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Roadmap to wellbeing: microskills for positive change

Roadmap to wellbeing: microskills for positive change

As clinicians, it’s essential to look after ourselves as well as caring for others. In this article, we explore some microskills that can help us make positive changes in our own wellbeing, and support our patients to take active steps to improve their emotional and physical health.

This article was updated in May 2024.

You may also wish to refer to our associated articles, including:

• Motivating behaviour change.
• Behavioural activation.
• Five ways to wellbeing.

If you are struggling with your own mental health or wellbeing, you might also wish to refer to some of our articles on clinician wellbeing, including:

• Burnout in health professionals.
• Mental health in health professionals.
• Moral distress and moral injury.
• Strengths and vulnerabilities in clinicians.

And, while enhancing personal wellbeing can provide a buffer against the challenges of life and work, it cannot be viewed as a ‘sticking plaster’ that ignores the impact of work-related pressures, e.g. an excessive workload, poor communication, a lack of respect or working in a culture of fear and blame.  Efforts to improve our personal wellbeing must go hand in hand with fundamental organisational change to ensure healthy, supportive and positive workplaces.

One simple definition of wellbeing is that it is a combination of feeling good and functioning well (Health Qual Life Outcomes 2020; 18, 192).

Wellbeing is a multidimensional concept that affects people’s emotions, thoughts, behaviour and relationships. It is not simply the absence of illness. It is possible to live with a health condition and still experience high levels of wellbeing. Nevertheless, physical and mental health can both influence wellbeing, and, in turn, wellbeing also influences health.

Wellbeing includes several dimensions:

• Experiencing positive emotions such as happiness, contentment and satisfaction with life.
• Having a sense of purpose and developing positive relationships.
• Functioning well on a personal and a social level, including developing our own potential and having control over our lives.

Our personal definition of wellbeing may also be affected by age and cultural differences. For example, younger people may place greater emphasis on happiness, kindness, fun and safety as being central to wellbeing, whereas for older individuals, concepts such as meaning and purpose may become more important (Int J Environ Res Public Health, 2023;20,5006).

Wellbeing matters! It has been linked to success in professional, personal and interpersonal areas of life.

Individuals with high levels of wellbeing may have improved performance at work; higher life satisfaction; are able to learn more effectively; and have increased creativity, prosocial behaviours and positive relationships (Health Qual Life Outcomes 2020;18,192).

Wellbeing may also be associated with a number of positive physical health outcomes, including an improved immune system response, higher pain tolerance, increased longevity, cardiovascular health, slower disease progression and improved reproductive health (Department of Health 2014, The relationship between wellbeing and health).

The ‘GROWTH steps’ were first described in the book, Boosting Your Mental Wellbeing: 10-minute steps for stressed healthcare professionals using CBT and mindfulness (Lee David and Debbie Brewin, 2023, Scion Publishing). DOI: Lee David is a Red Whale presenter and author.

This model aims to help both patients and clinicians move towards positive mental health and improved wellbeing. These six steps were developed from several theoretical backgrounds, including cognitive behavioural therapy, behavioural activation, compassion-focused therapy, acceptance and commitment therapy, and mindfulness. However, this section of the article is not designed to be an evidenced-based review, but rather a collection of practical tools that may be useful in our own lives as well as to support patients who seek our help. 

It’s not necessary to use all the steps at once, or to follow a rigid or linear pathway that moves through every individual step in turn. You can use them in any order, and you may also choose to focus on just one or two areas that seem most relevant to a particular individual. Here is an overview of the six GROWTH steps:

Our Guide acts as an inner compass which points in the direction of our most important values.

Following a Guide involves seeking out our own personal ‘Why?’, and helps to ensure that our lives align with what matters to us as unique individuals: making decisions and choosing actions that have personal meaning, a wider purpose and are important to us. 

Exploring values can help motivate people to make changes that may improve their health and wellbeing, even if these require effort, or when change involves facing challenges or coping with uncomfortable sensations or emotions.

Values refer to long-term, core priorities about what we find meaningful and important in life. Examples include:

This is not an exhaustive list and there are many more values that may be important to you or to your patients. What is important is to start having conversations about the things that matter to someone deeply, and to use this information to help inform decisions about health and wellbeing.

Knowing your values can help you make choices that are consistent with who you want to be as a person. For example:

• If you value being a loving, caring parent, it’s worth making the effort to take time to engage with your family after a busy day at work.
• If you value closeness and connection in your relationships at work, it’s worth making the effort to have lunch or a coffee break with colleagues, rather than simply ‘pushing through’ and ignoring your need for interaction.

You can use a ‘wellbeing wheel’ to help someone reflect on the balance of values relating to different areas of their life (see below). Ask the person to rate how close they are to ‘hitting the target’ and fully living out their values in each area of the wheel. It’s common to be achieving more in some areas of life (e.g. work and career) than others, (e.g. leisure and fun). Are any areas starting to dominate or take over their life? Are other areas being ignored or overlooked? What small changes might bring all their values more into balance?

Values reflect our long-term priorities, whereas needs refer to the immediate urges or impulses that can influence us in a specific situation. Needs range from basic needs such as food, shelter, rest and security through to emotional needs such as the need for love and acceptance, or space and autonomy. Thinking about needs involves being aware of what’s affecting us in the present moment, while also considering the needs of other people and the wider situation. If we ignore our needs, we run the risk of letting our fuel tanks run dry, which can lead to exhaustion, low mood, anxiety and burnout. We explore needs in more detail in our article Communicating our needs when making lifestyle change.

Being Ready to take action is a behavioural skill that involves making active choices about how we react to the changing circumstances of our lives. It’s often easier to change our actions than our attitudes or emotions, and we can take small behavioural steps in the direction of key values even when facing difficulties such as health problems, emotional changes and challenging life events. 

Being 'ready to take action' includes:

• Doing things because they are important or meaningful, even if we also experience negative thoughts, difficult feelings or lack of motivation.
• Being willing to try something new, rather than staying stuck in old habits or patterns of behaviour.

Values focus on the journey and route that we travel, rather than on specific goals or outcomes. When planning actions, it helps with motivation and makes them more meaningful if they are linked to important values. For example, if your value is education, an action may be to read a book, study for a qualification or learn a new skill. For a value such as health or wellbeing, goals might be to improve your diet, develop a regular exercise habit or include time for relaxation or winding down in your day.

To make behaviour changes easier to achieve, they can involve ‘microsteps’. These take only a few minutes and are realistic and easy to complete. One microstep is unlikely to completely resolve a major life problem, but even though they may seem relatively small and insignificant, completing microsteps can build someone’s confidence and self-belief in their ability to make change, and can lead to bigger changes over time, in a snowball effect. Microsteps also help people become less rigid or stuck in negative habits of thinking and behaviour.

Any activity that moves someone towards an important value or need could lead to improvements in wellbeing. There are also different frameworks that can help people choose helpful actions that are likely bring greater contentment, happiness and wellbeing. The Five Ways to Wellbeing (New Economics Foundation, 2008) defines five key steps that are likely to improve mental health and wellbeing:

• Connect with other people.
• Be physically active.
• Learn new skills.
• Give to others.
• Take notice of the present moment (mindfulness).

It can also be helpful to try and ensure that activities are varied and cover all the domains in the wellbeing wheel that we explored above. Another approach is to discuss ways to bring some SPICE to the person’s day or week! This involves five different types of activity:

We talk more about making behavioural changes using microsteps and SPICE activities in our article on Behavioural activation.

Learning to Open and observe involves noticing what’s going on inside you and in the world around you. This can help you understand yourself better, make decisions and cope more effectively under pressure. Learning to notice your thoughts and feelings without getting caught up in negative or catastrophic thinking styles can help you focus on important activities in the here and now, and get more contentment and enjoyment from life

Using brief mindfulness does not need to involve a lengthy time commitment. In a consultation, it may involve noticing when someone is experiencing a strong emotion, and offering validation and support, or encouraging them to take a pause and a slow breath to steady themselves before continuing the discussion.

Some examples of brief ‘open and observe’ skills that we can bring into daily life include:

• Focus on an everyday activity: practise taking a shower, brushing your teeth, having a drink or taking a short, mindful walk with a little more awareness. Notice what you can see, hear, touch, smell and taste during the experience.
• Mindful listening: take a few minutes to focus on a piece of music or listen to the sounds outside your window. Close your eyes and really listen. Notice the different instruments and vocals, and any rhythms or patterns. If your mind wanders, gently bring it back to the sounds as soon as you notice.
• 54321: this technique can help ground you and soothe distressing emotions such as anxiety, stress or irritability:
  • Notice five things that you can see. What colour are they? I can see a red cup, a blue book, a green pen, a white curtain and a black computer.
  • Notice four things you can touch. If it helps, move your body to create more sensations: I can feel my feet on the ground, I’m holding a cool water bottle, I can rub my hands together, I can stretch my arms and shoulders.
  • Take three slow sigh breaths. Breathe in and make your out-breath as long and slow as you can, while making a soft sighing sound, ‘Haaaaa’, or try a gentle long hum. This helps you to breathe with your diaphragm so that your chest muscles feel less tight and uncomfortable. Can you count to 6, 8 or higher as you slowly exhale?
  • Notice two sounds you can hear. Can you name the loudest and the quietest sounds? I can hear the hum of traffic and people talking in the next room.
  • Notice one thing you can smell or taste. You could smell a perfume or take a sip of your drink. I can smell and taste my morning coffee.   
  • Now bring your attention back to the task at hand. What’s the most important thing to focus on doing next?
• Appreciate the moment: take a moment to notice and appreciate small things in your day that bring a sense of joy, calmness or wellbeing. Describe the experience using all your senses. I see my garden and there are some beautiful colours at this time of year. I can hear the wind in the trees and the hum of traffic. I smell a gentle scent of flowers and grass. I can feel the wind on my face. I feel content and peaceful in this moment.

We discuss more about the evidence and use of mindfulness in our article CBT: mindfulness-based approaches. There are some practical mindfulness skills in the articles Notice the NOW and Attention training for managing worry.

Our mind is our inner voice, and includes our thoughts, beliefs, ideas, expectations, memories and personal stories. It enables us to make complex decisions and plans, and can be an incredibly powerful and useful tool. But at other times, our mind can be negative and unhelpful, focusing on everything that’s gone wrong, blaming ourselves unfairly and becoming preoccupied by potential future catastrophes.

Using Wise mind involves stepping back and remembering that we don’t have to believe everything our mind tells us, especially if this is negative or unhelpful! Some qualities of ‘wise mind’ include:

• Thinking flexibly: seeking ways to overcome challenges and cope with problems.
• Finding perspective and looking at the big picture.
• Being supportive, encouraging, friendly and fair to ourselves and to others.
• Remembering our strengths and qualities, even when facing difficulties or when something has gone wrong.

Here are some ways to develop and use ’wise mind’:

When we are struggling to make changes or are living with pain, uncomfortable physical symptoms, challenging life situations or difficult emotions such as anxiety or low mood, we may become our own worst critic, giving ourselves a hard time and blaming ourselves for everything that has gone wrong. Repeatedly getting into a habit of self-criticism or blame can have a big impact on confidence and mood, and can make it harder to make long-term changes in health – such as sticking to healthy eating or physical activity habits.

Three different emotion systems work together to help us feel happy and content, and to cope with stressful life events and challenges.

• Threat system: this alerts us to potential danger and helps us to take action to stay safe. Overuse of the threat system can lead to anxiety, stress and irritability as we live with an exaggerated sense of danger and risk.
• Drive system: this acts to energise and excite us, helping us notice opportunities and achieve important goals.  Overuse of the drive system can lead to excessive striving, exhaustion and addiction. Underuse can lead to low mood or depression. If drive becomes linked with threat, it can also lead to self-criticism and fear of failure.
• Calm and connect system: this helps us to experience feelings of contentment, safety and self-compassion. It is sensitive to closeness and bonding with others, and helps us recover when facing problems or when things go wrong.

We explore this in more detail in the article Self-care and compassion: the three circles model. Here are a few quick tips for balancing the three emotion systems:

Building healthy life habits involves finding ways to create healthy routines and patterns of living that will maximise our physical and emotional wellbeing. This includes a range of behaviours such as being physically active, healthy nutrition, maintaining a healthy body weight, getting enough sleep, taking care of long-term conditions and physical illnesses, and cutting back on unhealthy choices such as alcohol or drug use.

We have summarised some important areas that can influence wellbeing in the table below.

Here are some examples of questions or reflections that you could use for each step in GROWTH. You could use these in a consultation with a patient, or when thinking about difficulties that you are facing yourself.

Remember, you don’t have to use all the steps or all the questions! Just pick one or two areas that seem helpful and start there.

Roadmap to wellbeing Wellbeing involves a range of dimensions, including experiencing positive emotions, having a sense of purpose and being able to function well. Wellbeing has been associated with improvements in quality of life, interpersonal effectiveness and physical health outcomes. The six GROWTH steps are a series of microskills that can support wellbeing. These include: Guide: focus on your personal values, what you care about and your life direction. Ready for action: prepare for change and take small behavioural steps towards what matters. Open and observe: use mindfulness skills to step back and be more present and engaged. Wise mind: get perspective, and choose flexible, helpful responses for each situation. Treat yourself kindly: find ways to balance your emotion systems and motivate yourself with compassion. Healthy life habits: develop healthy routines that support physical and emotional wellbeing.

Useful resources: Books Mindfulness for Health: a practical guide to relieving pain, reducing stress and restoring well-being, Vidyamala Burch (2013, Piatkus) The Happiness Trap: stop struggling, start living, Russ Harris (2022, Robinson) The Compassionate Mind, Paul Gilbert (2010, Constable)