allow them to rediscover the joy the job that they love, which I think for many people we can lose. We can lose that joy and that passion. It becomes a day-to-day almost survival to get through.

Lee (04:38)
there's something there that really comes through about the culture of the organization that idea about being held, feeling supported, feeling heard, feeling understood. And I think there's probably something that we can take away all of us, whatever industry, whatever workplace we're in, It really feels like that is really fundamental to how we can operate positively in whatever system we're in.

Helen Garr (05:00)
absolutely. And one of the things I see that I've brought to Practitioner Health as a medical director is that whole value and approach around psychological safety, around compassionate leadership. Those values and bringing those approaches into our daily work really do make a difference to develop that kind of space where people feel held and got each other's back. It's around connection with the people that we work with. 

And when we start to be interested in the people we're working with, sometimes we get to like them, which is always a bonus. And you can only develop trust when you get to know each other. Once you've got trust, you then develop psychological safety. where the real magic happens. That's where people can go to work know their colleagues have got their backs. We know we can make mistakes, we can get things wrong, not going to be vilified for it. We're going to learn from it. We're all going to work together.

Lee (05:50)
that respectfulness, it's the communication and it builds relationships, doesn't it? if we're tired and a bit cranky, actually measured in how we then respond to that, it's not often the what, it's the how, it's the how we relate to
these pressures and I think that's so important for maintaining psychological safety as you say.

Helen Garr (06:03)
Yeah, but it's easy for that to go out of the window when we're all under pressure and we're working really hard and we're tired. I try to keep that at the forefront of my mind. In fact, there's something I do in fact, I got this from Rachel Morris, who's also got that podcast, You Are Not a Frog. When you are at your worst. 

How would somebody who knows you well describe you in three words when you are at your worst? So for me, I moan a lot I'm not clear in my thinking, lack confidence. And then flip it. How would someone who knows you really well describe you when you're at your best? So when I'm at my best, I am smiling, I'm having  fun. I am open, I'm responsive and I'm clear in my thinking, I'm confident. I have those three words of when I'm at my best on three post-it notes on my wall and then when I'm feeling under pressure, when things are hammering me, I just take a breath, take a pause, look at my three words. How would best Helen be responding now? Because I've been there where worst Helen has responded and it hasn't ended well.

So I try to remind myself of how I am when I'm at my best and how I can respond as best Helen to try and always create those conditions of civility.

Lee (07:31)
I love it and I love the idea of bringing 'best' Lee to work today -  the worst one can stay at home.

it almost feels like you can put on a cloak, the best Lee cloak, and that means it's not faking it. Sometimes people say, I don't want to fake it, and there's something about authenticity. it's about, my wise self would want to be those qualities. I would want to embody those qualities. It's not that they're not me. It's just that they can get hijacked when I'm a bit emotional, if I'm tired. And so it feels very congruent with being real, but actually choosing which version of ourselves we would like to take the lead, I suppose, in a different situation.

Helen Garr (08:07)
Yeah, absolutely.
And it's all about when we're stressed, when we're under pressure, so you use the word hijack, people might have come across this term So the amygdala, the part in our brain that helps us manage our emotions and respond to that when our amygdala reacts for us automatically, that's when our best self doesn't always come to the fore.

But actually we can stop that amygdala hijack by just taking a pause, taking a breath, reminding ourselves it's not faking it. It's giving yourself a pause to allow yourself to respond rather than react in that situation. And it's a skill. And then that also leads to this concept called emotional contagion or social contagion. it. So we know that how we act and behave.

and our emotions, literally are contagious. They leak out. So if you go to work, it doesn't matter if you're a leader, doesn't matter what your role is, if you're going into work and you are all moaning and stressed and, oh, it's a bit rubbish outside and I hate this job and I can't stand everybody I work with, that literally will be contagious in your team. If you are conscious of how you present yourself and it's not about faking it, actually just noticing the little things that actually, aren't I really lucky to work with you people? And did anyone see the sunrise this morning? I know it all sounds a bit daft, just if you come in as your best self, is literally contagious. So that spreads throughout Teams.

And I try to be mindful of that, don't always manage it. We're all human. A phrase I also keep in mind is from one of our brilliant psychiatrists who works with us at Practitioner Health, Caroline Walker, she talks about permission. So I give myself permission to, how does that sentence end for you? I give myself permission to, eat well, to take a short break, to go to the toilet when I need to, to take a nap when I'm tired, to, you know, go for a run, to see my friends, to call in sick if I'm poorly, whatever it is.

However that sentence ends for you, I think it's worth holding on to internal civility and kindness.

Lee (10:20)
That is so important. And I think, it would be wrong not really draw on some of your expertise, Helen, around some of these workplace I know that's an area that you're so knowledgeable. But let's think about winter, because actually, I think all the stuff we're talking about gets amplified often in the winter months.  

Are there any changes in the service in terms of how people engage in the winter months?

Helen Garr (10:39)
Yeah. Absolutely.
So what we see really mirrors happens in the wider population. in the winter months, particularly in January, February, we will see higher numbers of people coming into us. The people who access us the most are women between the ages of 30 - 39. And they're what we call the squeeze middle. 

So often women who are progressing in their careers, so they're under a lot of stress, often in leadership roles, might be having speciality exams or new consultant posts, for example, if their doctors often got young children that they're managing, older parents that might be relying on them, ⁓ juggling mortgages and schools and nurseries and high-pressured careers. And on top of that, we know if you're working in health and care, then the pressures of work in the winter months, go up so we see people who are often depressed, low mood, anxious, struggling with work. We see a lot of relationship issues coming in in the winter months as well.

So yeah, what we see our numbers rise and it reflects really what everyone listening to this podcast might be nodding along thinking, I'm feeling a bit of that too in my day to day life.

Lee (11:55)
Yeah, so it sounds like really in the winter months there's a genuine shift in terms of people do struggle with mood, relationship challenges become compounded, the pressures of life and work can seem to accelerate. So it feels like there's a lot of external pressure and then internally perhaps our resources are a lower ebb relating to there's less light, there might be some seasonal impact we go to work in the dark.

Helen Garr (12:09)
Absolutely.

Lee (12:21)
We come back in the dark. We're not seeing that sunshine that lifts There's illness within the NHS in terms of increased winter pressures. There's also illness at home. which may be more significant in the winter months And they can also affect your resilience to mental health conditions, can't they?

Helen Garr (12:22)
Winters in the UK can be really tough. It's pretty much grey a lot of the time, it? And people might have heard of sad seasonal affective disorder.  and the lack of light is key. So, we're animals who hibernate in winter or our evolutionary body clocks want us to hibernate.

and if you are in a high-pressure job where it's impossible for you to get outside and get some daylight, essentially your brain, your bodies aren't being exposed to any light at all and light is key for circadian rhythm

and actually just a couple of years ago said I am actually going to take all the pressure off myself over winter. I'm going to do all the things that I know will keep me well but I am going to allow myself to hibernate a little bit. I'm going to allow myself to not have to put all the pressure on myself to socialise because I know I'm not going to feel quite so good in winter. And the January blues, the reason have that term is because it's really quite normal to have that dip, to want to sleep more, ⁓ gain a bit of weight, we're eating more stodgy foods, we want to stay inside, we're less motivated to do but like I say, lots of things we could do to try and hack those.

Lee (13:54)
think that idea of permission, feels like there's a balancing act, isn't there? Because it is possible that when we get quite down, that we let a lot of stuff go, our motivation drops really and we're not doing as much as perhaps would be good for us. I often think about a seesaw of pressures.

and on the other end, we might put ourselves under massive pressure and you look around on social media and people have all got these amazing New Year's resolutions and perhaps there's an expectation. wonder if there's something around the Christmas period brings a lot of comparisons, a sense is everyone doing better than me?

and then when it perhaps is harder, maybe our body is needing time to actually energy activity to do that hibernation but we're expecting ourselves to be full octane, getting out ACHIEVING everything. I wonder if there's a mismatch there that can also cause challenges.

Helen Garr (14:39)
Yeah.  absolutely. And I like that seesaw analogy because it is about finding that balance giving yourself permission to do what you need, what your body needs. There is the temptation to hibernate too And it can be very easy to slip into isolating yourself which is absolutely not good for us. 

On the other hand we've got that typical January new year new me these are my goals and you know if you're on social media it is absolutely flooded this pressure to succeed and I think also many of us me included did that thing before Christmas where we were like this can wait till the new year, And then suddenly you find yourself in the new year with all these things that you've put off and it can feel quite overwhelming. So there definitely is a balance between what is achievable and what you're motivated to do and doing things that do get you out there and keep you well, but also not putting too much pressure on yourself.

for many people it's a high over Christmas, lots of activity, lots of things going on, lots of socialising, then there's a sudden drop in January. But for other people, Christmas is a really difficult time and can impact on how we go into January. think it's easy to underestimate how difficult Christmas can be for many people.

and what you said about comparing with other people. So you see people having these perfect Christmases. They might have lots of presents, lots of money to spend, family around. if you've had difficult times, have lost I think it's really important to acknowledge that time of year, can be incredibly difficult and that can have ongoing effects into the new year.

Lee (16:32)
Yeah, so it really feels like it's what's important as a starting point for us as an individual is to take a pause and is going on for me. 

What are my unique pressures? Is it that there's a lot going on? Is it that I have lost somebody and I'm grieving? Is it inner critic is giving me a hard time and comparing me to all the other people I'm seeing and actually I'm feeling like I'm not living up to some... version that I'm supposed to be putting myself under pressure? Or is it that actually am isolated I've been so busy with perhaps work that I'm not doing things that bring me joy. I've let those things go and maybe my mood's dipping and I'm really not feeling very motivated. I mean, a lot of people I would see around this period, it's dipped and dipped and dipped to the point that their fatigue is very high. They're tired, motivation is very low and so the idea of going to do some of these activities feels really far away because it's just like well I just don't want to do them and and so trying to is it low mood getting in the way of being able to make healthy choices in which case we need to recognise that sometimes how we get through that versus is it that no I've just over committed and actually what I really need to do is is cut down so it's it's quite individual isn't it.

Helen Garr (17:47)
That's a really good point. And something I talk about a lot checking in with yourself that you just mentioned. And we tend to do as humans, we go and go and go and go and go.

until we crash and actually we don't learn the skills or take the time to check in with where we are. Are we about to fall off that cliff and we know if we take the time to check in we can pull ourselves back. So something I talk about a lot is

getting into the habit of checking in with yourself every day if possible? You can do it when you're in the shower, when you're cleaning your teeth. Where am I today? So some people have told me they like to use a number scale. Where am I on a scale of one to 10?

Some people like a color scale. So am I red? Am I amber? Am I green? Where am I? Somebody told me that they take their phone and every day in their calendar, they give themselves a number in their when we get into the habit of tracking where we are every day, it only takes a few seconds. We then can get into the habit of actually,

Am I slipping? Am I ⁓ moving orange or the red? What do I need to do to bring myself back into the green? We can start to notice patterns. I know when I don't walk the dog every day, then definitely I start to slip.

when we get used to checking in with ourselves we know where we are. It's thinking about something called a wellbeing plan.

some of the things that a wellbeing plan gets us to do is to write down, and we know if we write something down, we're more likely to do it. Things like, what do I need to do every day to stay well?

What do I need to do less of to stay well? What do I know if I was to start doing or have something I've done in the past that helped would make a difference? What do I need others do for me? So for me, simple things like making sure I a five minute break to get some daylight,

Making sure that when I'm not working from home, so when I was working full-time as a GP, making sure I took a lunch with me rather than sending out a screen message saying has anyone got any food they can lend me and somebody's bringing me in five quality reception to get me through the day. I know that I need to take lunch with me to work in order to stay well. So I think

Getting into the habit of checking in with ourselves, however that works for you, and then thinking about what are your needs to stay well, keeping them really small and simple can really make a big difference.

Lee (20:10)
really like that idea of checking in with yourself and noticing.

so Richard Duggins is another one of our Practitioner Health and he's written a brilliant book, Burnout Free Working. And he talks about radiators and drains, which I think you can relate not just to burnout, but to really just about I think the idea about what kind of activities acts as a radiator that warm me, that lift me, that give me a bit of energy.

in small ways. And then what things deplete me? What are the drains? I sometimes use an analogy of if I was a car, then what kind of activities would mean that I'm going to the petrol station? And even if it's only like a pound of petrol, which doesn't look very much in the current climate, but actually it's cumulative and just a few of those little micro fills at the petrol station can really make a difference to mean that we then don't hit the red zone and run out of fuel when we're trying to drive up a 
hill tomorrow. So I think it's that awareness of what those things are. 

I'd like to pick up what kind of things might be radiators and drains for people, but also before we get to that, when we're checking in, what should we be looking out for that might suggest that we need more support, that it's not just a question of I need to go out for a walk, but actually I might need out to a service like Practitioner Health, to my GP, it might be a friend or a family member first of all, but to somebody to say hey struggling and I think I probably need some more support. So when do think we should be doing that?

Helen Garr (21:35)
Yeah, yeah, I think it can be really difficult to know yourself. And one of the most common things that people say to me when they come see me is, I'm sure there's so many more people worse off than me who need this service more than I do. And I'm not sure I should have come here. I think I'm wasting your time. So I think we have a tendency as humans sometimes to ignore things or minimise things and not want to take up anybody's time.

So I would say first of all, if there is any doubt in your mind, there's any worry, if there's anything you think, actually, I'm struggling a little bit here, seek support as a GP, as a practitioner health doctor, I am always so pleased that anyone comes to me. And we see people sooner, it's easier to get people better than when we wait too long. would So when we get into the habit of checking in with ourselves, if we are

consistently low, so numbers on the low side, sitting in the red zone for more than a couple of weeks, then it's probably time to think about what do I need to do to make a change. If how you are feeling is interfering with your life, so if it's interfering with your function, stopping you doing things, then really that's a sign to speak to somebody here. if other people are worried about you.

So if you find family members or colleagues are worried about you, people might just say, you're not quite yourself today. And that in itself actually is something that's really brave for people to do to say, I've noticed you're not quite yourself. How are you doing? Are you okay? Do you need to have a little go and get some support? That's a really valuable thing we can do for each other, but we don't always do that. But if somebody has, noticed you're not yourself as other people are worried about you then absolutely I think it's time to think about how do I get some support here.

Lee (23:28)
So turning to a serious aspect of low mood that can sometimes be exaggerated in the winter months, people can start to feel quite hopeless. They can start to feel very low. And sometimes that can then lead to more serious thoughts that we are worried about. People start to question whether they want to even continue living.

And I'm aware that this is a very sensitive area for people to hear about, but it is an important area, I think, because these are the conversations that we need to be able to have openly so that people are able to raise it. What are your thoughts about that, Helen?

Helen Garr (24:04)
Yeah, thank you for raising that. And it can be really hard to hear about, it can be really hard to talk about, but we know when mood gets low, particularly over the winter months, it is not that uncommon for people to present, thoughts of feeling like life's not worth living, thoughts that you may be better off dead or suicidal thoughts and certainly we do see that at Practitioner A third of everyone who registers with us actually experienced suicidal thoughts in the two weeks before coming to us and a third of those have made plans to end their life. It is really important that people feel able and know how to seek help if that is happening to you.

It's a horrible place to be, but there is always hope and there is help. And it's incredibly important that you're able to reach out and to speak to somebody. We know that this is so difficult. if you are worried about somebody, it can be really difficult to know how to approach this to, am I going to say the right thing? Am I saying the wrong thing? If you are experiencing thoughts that life's not worth living, it can be difficult to know where to turn or what to do. 

And actually we've recently created a fantastic guide on our website, a suicide prevention and postvention, which means what to do after, if there has been sadly a suicide, how to support yourself and others. I just want people to know you are not alone.

And there is always hope and Practitioner Health are here to support you, so many organisations out there who are able to help and support. Your GP is there. We want to see you if you are So I would really recommend people take a look at the guide on our website. And please, please, please do reach out if you're struggling.

you're not alone.

Lee (26:08)
sometimes say to people that these thoughts, they're a sign of distress, they're a sign that we're struggling, they're not a sign that they're accurate or that they need to be believed and it's trying to recognise that this is a sign that I need more care, it's a sign that I need to reach out and feel held rather than the opposite and I think it's really important to it's common to have the thoughts and it doesn't automatically mean that people are going to go and act on those thoughts.

But if they're there, it's really important to talk about them get that professional support with knowing what the next step should be.

Helen Garr (26:41)
Yeah absolutely and things can and will get better with the right support.

Lee (26:51)
This is the choice pause.  A short two to three minute tool drawn from my books and online courses, that you'll hear in every episode.

Each time with something different to help you pause, notice and choose your next step.

Today's pause is creating space positive action. 

Take a slow breath in and a longer breath out. 
Let your shoulders hang down. Soften your jaw and the muscles around your eyes.

For a moment, let go of any judgment or expectations about how you should be feeling or what you should be doing right now.

when our mood or energy is low,  taking action can feel really hard.
we might notice there's tiredness, lack of motivation, or unhelpful or negative thoughts.

Yet often, action comes before motivation, not the other way round.

Bring to mind something that matters to you. Maybe it's your family, or a love of the outdoors. or perhaps it's around values such as curiosity, movement or connection.

Now think about one small action that you could take.  something that would take only a few minutes and feels realistic today.

We may be still carrying fatigue, low mood or doubts with us and that's okay. We can bring those with us as we choose to step out for a short walk.

Send someone we care about quick message. Gently move our body spend a few minutes doing something creative or absorbing.

See if you can treat this as an act of kindness towards yourself.  it's not about creating pressure or stress.

Just making a start, doing something that matters.  And carry that permission with you. to start small and choose something that matters to you into the rest of your day.

Helen Garr (28:49)
if you want to perform at your best, if you want to get better, then the way to do that.

is to have a crew. So Richard Duggins, actually one of the things at Practitioner Health is we just have the most amazing people work for us. blows me away the expertise we have in our workforce. But Richard Duggins talks about in his book, who's your crew? So times are tough,

Who's your crew? And he talks about, you know, that children's song, head, shoulders, knees and toes? So identify your crew. Who's your head person? Who do you go to when you need to, you know, talk about a problem, sort a problem out? Who's your shoulder person? You know, if you need a shoulder to cry on.

who's your knees person, can have a knees up with, who you can have fun with, you chew the fat with. We all need to have fun, let off steam. And the toes, who's that person that's going to give you a bit of a kick up the backside and point you in the right direction? I hope I've done that justice to what he says in his book. But I really like that concept of identifying who's your crew. And it might be different people for different things. It might be the same person, but we've got to put

we've got to put the time in with our crew. can't expect our crew to just suddenly be available when we need them. So I think there's something about cultivating your support network and putting that time in with the people who are important to you, who you value, you enjoy spending time with, who bring out the best in you, your head, shoulders, knees and toes people. But...

sometimes we need professional support it takes a lot of bravery to stick your hand up and say I need some support but we know that with professional support whether that be your GP whether you're going to your local talking therapy service

whether it's a professional through your employer or an EAP service or whether that be practitioner health, that when you get professional support, people get better quickly.

Lee (30:46)
do love that idea of head, shoulders, knees and toes. I'm going to be singing that away such a great idea and

I would really encourage people to lean into connections where they feel like connecting with this person feels like it's filling up my petrol tank a bit, because there are other connections that actually feel quite depleting. And I think particularly if we're low or tired or stressed, then actually we might want to reduce contact in environments where perhaps that is more negative and try and focus on these uplifting type of interactions.

Helen Garr (31:14)
So I talk about juicy strawberries. you've got a punnet of strawberries in your fridge, beautiful, juicy red strawberries, but there's one mouldy one, very quickly that punnet goes mouldy. So I talk about this concept of identifying who's your juicy strawberries, who are the people who make you feel great and you don't need to have loads of them. But when I did this sort of strawberry audit in my life a few years ago, I was quite surprised actually. People I was spending time with who were draining me, who were depleting me, and I hadn't quite recognized that happening.

And I have an actual list. I know who my people are who make me feel good about myself. And I'm intentional about spending time with them. I'm also well aware about the people who might drag me down and I'm intentional about limiting the time I have with them or how I approach
time I have with them. Another exercise that's really and deplete and nourish exercise.

and you write down everything you do in a typical day from getting up in the morning, making the packed lunches, driving to work, turning on your laptop, looking at your appointment list, whatever that might be. You write down every single activity. And then next to each activity, you give that a D, does this drain and deplete me? Or an N, does this nourish me? And then you look at your list and all the things that drain and deplete you.

How can you either get rid of them or how can you change them and approach them differently so that they're more nourishing? You look at your nourishing activities and you think, how can I do more of those? How can I be more intentional about when I do this? take notice when that's happening? I did this when I was a full-time GP and one of my

D's was my commute to work and I just hated my commute to work. It used to take me an hour each way every day just drained me so much. So I reframed my commute to work to this is an hour just for me, where I can't be interrupted and I downloaded all my favorite podcasts, downloaded some lovely music to listen to, some audio books, and I reframed that this hour was my hour where I could do things that nourished me. And I started to almost look forward to my commute to work,

Lee (33:30)
there's quite good evidence that behavioral activation a really effective treatment for when people are low. that's just about doing more stuff that not an endless list of stuff, but making sure that we are doing things that are the nourishing activities. And so I sometimes use a mnemonic called SPICE, which is five types of activity think are

Helen Garr (33:35)
Yes.

Lee (33:50)
S is something that brings a small sense of achievement. P is some kind of physical movement, moving our bodies. I is something that's important and meaningful. And then C is that connection that you're talking about, that, you know, the head, shoulders, knees and toes. And then E is enjoyable things, things that are relaxing.

Helen Garr (34:03)
Yeah.

Lee (34:07)
listening to the audiobook or doing some knitting or, you know, sitting enjoying outdoors. So for you, what kind of activities do you see as being particularly important for helping cut through some of the low mood that can come in the winter months?

Helen Garr (34:22)
So I love your spice analogy, actually. on the similar lines, I work to the five ways to wellbeing model, which are around connect, learn, be active, take notice, and give.

and the evidence shows us if we do one or two things from each of the five ways to wellbeing, couple of times a week, but every day even better, then we will see demonstrable improvements in our mental health and wellbeing. For me, movement absolutely is so imperative and...

When I say movement, I'm not talking about gym or running marathons, just simply moving our bodies, we know makes a difference. Every time we move our body, we release chemicals in our brains and in our cells that reduce inflammation and that make us feel happier. And

we know that in the hour after moving our body, we're better at problem solving, we're better at remembering things. So for me, I try and prioritize movement. Sometimes it will be as simple as if I'm in a meeting, I can do that standing, keep weights by my

It can be very difficult to bring physical activity into our lives because we're all so busy. Time is a big barrier. So something I like around movement is this concept of habit stacking. So you pick something you do regularly like, I drink a lot of tea. So every time I boil the kettle, I do five squats. So I stack a habit onto something I do regularly and it's an easy way to bring movement

Secondly connection, so a whole body of evidence about value of connecting with a really famous study is the Harvard study of happiness

And the number one thing that's come out of that study is having close personal relationships makes a massive difference to our mental health and well-being. It's not success, it's not fame, it's not money, it's close personal relationships. So I

Cultivating our relationships is really important and if we're lucky enough to have a spouse or children or family members. It can be really easy to not put the time in with that. So how could you come home from work and actually you're all just getting into cooking tea or doing whatever and you haven't taken a minute just to say how was your day? What went on for you today? So just being intentional about our relationships. But there's also a lot of evidence that actually

having small, meaningful interactions with people who aren't in our close personal circle can also make a difference. chatting with the bus driver or the checkout operator or your colleagues at work, you know, what did you do last night? How's your day going? Those small meaningful interactions can also make a big difference.

We'll go through our day with our heads on our phones, our heads eye contact with strangers. We don't make conversation. I would prescribe for anyone listening to this podcast today, IN the next 24 hours.

seek out a small meaningful interaction with somebody, the postman, in fact my postman came this morning and I had a lovely little about the weather. and even if that makes you uncomfortable, just do it as an experiment and see how that makes you feel So for me, the big ones are movement and connection,

getting outdoors, so nature, daylight, really, really important. And Richard Jones, who's our amazing clinical director at Practitioner one of his catchphrases is, nature is cheaper than therapy. And do you know what? He's absolutely right. And again, there's a whole body of evidence about the power of green and blue spaces on our mental health and wellbeing

Lee (37:51)
Hahaha

Helen Garr (38:00)
and spend a couple of minutes a day in that green or blue space if you can. But there is evidence that even looking at a picture of nature can have benefits to our wellbeing. So apparently within four and a half minutes of looking at a picture of nature, our parasympathetic nervous system is activated. So that's the opposite to our fight or flight, we're calm and relaxed and, feel good about ourselves. So even just changing your screen saver at work or putting a picture on your phone can make a difference.

Lee (38:30)
Those are so, that's so helpful, Helen, and really powerful. And it sounds like just a little bit about being present. So we might have people around us, but are we present? Are we bringing our attention and focus just for a few minutes to that interaction? And I try and often have a chat the supermarket delivery driver who brings our shopping, as I'm lugging in all the shopping, but it's just really lovely. You just have a little chat about their day and how things have been going and it's small but important.

Helen Garr (38:54)
Yes.

the taking notice is the key. So if we are aware that actually having a meaningful small interaction with somebody makes a difference, what then gives you real impact is taking notice. So actually I had that small interaction. This is how it made me feel. Just being present.

If you're outdoors, you might be standing at the bus stop and there's some trees nearby, just taking notice of what is going on around you and appreciating this is what really makes a difference. I think the other thing I wanted to say is one of the things that really helps me is at the end of every day, I try and think to myself, how did I make a difference?

the five ways to wellbeing, the give, the random acts of kindness, doing things for other people without the expectation of anything in return, we know makes us feel great. That is where we get real purpose and value, taking notice of where did I make a difference today?

And I'm going to give you one example. Many, many, years ago, my son was quite poorly and he was admitted to the hospital where I worked as a junior doctor. I observed a consultant on the ward who wasn't looking after my son, he just worked on the ward, making the biggest difference to my family. And he would never have known really he did this. He was walking onto the ward at the same time as my husband. And he just stopped and he held open the door for my husband. And I watched this happening. He was like, how are you doing? And my husband was fine, thank you. And my husband was so grateful that someone had just opened the door for him, asked him how he was, let him in.

And it was so impactful for us because it was such a difficult time for us. We were tired, we were worried, and just that small act of kindness of you holding the door open for father. Just how are you doing? You didn't know us, you didn't know anything about our circumstances, but that made a big difference. And we still talk about it 16 years later and he was like wow I had no idea. 

So I think taking notice of where we can make a difference and being intentional about what we do in our day even when it's tiny tiny little things like we checked in on a colleague or we held a door open for somebody that can be huge for our well-being and I try and prioritise those kind of things especially over winter.

Lee (41:17)
so Helen, I think we probably really could keep all morning about this, to finish, always do a Choice Space takeaway, which is just one or two small steps people could do to try the next few days weeks to support their mood or to lift their mood in the winter months.

Helen Garr (41:34)
Top tips number one, move your body. So we do not feel like movement when winter comes. We just often want to hide under the duvet, stay in bed, move your legs. Your mind will follow.

So move your body however that may be. It might be doing some star jumps in between patients. It might be doing some squats when you're boiling the kettle. It might be just standing in a meeting, taking a walking meeting, parking your car a little bit further away in the car park to walk to work, taking the stairs instead of the lift. 

Number two, get light into your day. is so easy to go all day without seeing any natural daylight. So lighten your mornings, darken your evenings. That's the best way to get some sleep. if we sleep well, we cope better. So just even a few minutes every morning by a window or having a cup of coffee at the back door, even on a gray allows us to absorb that light, to allow us to feel more alert, more awake. get some daylight into every day. And if you can bring some green spaces or blue spaces, some nature into your day and take notice of that even more important. 

Number three, I love this concept of thin slices of joy. finding little things in your day that bring you joy and taking notice of them. Things that happen to all of us every day, like slipping into freshly washed bed sheets, your child's hand in yours, that first sip of coffee in the morning, seeing a blue sky, seeing a bird outside the window, that colleague greets you with a lovely smile. 

taking notice of these thin slices of joy make a massive difference to our well-being and when we start to take notice of them we can then start to craft our days to have more of them so joy on demand one of my thin slices of joy is a really good cup of coffee in the morning. I drink it mindfully. I take notice of how nice the coffee is, how beautiful the mug is and this is my joy on repeat

my takeaways are... The things that can make us feel better don't need to cost money. They don't need to take time. We just need to be intentional about them. And finally, if you are struggling, please, please, please do not struggle alone. Please seek help. Please talk to somebody. Practitioner Health is here - If you are a health or care professional

We are here to look after you and care for you and treat you.

Lee (44:03)
Thank you so much, Helen. IT'S been such a great episode. So thank you so much for taking the time. I know how busy you are. So we really appreciate you taking the time join us today.

Helen Garr (44:12)
Thank you for having me.

Lee (44:15)
Thanks for listening to the Choice Space podcast. hope this conversation has offered a little more room to breathe and find your own way forward. We've linked all the ways you can connect with Helen and how to access NHS practitioner health in the show notes. If today's episode has been helpful, please download follow and share with someone else who might value the space as well. I'd love to have you with me for the next episode. then, take care and keep making space for what matters most. 

This episode was edited by Elle Dixon.