Nikki Scheiner
Psychological Tips: Managing Anxiety and Fear, Developing Resilience Through Connection

Dr. Nikki Scheiner - Psychological Tips: Managing Anxiety and Fear, Developing Resilience Through Connection

- Good evening everyone, and it’s my very great pleasure to introduce Dr. Nikki Scheiner and her topic. And I think it’s so important at the moment when so many of us are all over the place, we just don’t know what to do. And so, her topic is Managing Anxiety And Fear And Developing Resilience Through Connection. She’s a consultant psychologist who specialises in PTSD and acute chronic stress. She’s treated survivors of war in conflict zones, such as Bosnia, Sierra Leone, Sri Lanka, and Northern Ireland. She also taught on the war and psychiatry master’s programme at King’s College London, focusing on the role of women in war. She designed the CST psychological first aid response in the event of an attack on the Jewish community. She’s offered resilience training and crisis management to community leaders working with consultant psychologists Dr. Amanda Lurie and Yotam Dagan, Israeli operational stress expert, and former Navy Seal who takes the lead on crisis management at CST. Nikki, thank you so much for coming in and sharing your expertise with us, and welcome.

• Thank you. Welcome to everyone, and I hope that everyone will find something helpful in my talk. I just want to start by saying a huge thank you to Wendy and to Trudy, and to all the staff at Lockdown. I feel really grateful and privileged to be a student of Lockdown University and have access to such knowledgeable and gifted speakers, and I’m sure that I speak for a lot of people. And even better, unlike other universities I attended in my youth, there’s no homework and I don’t get reprimanded for missing sessions, all glorious. So, coming to today’s subject. I’ve just put together some tips to help us all manage the anxiety and fear that we feel and to think about how we might develop resilience through connection. So to start with, an overview. What I’m going to do in this talk is to try and understand our emotional reaction to the war in Israel, the protests on our streets, and the rise in antisemitic incidents throughout the world. I’m going to talk a little bit about understanding hatred, not in order to frighten any of us, but actually to reassure people that faced with hatred, there is little we can do to undermine it. Obviously a large thrust of the talk will be about anxiety, understanding it, recognising it, and reducing it. And then I’m going to give you some tips for maintaining wellbeing, and talk, it’s a thread that runs through today, about a connection through community and using community as a tool for resilience. So I found this slide, and I rather like it because it just shows there’s an absolute maelstrom.

All these emotions are swirling round, there’s no sense of direction. We’re all at a loss. And so, these are some of the emotions that most of us are feeling. There may be other ones that aren’t here, and that’s fine. I’ve just put together the ones that I’m hearing in my own clinic and people on the street telling me. So, incredible sadness, grief, anger, shock, fear, guilt. Could I do more? Terror, pain, self-doubt, ambivalence, incredulity, betrayal, it just goes on. So I’m sure that there will be some people today who will say, oh, but I’m experiencing something different. All emotions are validated. Somebody sent me this the other day about giving meaning to our suffering, and it’s the Jewish virtue of Nosei B'ol Chaveiro. And I wasn’t sure, so I checked this with Rabbi Jeremy Rosen and he said, yes, this is a very important virtue, and it’s about meaning. “We are all meant to carry the burden of our friends and other people. Jewish people do not ignore the pain of others.” And this virtue comes… It’s described in the Book of Exodus, Chapter 2, when Moses, who’s been raised in a palace, goes out and meets the other Hebrews who are suffering, they’re slaves. He tries to understand and be with them in their pain. And when I thought about this, it reminded me of a book that I’m sure a lot of people have read. Viktor Frankl, “Man’s Search for Meaning”. And I thought, this is what we’re doing as a community. There is meaning in our suffering, we’re suffering together. We’re standing by Israel and by each other. So, going back to our emotions and our feelings and our thoughts, they’re all free and they’re all valid. What matters is what we do with them. It’s not what’s going on in our head, it’s how we behave.

And I thought it might be helpful to tell you a little bit about hatred. And I’ve been told there are people around the world, Jews around the world who hate the government of Israel. And I’m not sure if that actually fits into my understanding of hatred. You can have rage, rage at what’s happened. You can have absolute disagreement and anger, but the hatred that we have experienced, October 7th and onwards, is something different. And these are just a few points about hatred. So, hatred is based on what we take to be people’s character. It’s not based on reality, it’s not based on knowledge. And we know that in the attacks on the 7th because nobody stopped to say to the Filipino lady who was looking after the disabled Jew, oh, you’re a Filipino, you know, what do you think about Israel? So it’s not based on reality or knowledge, which makes it frightening, but more importantly, it means that we can’t really tackle it. It can’t be cured by time. It’s not an emotion, like you get up and you’re angry and you do something. You shout and then you feel better, or you say sorry and then you feel better. But it’s a sentiment, it’s enduring. And I think that when we look at the structure of Hamas and the underpinning philosophy, if one can call it that, of Hamas, we can agree that it’s a sentiment, it’s enduring. Hatred entails irreconcilable discourses and values, hence the lack of possibility of negotiation. And values, for me, is the same as the virtue of suffering with people. One of our values is community. Hatred, as we know, typically descends into violence. Physical violence, eliminationist, you know, from the river to the sea, psychological violence, lying, taunting, playing German military songs, live streaming using the hostages phones, and glorifying what’s happened. And very importantly, emotional hatred, denigrating people, terrorising people. And also, hatred is used as a rhetorical device. It weaponizes language. Language becomes a weapon of war by defiling it and desecrating it in the same way that the bodies of the babies and families were desecrated.

And so the example, the obvious example here, is how on the 7th of October we were victims, and by the 9th of October it seemed that the discourse had switched and Jews and Israelis were the aggressor. So that comes from hatred. So just that you understand, it’s almost, in a way, to be expected. And I could’ve called this slide Hamas’s Procrustean Discourse, but I’ve called it hatred. So I don’t know if you know, but Procrustes was a bandit in Greece, and in fact, he was an innkeeper. And people came along and he had two iron beds, and he put them on the iron bed and he said, you know, “Everybody fits into my bed.” And if you were too long for the bed, he chopped your legs off. And if you were too short for the bed, he stretched you. So you fitted the bed but you died. And I think that this is what we’re seeing with Hamas and other enemies of the Jews. That they have a discourse and, whatever happens, they will make it fit the equivalent of Procrustes’s bed. So that’s hatred. So now let’s turn to something about anxiety, because I think that that is the most common symptom being reported at the moment by Jews the world over. So anxiety is a response to danger, and it can be a real danger or it can be a perceived danger. And you can use the words threat and danger interchangeably. Anxiety is the intolerance of uncertainty. People who are very anxious just want to get to the end of something. They want to know it’s going to be okay. They can’t cope with process.

Anxiety entails an experience of a lack of control. We can’t control what’s going on. And of course that’s why a lot of us are anxious because we can’t. But at the same time, it prevents problem solving. And in this context, the context of today’s talk, I mean problem solving in how can we keep ourselves well? What can each and every one of us do to help ourselves and our communities? Typically with anxiety the symptoms are physical and they’re unpleasant. So anxiety is an evolutionary response to danger. So if you meet or if you met this saber-toothed tiger, I assume you wouldn’t be saying, oh, I wonder if I’ll take him back and introduce him to my family and see if we can tame him. Or, maybe he’s quite friendly ‘cause he’s already eaten. Because, by that time, you will be what the tiger wanted to eat. So, when we find ourselves in this danger, we get ready for fight or flight, those of which are survival mechanisms. And what happens in the body, it activates our sympathetic nervous system. That’s not particularly important if you’re not interested, but if you are, it’s the sympathetic nervous system that’s activated. And anxiety prepares us for action. Well, obviously. So our breathing becomes shallow so we’re ready for flight. Blood goes to our major muscle groups, legs, arms. Our heart beats faster to help oxygen circulate. Our hands may sweat. Yep, makes us lighter, we’ll run faster. Urination may increase in frequency. You may void your bowels, or you may have diarrhoea. You’re getting rid of weight, we’re more able to run fast.

So that’s great when you’re facing a saber-toothed tiger. You might be lucky, you might outrun the tiger. But what if I’m at home watching television? And so the anxious person might have the same response as if running away from the tiger, but you’re not using the adrenaline that your body’s producing. Instead you’ve got so much adrenaline that you’re now producing more stress hormones. Cortisol, et cetera. And what that does, because you’ve got an imbalance in your body, you’re not getting rid of them, you’re not running for your life, it produces headaches, stomach aches, you might feel nauseous, shortness of breath and fear. So all those physical symptoms are because we’re getting the same response as we always did, but we’re not running away. We’re just sitting, in this case, at home watching television. And anxiety leads to fear. And Lovecraft, who was an American writer, he died in 1937, he wrote all kinds of weird and wonderful books, wrote, “The oldest and the strongest emotion of mankind is fear, and the oldest and strongest kind of fear is fear of the unknown.” And fear spreads. You’ve only got to think about football, instants in football stadia. And remember that people panic and then you get the crush. Fear spreads rapidly. So, if fear is a result of anxiety, let’s see what makes anxiety worse. Spending time online searching for updates. And we don’t even know whether the sources we are accessing are trustworthy. Sharing with your friends videos, images, and so-called news. It does you no good at all, it’s very unhelpful, and it’s not helpful for your friend.

So as a psychologist, I never talk about wrongs and rights except in moral terms, but in psychological and emotional terms, I talk about helpful or unhelpful. So you need to ask yourself the question, is what I’m doing helpful for me and others or not? Catastrophising and overthinking or ruminating, which is that closed loop when you just go round and round and round, is again unhelpful. Only the worst will happen and you can’t get away from it. And the result of that, again, is going to be more anxiety and more depression. Telling yourself that of course you’re anxious 'cause you’ve always been anxious. Well, that doesn’t help either. So my response to this is you weren’t born anxious. You might have had, if you’re unlucky, you might have a predisposition towards it, but that doesn’t mean you have to become anxious. We can all learn you weren’t… You didn’t arrive on the planet as an anxious baby. And I give this example, because it’s always helpful to give examples, about learning to do things differently. So say I go out of my house on a Monday and I stub my toe, ow, and I do the same on Tuesday. And guess what? I do the same on Wednesday. Does that mean I will stub my toe for the rest of my life, or does that mean that maybe I can learn another strategy? Like maybe look where I’m going, be careful. And that’s really important because people who are very anxious think it’s a life sentence. No, it’s unpleasant, but we can learn to manage it, live with it, sometimes overcome it, but be in charge, be agents of our own wellbeing. And the last thing that anxious people do, and it’s disastrous. I don’t normally use such dramatic words, especially at the moment, but this is, is ask for reassurance. Why? Because reassurance doesn’t last. So say I’ve got a mole on my hand and I go to the doctor.

I go, “Doctor, doctor, look at this mole, I think it’s cancerous.” And the doctor looks at it and says, “Okay, we’ll scan it. Or we’ll do something to check it.” And it comes back and I’m absolutely fine. And three days later I go back to the doctor and I say, “Doctor, doctor, look at this mole on my hand, it’s cancerous.” He says, “But Nikki, you’ve just had a scan.” I say, “Ah, that was three days ago.” And that’s the process of reassurance. Because it’s coming from an external source, we don’t reassure ourselves. We never manage to reassure ourselves, we are always dependent on other people. And it’s about developing our own reassurance. So I thought what we’d do is three short exercises to help reduce anxiety. And just before I go through these exercises, which you’re very welcome to do at home, is to say that they’re all very, very short exercises that can be lengthened. And I’ll show you how as we go through. So the first one is to calm your breathing down. So learning to breathe from your diaphragm. So what you do is you put one hand here on your chest and one hand here on your diaphragm, on your belly, whatever you call it. And you then imagine that you have a balloon here, like at a child’s party, and you colour the balloon. I put a blue balloon, it can be any colour you like. And what you’re now going to do is you’re going to inflate the balloon. And so just watch what happens to both my hands, I want you to notice. So I’ve got this balloon and I’m going to try and blow it up, inflate it, for three seconds, hold it for say two, and then deflate it for four. Okay, watch my hands. So here I’m going to inflate my blue balloon. Hold it for two.

Through my mouth. Going to do it again. Hold it for two. And I hope that what you see is this hand gets pushed out from the ribcage as I inflate my balloon, and as I blow out through my mouth, it goes back. It goes back in towards my ribcage. If this hand is moving a lot, you are doing what’s called shallow breathing, and shallow breathing is associated with anxiety and panic. And then what happens, just so you understand, is that you don’t get rid of the carbon dioxide in your blood, so you’re just going, taking in more and more oxygen and then you get a funny mix, an incorrect mixture in your bloodstream. And guess what? You start to feel ill. You might feel lightheaded or dizzy. And what that is, is that you have an imbalance of those two gases in your bloodstream. Don’t worry if you say, look, I’m 40 or 50 or 60, I should learn, I should have learned to breathe by now. Lots of us don’t breathe like that. The only people who really do well in breathing are people who do martial arts, and they always breathe like this. So if you start and then say, oh, well, I can’t breathe, or my hand’s going up, that top hand, don’t worry. Just practise. And you can do this exercise sitting down, standing up, it’s free. I wouldn’t suggest you go out round town with your two hands stuck to your body. The reason you do that is so that you learn if you’re breathing well. So when you are at home, you can do it. You can do it for, say, practise five breaths. You can do it as many times a day as you want. And once you know how to breathe, you can calm yourself down when you’re at work, in a shop, anywhere, by doing that exercise. So you can make the, you know, you can make the in breaths longer if you want to do six or seven seconds.

The important thing is to try and make the out breath, when you are deflating the balloon, longer than the in breath. You want to get rid of all that stale air. So that’s the first one and that’s for breathing. And we know that if you get your breathing right, you get your heart rate right and you cannot be anxious. If your breathing is right, your anxiety levels come down. So this is another exercise, and this one now is to do with muscles. And so it’s about tensing and releasing groups of muscles. So you can either start at the top of your body, screw up your eyes really, really hard, grit your teeth. Or at the bottom, your toes, your feet, your calves. And you individually tense each muscle group for about 10 seconds, and then relax them. And the important part of the exercise is to notice the differences between having, for instance, clasped hands like this and then releasing. You should do this systematically. So you can do both sides of the body at the same time. So you can do both your feet, both your calves, both your thighs, and that’s easier for anxious people, because I can’t remember where, you know, if you’re very anxious, you can’t remember which side or which muscle group. Or you can start on one side of your body and then progress to the other. And again, you can do this exercise for a few seconds, holding and contracting and releasing, or you can do it for much longer. This exercise is lovely. So Russ Harris is an Australian author and psychologist who’s written a lot of books about ACT, which stands for acceptance and commitment therapy. And he has a very good exercise called dropping anchor. So how do we drop anchor in a storm?

And the storm is an emotional storm. So, you can do this exercise sitting, standing up, lying down or walking. So you need to feel the ground under your feet or the bed or the settee under your back. And there are three parts to this exercise, A, C, and E. So A is acknowledge your thoughts. So right now, I’m sure we’ve all got feelings and emotions and memories and urges and sensations going through our head. And then, don’t do anything with them, just connect with your body. Quick stretch, shake your hands, move your head from side to side, and that’s the C, the connection. And then engage. There’s a room around you. Look around and notice, what can you see? If you want to name things, wall, door, light, do. And finally, just notice that you’re present here today, and I hope listening to this presentation. So you can do this very fast as almost like an emergency. You know, I’ve got to drop anchor, because it’s brilliant, it just calms you down. Or you can do it for 10 minutes. And if you go onto the internet, you’ll see that there are lots of scripts for dropping anchor. If you can, go with Russ Harris, find one of his scripts rather than all the people who’ve copied him and changed things, it’s probably a good idea. So, that’s specifically anxiety. And now I’m going to just give you some more tips for maintaining wellbeing and developing resilience. So resilience is, I’m sure everybody knows, the ability to bounce back. It’s like the buoy, B-U-O-Y, on the sea. It gets buffeted by the wind and then it rights itself. It’s like an elastic band. You stretch it and then it goes back to its shape. If you’re really on edge, it’ll snap. So let’s have a look at these tips. The first tip is keep a structure, keep a routine. Try and get up and go to bed at the same time within half an hour. Not, oh, I watched news very late last night and I’m so distressed and I tossed and turned all night and, yeah, I just overslept this morning. That doesn’t help, routine helps.

Don’t take a daytime nap unless that’s what you always do. And if you do, limit it to 30 minutes and limit it to no later than early afternoon. You know, having a daytime nap at six o'clock, you’ll just make it more difficult for you to get to sleep. The next one is to eat healthily. When anxious, some people eat more, other people eat less. If you’re struggling to eat, just make sure that you have small snacks throughout the day so that you’re not starving. If you are overeating, just don’t order pizzas and donuts to come to your home every three hours. Just monitor yourself. That’s the important thing for maintaining wellbeing. Monitor how you think you’re doing. Try and limit your caffeine intake as this may increase your anxiety. And again, not after, some people lunchtime, some people two o'clock. I do meet people who tell me they go to sleep beautifully on a double espresso, but it’s not my recommendation. When anxious or not wanting to think about situations, people tend to use alcohol. Alcohol, it helps you get to sleep, but it wakes you up in the middle of the night. It interferes with a lot of medications and it has a tendency to move people towards a state of depression. So hugely tempting, and therefore, try not do it. Continue to exercise, so important, yeah? That’s the adrenaline, use it up. Take the dog for a walk or swim or go to the gym, or if you’re scared to go out, join a zoom session online. Doing exercise will keep you fit and it will also reduce your anxiety. Sleep. Sleep has a function and the function is to restore us. Really important. Turn off all electronics at least one hour before you want to sleep. Don’t watch horror movies. It’s not going to help you have a good night’s sleep. Do some simple stretches before you get into bed so you can just be in the bedroom and just stretching, you know, head down or toes towards your feet. Once in bed, you could do the progressive muscle relaxation. It’s fantastic.

The other thing that you can do is you can have a pencil and a pad by your bed and you write your worries down on them so you don’t have to dwell on them during the night. You can keep them for the morning. And a very interesting piece of research divided a group of insomniacs into two, and one was given a pad and a pencil and one were given zopiclone and pills to help them sleep. And after the six weeks, the ones who had sleep medication were not sleeping any better. And yet the ones who let go of their worries were sleeping a lot better. And we know that the number one reason for not sleeping is worrying about not sleeping. So if you have a thought during the night, don’t ruminate, don’t go round and round the thought, just write it down and leave it till the morning. Another exercise to help you get off to sleep is think about a favourite activity. So it could be DIY. I know Jackie Mason would say Jews don’t do DIY, so it could be painting, it could be gardening, it could be playing a sport or watching a sport. I don’t know why I’ve got cooking twice. It’s obviously the Jewish mother there. And you use all your senses. So if you were cooking, you would take the ingredients out of the cupboard, you would see them. You would feel, say the butter and the flour. You would touch the ingredients, you would put them in the oven and hopefully smell the ingredients as it cooked, and then taste them. So whatever you do, whether it’s painting, you’re dealing with textures, or gardening, you want to use all your senses in the exercise because the more we can visualise something, the more powerful it is, and then you will go to sleep faster. And the last part is about keeping connected. Help yourself and others to become resilient. A lot of people find great comfort in prayer. And if you’re able to, you could consider setting up a Tehillim group. Socialising.

This is a difficult one, because when we’re anxious we often want to withdraw, but we know that isolation makes us feel more fragile. You know, if you stay in a dark room all day under the duvet with the curtains drawn, by the end of the day, you’ve got nothing to think about apart from the dark room. Choose, make a choice to keep in touch with people. Not by sharing war material, but just saying how are they? The other day on Lockdown, we heard retired Colonel Miri Eisin, who’s the MD of the International Institute of Counter-Terrorism, talking on Lockdown about the situation. And she said, you know, “Ask for a hug.” And I think, you ask for a hug, will you give a hug? Don’t feel bashful, it’s so important. Meet friends for a coffee, but not too much caffeine, so this is meeting friends in the morning, yeah? And then give back. So volunteering can be hugely beneficial both for us, for obvious reasons. We feel good, we feel that we’ve done something. And it’s taken our mind away from our anxious thoughts, and it helps other people. So if there is a possibility, volunteer. And if you can’t volunteer, just make a point of asking people, how are you doing? And what’s really important with that question, you’ll notice it’s an open question. It’s not saying, God, this is really terrible, isn’t it? Which kind of pulls for the answer yes, it’s an open question, it shows you want to listen. So not, are you really suffering? Just how are you doing? And if you really can’t cope, it’s okay. It’s okay not to be okay, but don’t suffer. Go to your doctor, ask for help. And just remember that on the 15th of October on reopening the Be'eri printing factory, President Herzog said, “You will never break us. The nation of Israel lives.” And that’s the end of my presentation. I just want to say that if you have any questions that I don’t get round to answering today, you’re welcome to send them in. And Trudy has very kindly said you’re welcome to send them to Lockdown and then they’ll pass them on to me. Thank you.

Q&A and Comments:

So, the first question I see from Ralph seems to be sent to Trudy and it says, download an Israeli flag from the internet and put it in your window and tell everyone. As a psychologist dealing with anxiety, I’m neither going to say that’s a good idea or a bad idea, because some people are very, very scared and what they don’t want to do is to draw attention to themselves. You know, if you live in northwest London where there’s a high concentration of Jews, or in a Jewish area in New York, sometimes being circumspect rather than announcing that you’re Jewish is a good idea. I don’t think it’s cowardly not to put an Israeli flag. I think that it might be politic, in the real sense of the word, not to. So remember what I said, that you can’t negotiate with hatred, you can’t go out and start talking to people who want the destruction of the state of Israel, or just hate Jews. So very brave if that’s what you want to do, Ralph.

So, the next question is from Rita who says, please address PTSD. Okay, so you will have heard Trudy say, it’s a very important question, Rita, thank you for it. You will have heard Trudy describe me as a traumatologist, as a specialist in post traumatic stress disorder. You will also have noted that I have not mentioned the word trauma in my talk. And there are very good reasons. The events may be traumatising. PTSD is a word that has a psychiatric and a psychological value. It is a diagnostic criterion and it is not given to anybody till at least 12 weeks after the event. In the early stages, what we are struggling with is acute stress, not trauma, not PTSD. There may be people, there may be a lot of people who come December, will demonstrate, exhibit symptoms of PTSD, and that is the right time. I also want to say that PTSD is a rather overused word, especially in England, when kind of people, their football team loses, you hear people say, “Oh, I was so traumatised, I think I’ve got PTSD.” And it’s really important that we use the words correctly. So yes, Rita, you’re right, there will be people who develop PTSD, we will need to address that. At the moment, what we’re doing in the UK is we’re getting together teams of psychologists to address these symptoms when we need to further down the line. Israel have also put out calls for traumatologists, but not yet. So at the moment, acute stress, severe anxiety, but not PTSD. I hope that answers your question.

Adrienne, so maybe the old adage is right, no news is good news. I understand where you’re coming from. If you’re somebody who does better living in a news vacuum, that’s great. What I think is you go from one extreme to the other. So the best way, if you want to know what’s going on, is that you have a regular time each day, 10 minutes, 15 minutes, and you trust the source. So you’re getting an update, you’re getting the bullet points, but you’re not going into details, because I think it can suck us in, and yeah, you just hear a lot of hatred going around the world and attacks on Jews here and there and how terrible, on the hospital, et cetera, et cetera. And there’s so much bias and you end up far worse. So I think each and every one, Adrienne, each and every one of us has to make the judgement what is right for me? But I would say do it regularly and limited, and absolutely with social media, you know, going on social media and seeing all the propaganda is not great.

Leon, it’s also yoga breathing. Yes, I’m sure. Loads of yoga is about breathing and it’s wonderful. And yoga and yoga stretches before you go to bed at any time, just wonderful. If…

Oh sorry, Yona. It’s not only martial arts, such breathing, wind in… Okay, thank you, thank you. I only know the martial arts, but thank you for telling me about the wind instruments, musicians. Well, there you are, you can teach other people because it’s about reaching out and telling people, you know, this works, this is what I learned as a, you know, trombone player.

Q: Michael, if fear is the oldest and strongest emotion of mankind and it’s a root cause of anxiety, is it also the basis for hatred?

A: Oh! There will be fear in it. If you read the psychological literature, you will see that there’s a lot of jealousy. And it’s interesting because it’s not. People think that it’s poverty, it’s poverty that causes hatred. But if you look at the literature from the Holocaust and also the people who are protesting the streets round the world, whether it’s Vienna, Barcelona, Sydney, London or Joburg, it’s intellectual. So it’s not about fear. It’s not about the fear that they haven’t got something, they’re never going to have something. I think it may play a part, I think it’s a constituent, I don’t think it’s the major part. And if you think about antisemitism in England and you think that the Jews were expelled in 1290 and I think they were out for 400 years, and the levels of antisemitism didn’t drop. And people didn’t fear the Jews, they weren’t there, but they still hated them. So I think it’s a very complex question and I’m sure I haven’t done it justice, but thank you, it’s an interesting one.

Oh, I’ve just lost, let me just see. Trudy? Oh, no, I’ve got them, Yehuda, you’re welcome. Dawn, you’re so welcome, thank you. Thank you so much, it was absolutely my pleasure. My heart is with everybody as people who are watching, people who are fighting, and I will do whatever I can. And this little thing was something that I could do. So thank you all, thank you all.

Ah, Suzanne, hello Suzanne. Some of us feel shock. That, okay, let me… This is a very interesting question and I want to answer it, and thank you for asking that, Suzanne. You always ask interesting questions. So I think that the shock, I can say two things about shock. What I’m being told by people, the supervisors and the managers at all the organisations who are at the coalface, who are dealing with the research and the imagery, et cetera, is that younger people are more shocked. That may not be the case, but that’s what they’re reporting. And I think, 'cause I’ve been thinking about shock and it was on the Star of David and the emotions I put there. I also think that we all thought that Israeli intelligence was gold standard. And I think a lot of us are shocked by what happened, that failure of intelligence. So I think you deal with shock like you deal with all difficult emotions, self-care, self-compassion, reaching out to people, looking after yourself. This too shall pass. So you validate the emotion, it will pass.

Let’s see, is that that? Can we see the questions?

Oh, goodness, that is a very technological question. I would have to ask somebody from Lockdown to help because I don’t know how to do that, Mona, I’m so sorry. Carla, thank you.

Well that’s very interesting, Sally. So I think being circumspect, that was the point I was trying to make to Ralph. I think that’s circumspect, I do not think it’s cowardly. So I wear a Magen David, I also wear a Chai. I hide it when I feel prudent, absolutely. One, it’s a judgement call, but when you go out, in the same way that you’re not going to start talking politics in a public place, you don’t have to draw attention, but you’re still wearing it, it’s still close to your heart. It doesn’t make you less of a Jew to where your Star of David close to your heart.

Any particular guidance, Louise, for someone who is an A&E paediatric physician who cannot control sleep or schedule. That is a very difficult one. But what I would say is that absolutely minimise the exposure to social media, et cetera. And you can’t control sleep, but you can ensure that when you get to sleep, your sleep hygiene, the relaxation, all of that, is as good as it can be. And using that, they call it the intelligent man sheep counting. The exercise where you, you know, you play a basketball game or a football game, or garden, that is very fast. So do those exercises. So you really need to do more self-care, you have to. The very lifestyle ones for somebody in A&E has to be much more important. You know, make sure you eat, make sure you’re hydrated. You can always run through the wards and run up and down. I’ve worked in NHS hospitals for years. So you’re burning off the exercise, but it is difficult. Try and get time off when you can so you’re not doing 80 hour weeks. And make sure you don’t talk to anybody about the… Don’t get involved in, don’t get drawn into conversations.

Q: Rita, you’re very welcome. Any special advice about sleep quality and length of sleep for post-menopausal women?

A: That sounds like a question that you need to send to Trudy and she’ll send it on to me because I don’t know enough about quality of sleep, et cetera, and it’s about if you’re asking about in the context of Israel or in general. I’d be very happy to answer that outside this webinar, but not in the context. Save and print out all the advice. Well, I’m going to send my slides to Lockdown and you’re all welcome to them.

We are, I don’t know where you are, Marilyn, but we have produced this top 10 tips, but it’s slightly different from what I’ve done today, that’s gone out and it’s all over. If you’re in England, if you go on CST’s website, or the Board of Deputies, it’s there. I can certainly send you, if you send Trudy your email, I’ll send you that, and send to anybody. I can make it, I can extract those three slides if you like, plus the top tips, I can put them in a document for people to have. That would be a pleasure if that’s something people would like.

Q: Is my talk available on recording?

A: I think so. Is that right Trudy?

• Yes.

• It is, Trudy’s nodding.

• Yes, it will be available now.

• Okay, it will be, that’s right David.

Q: Anonymous. Okay, so somebody said, the thought of somebody breaking into their home and attacking is keeping them from sleeping and causing anxiety, so how can I manage it? I’m not usually anxious.

A: And this is what the talk was about. This was for people who are always anxious, or typically anxious, but also for people who have become very anxious in the context of the violence on the streets, as well as the violence in Israel. So one of my patients said that her husband said he was very hot at night and he was going to open the window, and she said, “No, no, no.” And I said, “Look, nobody’s going to start crawling through your window.” So the first thing I would say, apologies Ralph, don’t put an Israeli flag in your window, yeah? That’s what I would say. You’re probably more in danger, you know, crossing a road than anything else. And I think that what you need to do is follow the tips on anxiety. I will try and add something on how to stop catastrophising and ruminating because, of course, as I said, those lead to anxiety, but maybe I need to put some tips in to help you. I’m just very aware of time. Yes, well, Hava says, looking after one’s children, parents, husbands, who are too old for the army, but feel frustrated they’re no longer fighters doesn’t leave much time for yourselves. And what I’m going to say, whether you like it or not, you have to create some time, some downtime for yourself. It doesn’t matter if it’s short or whatever. You meet a friend, you go for a walk, the husband can look after the children and you also say to your parents, in order to look after you, I have to be able to look after me, okay? It’s absolutely, if you’re not in a good state, you can’t look after anybody.

Talk a little about anger. Well, the anger is about what’s being perpetrated. I didn’t have time to go into every emotion. It would be another talk. Whether it’s what’s been done to Jews in Israel, what’s been done to Jews around the world, or whether people are blaming Netanyahu. There’s loads of anger towards Netanyahu, we know that. There’s loads of anger towards the people in Mea She'arim because, you know, where are all the soldiers looking after them during Sukkot, et cetera. It’s a whole 'nother talk. I’m happy to do it, but sadly not today, Eleanor. But it would be a pleasure.

Q: Why do I cry at different times?

A: Nothing wrong with crying, Ronald. It’s just… Crying is an indication that we need comfort. So don’t worry. And you might cry, you know, our emotions don’t have a clock. You might cry at three o'clock, you might find yourself crying in the middle of the night, it doesn’t matter. You’re acknowledging your pain and everybody shares that pain.

Q: What was missing in Israel?

A: I can’t, yeah, it’s a bit of a political issue. We could debate that. There are people much better than me to do that. Sadness was also one of the largest emotions on the Magen David, yeah? We’re all sad, we’re all sad, because how could this have happened and how’s it going to end? There’s huge sadness. And the only thing you can do is acknowledge your sadness, validate your emotions. Don’t criticise yourself, be compassionate. We’re all sad, we’re all crying. But then see what you can do to function. If you can’t function, that’s when you need to go to the doctor.

Whoever said thank you very much, you’re very welcome. Leon, you’re very welcome.

Q: Do I think babies are born without anxiety?

A: Oh, goodness, that’s fortune that one, Janet. I don’t think… It depends. If you have babies born to mothers who have high cortisol levels, no, they will have a predisposition, but they’re not born with the type of anxiety. They might be born with adrenaline and, you know, babies born to alcoholics, we know all of these things. I was talking about behaviour as we learn it. So yes, you’re absolutely right, but I think in general, the point I was trying to make is we learn to be anxious. And, you know, we see it. We we see it, it’s mirrored.

Put the slides and tips, yes.

Q: David Elta, how can I give my daughter support when her boyfriend of five years was murdered in a party by Hamas. Her world has disappeared. She’s lucky she didn’t go to the party.

A: First of all, my condolences. I’m also a bereavement counsellor and I also work with a Jewish bereavement counselling service, and rather like PTSD, you cannot do that work when it’s so raw. All you can do, David, is give her love and listen. Just those two things. There is nothing you can do. You can’t, because there are no answers. This is hatred. Thank God she didn’t go to the party. Okey-doke, I think that-

• May I ask a question, if you don’t mind, Nikki? We work quite a lot with Holocaust survivors. Is there any special advice on that? 'Cause you can imagine, many of them have given so much of their working lives to cure all the horror.

• Yes, that’s a great question because, and I, again, deliberately left out the Holocaust, but I have just done a trip across Eastern Europe, going from, you know, Austria to Hungary, to Poland, to Germany, and it’s everywhere. And I’m also reading the Daniel Goldhagen of “Hitler’s Willing Executioners”. And it’s not about resonances, it’s the same, it’s the same. And the advice I think has to be for this group, processing as a group, and whether that’s with a psychologist, if you wanted me to facilitate anything, I would. I think it has memory and the, this is happening all over again, is a whole 'nother layer on what we’re seeing, and it’s hugely important. And in the same way that I try to make this general and not talk about specifics, I’ve done the same with the Holocaust. But more than happy, this is so important, and whatever you want from me, Trudy, you just tell me and I will put something together.

• I don’t know what to say to you. You’ve seen from all the wonderful responses, it’s obviously meant an awful lot of people. We’re all floundering. And you brought wisdom, you brought clarity, and yes please, we would like you to come back and we can talk offline. And if anyone wants everything, I believe it’s best you write to Lockdown. If you write to Lockdown University, then it will all be sent out. And what can I say to you, Nikki? I mean, we’ve just got to keep going. You know, Wendy and I discussed whether we should change our programme because of this, and in the end-

• It’s wonderful that you haven’t. I’m very aware that you haven’t and it’s wonderful.

• We’re bringing in, obviously, people to talk about the situation, and obviously people with your incredible expertise, but we did feel, we felt very strongly that in a kind of way, because I think quite a few of the people who listen live on their own, and we felt that it gave a kind of normality to it, to life.

• Yes. Yes, I think so. So I will do something, I’ll put these tips together.

• Yes.

• I’ll put something on sleep. The person who asked me about postmenopausal sleep, that will be a separate, but I’ll do that. I’m very happy to do something on anger. Very happy to do something on sadness. And very happy to facilitate a session for people who’ve survived the Holocaust.

• Thank you, thank you so much. And God bless all of us, yeah?

• Absolutely, keep safe, keep well.

• God bless you, bye-bye.

• Thank you Trudy, bye-bye.