Category Archives: COVID-19

Are You Smiling? The Complex Implications of Face Masks

Are You Smiling?
The Complex Implications of Face Masks


 By Annette Willett 
Associate Occupational Therapist at the Purple House Clinic, Loughborough


The extensive new government rules on the wearing of face mask / coverings in many indoor public spaces was written into law on the 8th of August 2020. We are now slowly getting used to seeing masked people everywhere, but this strange new world we now inhabit brings a wealth of new challenges.


Although the rules vary slightly across the UK, face coverings are generally now required in most public indoor settings (excepting children under 11 as well as people with certain conditions for whom mask-wearing is not advisable or could cause significant distress). Such measures have markedly changed our daily lives, and will continue to do so for some time to come.

Regardless of whether they are wearing face coverings themselves, what might this mean for young people and for those with mental health challenges or disabilities?



Whether aged over 11 and required to wear a face covering (or under 11 and not), young people may struggle with the mask-wearing world. Indeed, many of us may have particular empathy for the experiences of infants and young children who will spend many formative months meeting the wider world around them without the benefit of seeing people’s smiles and facial expressions. How will this impact their developing brains? We must hope that the impact is marginal when compared to the non-mask wearing experiences they will encounter at home and in childcare settings.

From an emotional point of view, the idea that there's something in the air that can harm us, is a difficult concept on its own for the developing child. That it’s possible to cause illness to others further compounds the worries. 

Whilst parents worldwide seek to help with their children’s difficulties, they must also try to understand and process the ever-changing news and guidance whilst simultaneously coping with their own fears and anxieties.

We don’t yet fully know how mask-wearing and covid in general will impact upon our children’s perception of their own safety within the world, but we have to accept that their worldview may be irreversibly altered to some degree.

However, by their very nature, children and young people do often feel a certain sense of indestructibility. To a large degree this is a biological imperative as (even in the pre-covid world) children have always had to navigate a continual series of new challenges in order to become well-rounded adults. ‘Risking on purpose’ is an essential skill, and parents will need to be balancing those vital opportunities with the covid challenge. 

Somebody really needs to write a chapter on covid and put it into that ever growing ‘parents manual’ that we all wish we had to hand when children are in our care! Until then, there are a few key things we can do to support our children:


  • Give them age-appropriate information about covid;
  • Offer a calm and balanced perspective about risk and mask wearing;
  • Pay attention to our children’s emotional experiences;
  • Stay curious - sometimes our assumptions about our kids’ feelings can be misguided or plain wrong.


Mental Health

Whilst covid has challenged us all emotionally, it is particularly difficult for those who were already experiencing mental health challenges. Everyone’s psychological experience is different but, for some, key pre-existing vulnerabilities such as social isolation and fears about safety will have been deeply exacerbated.

For these people, this year will have undoubtedly brought about some very dark moments. Even those with seemingly robust mental constitutions will have been tested by covid and lockdown.

Face coverings add a further challenge for people struggling with their mental health. Imagine navigating a masked world when you already struggle to trust those around you and fear what people may say or do. Imagine having cripplingly low self-esteem and issues with body image and being asked to wear a mask. Imagine feeling ‘masked’ already, burdened already with experiences of abuse that you cannot tell – and then add to that an actual mask to make you feel even more hidden and alone.

There's no doubt that mask-wearing can be distressing to our mental health. Therefore, sensitivity and support for those around us who may be struggling with masks is vital at this time. Furthermore, we must try to remember that people’s mental health difficulties are rarely conspicuous  - so let us all think carefully and empathically before we challenge those naked faces.



Masks challenge our ability to ‘read’ others and this may be particularly tricky for those with an Autism Spectrum condition - where they may already struggle to process social communication. 

Masks also present challenges to individuals with other types of disabilities - such as impairment of vision, speech or hearing. For the deaf community in particular, there are obvious and significant challenges around lip reading.

With this in mind, we need to think about alternative ways that we can communicate intent, meaning and expression. At this time it’s important to pay particular attention to your body language, tone of voice, communicating through the eyes, eyebrows and hands (give a wave to say hello!). 

The Duchenne smile is a particular type of smile where the corners of your mouth lift at the same time as your cheeks causing the corners of your eyes to wrinkle. This type of smile signals genuine pleasure and enjoyment - and right now it will be more welcome than ever! 


The Duchenne Smile - Smile with Your Eyes!

Face Masks - 'The Duchenne Smile'

Vera Davidova / Unsplash


For all of the potential negative psychological implications of mask-wearing, we should also bear in mind that masks may actually come as a relief to some. Face coverings could potentially provide a useful barrier, allowing some of us to explore our social world a little more confidently.


Learning from Others

I have listened with great interest to the opinions of those around me regarding mask-wearing - and it’s fair to say that there appears to be a bit of ‘Marmite effect’ going on: Some are embracing them whilst others are extremely bothered by them. 

A wonderful lady I know draws a picture on her mask at work before she throws it in the bin at the end of each work day (thank you Kerry for sharing these!). A little bit of good humour can go a long way!


Another friend of mine accidentally bumped into a stranger in a shop (inadvertent error on the one-way system). She immediately apologised from under her mask, only to be told, “Well, you don’t look sorry!”. My friend was left wondering if the stranger really meant that comment, or whether she had missed the possible sarcasm as both were wearing masks!

I am sure all of you will have some very personal stories about masks which I would be very interested to hear.


The potential complications from wearing face masks!



  • Be kind! We are all in this together - and whilst tensions may be high do try and support anyone and everyone.
  • Pay special attention to those who may feel more vulnerable due to their age, mental health or physical health disabilities (and remember many problems are not visible).
  • For people who can’t wear a mask and fear judgement for not doing so, consider wearing a badge saying ‘face covering exempt’ (some local authorities are providing these).
  • Talk to your children - be curious about their feelings and educate them in a calm and balanced way about the risks measures in place.
  • Consider how you communicate (even more so now): Be clear, be positively expressive and remember our brain knows we are smiling, even if it’s not apparent due to our masks, so the feel-good endorphins will still be released.
  • Have a couple of extra masks tucked away. We’ve all left home and had to go back for our keys, glasses, etc. So let’s try and not add masks to this list!
  • Wash masks daily if they are washable and dispose responsibly of non-reusable masks. We don’t want a landfill problem or to find our sea creatures wearing them in a month or two! 
  • Also think about where you are buying your masks from. This could be an opportunity to support small or minority group businesses that have been disproportionately affected by covid.
  • Stick with it. If nothing else, this pandemic will have taught us about the importance of resilience and persistence - skills that we will always need!



Other Articles by Annette Willett:

Why Everyone is Going Bananas for Banana Bread!


Other Covid-related articles:

There's No Place Like Home: The Secret to Harmonious Relationships During Lockdown

COVID-19 & Your Kids: Adapting to the New Normal

Our Family In Lockdown


Why Everyone is Going Bananas for Banana Bread!

Why Everyone is Going Bananas for Banana Bread!

 By Annette Willett 
Associate Occupational Therapist at the Purple House Clinic, Loughborough


Why has the nation so passionately reignited its love for this yummy loaf during lockdown?

Is it just that it tastes so good? Have we all accumulated mountains of bananas? Or do we all now fancy ourselves as future Bake Off winners in this time of unprecedented domesticity.

An Occupational Therapist may well have the answers!


The History

Banana bread first became a standard feature of American cookbooks with the popularisation of baking soda and baking powder in the 1930s. It appeared in Pillsbury's 1933 ‘Balanced Recipes’ cookbook, and later gained more acceptance with the release of the original Chiquita Banana's Recipe Book in 1950.


The Recent Rise

In the UK we now have recipes from Jamie Oliver, Mary Berry, Nigella and of course Delia Smith. My favourite recipe is Nigel Slater’s ‘Black banana cake’ which contains chocolate....and it is VERY good! GBBO’s Selasi even brought the humble banana bread to our screens not so very long ago.


The Versatility

You can make it if you are a vegan or gluten intolerant - it’s so versatile! And this may well explain why it’s become the staple bake during lockdown. An added bonus is the flexibility to use basic store cupboard ingredients - the riper the banana the better (which, in these frugal times, is a great way to use up leftover fruit and reduce waste!).



But what does it actually do for us? There must be something about baking that serves us so well in times of crisis...

‘Activity Analysis’ is a scientific approach that enables Occupational Therapists to gain a deep understanding of a particular activity - such as baking banana bread!

This process breaks down an activity into steps and detailed subparts so that others could be instructed to complete the same activity (e.g. methodology, equipment, materials, cost, time, personnel etc.). By analysing activity in this way, Occupational Therapists can learn when, where, for whom and under what circumstances the use of the activity might be therapeutic.



Let’s delve deeper into banana bread (yes please!)...

Purposeful activities such as baking have both ‘means’ and ‘end’ benefits. The former are the skills required/gained by ‘doing’, and the latter refers to any functional gain from completing a meaningful and purposeful activity.


The ‘Means’ Benefits

  • Motor Skills (from moving and interacting with tasks, objects & environment): We can improve our posture, strength and effort, and fine and gross motor skills e.g. we bend, stand, reach, lift, cut, pour and mix.
  • Communication & Interaction (communication skills and coordination of social behaviour): Speech and language skills develop through information exchange via verbal and non-verbal communications e.g. we bake and work together, read recipes, use literacy skills, use computer skills, express/share thoughts and ideas.
  • Mental Function (affective, cognitive and perceptual): Baking can enhance general and specific mental functions, and sensory functions such as motivation and impulse control e.g. don’t eat all the raw mixture! Baking can improve: attention; memory; emotion and perception; smells; touch; taste; movement; balance; hunger; linked emotions such as memories of baking with grandma; sequencing, time management; and problem solving.
  • Emotional (so how do we feel about baking?): Baking can be fun & bring shared enjoyment. There’s the excitement of anticipating the outcome. It can help us recall pleasant memories of past times; develop mutual connections; be mood-lifting; provide structure; teach us to manage frustration; and so much more.


The 'End' Benefits

We all recognise that sense of achievement from baking a tasty cake or loaf! It gives us ‘role affirmation’ and/or knowledge of a new role or competency. It also lets us reflect on our skills if something didn’t go quite right. And we can usually work out why. Did we rush the measuring? Was the oven temperature perfect? Did we open the oven door early to sneak a look? Did we sufficiently grease the tin, etc. etc.

The great thing about baking is that no one usually gets hurt and it’ll probably taste good even if we have to add custard or dunk it in our cuppa! Furthermore, we can take positives by reviewing any failings so that we can put it right next time. This is a great life skill to acquire.

In addition, we can gain a sense of pride, and the satisfaction of providing for family or friends. Baking at home is also very economical and, by virtue of lessening the need to go to the shops, it can even help lower the risk of exposure to COVID at this time.

Of course, we're all acutely aware of our increasingly wasteful society - and every little helps. We can now feel rightly proud of ourselves that those overripe bananas, that were otherwise destined for the bin, have been given a tasty purpose.

And the ‘icing on the cake’, is the cake!. We have the yummy treat to eat, along with the kudos gained from friends and family (including the feedback you get from millions of Facebook ‘likes’ and ‘loves’). Got to love social media sometimes!


Therapeutic Benefits

So it's clear that simple wholesome activities, such as baking Banana Bread, can be beneficial for mental well-being.  Whilst nobody could claim that baking banana bread will solve all of our problems, such activities may help to give us a sense of normality, pride and purpose during difficult times.


The Future

So, the future is bright for home bakers. The old bread machine that’s been sitting in the shed for years has been well and truly dusted off  - and many, including myself, are now baking bread on a daily basis. 

Facilitating this craze, many small companies will now deliver larger quantities of flour and other baking ingredients. Families can be healthier, happier and more connected through home baking. Connection at these times is particularly poignant.

But let’s not wait for another lockdown to re-awaken this time served occupation in our own homes! So next time you decide to bake, remember it’s not just about the cake - it’s about SO much more!!



Inspiration & Resources:

The Secret to Harmonious Relationships During Lockdown

There's no PLACE like home

Lockdown, by nature of its social and economic implications, is putting unprecedented pressure on relationships of all kinds - personal and professional.

There are families who are used to spending hours apart each day, suddenly thrown into being with each other 24/7. And conversely, work colleagues, extended family and friends are now distanced, connected to us only through electronic devices. 

Whilst existing in all of these different relationships, each and every one of us is experiencing our own additional stress, anxiety and trauma. This might include worries about keeping ourselves and family members safe from the virus, how to get food, stress about paying bills, the trauma of losing a job or keeping a business afloat, trying to get to grips with homeschooling and meeting your kids needs, worries about how to access healthcare, being lonely/disconnected from loved ones, or perhaps even suffering from losing a loved one to coronavirus. 

Every time we interact with someone else right now, we’re connecting with them in the midst of our own individual experiences…and theirs. Though this creates a great opportunity for meaningful connection, it also poses a great threat from ‘misconnection’.

Get it right, and you and your family member or work colleague feel great - you both feel understood, cared-for and secure. Get it wrong, and both parties are left feeling bad - perhaps feeling rejected, invalidated, or neglected - and in no better position to cope with their current trials. At this unprecedented time, how you conduct yourself, and how you are perceived is being tested as never before.

So how can we get it right?  To help with this, I’m drawing on a well-known therapeutic approach from the psychology world: PLACE. This memorable acronym stands for: Playfulness, Love, Acceptance, Curiosity, and last (but certainly not least), Empathy.

Developed by the wonderful American Psychologist, Dan Hughes, PLACE is most closely associated with therapeutic relationship work with adopted and looked after children. However, many of us Psychologists see the benefits of extending this philosophy to life in general - to all relationships - whether parent-child, adult-adult, personal or professional. Adopting PLACE can be life transforming. So please, accept this nugget of wisdom as my gift to you during this most testing of times (all accolades to Dan of course, for I am just a messenger!):



Playfulness. Find things to enjoy within your relationships, something fun and light-hearted. When times are tough, you need this more than ever to keep your relationships going. Have some silly fun in the garden with the children; have a giggle over funny YouTube clips (other online video-sharing platforms are available!) with your friends over a virtual coffee morning, or share some jokes with colleagues. Allow fun to blossom within your relationships, and within your own daily routine.


Love. Find something to love (or at least like!) from all the people in your life. Yes, someone might be causing you headaches, heartaches or stress (and it may feel like you’re getting little back). But take a step back. You may have fallen into the well-worn trap of dwelling on negatives. Your relationships will have been forged around someone’s principal characteristics. As time passes, relationships may struggle as one party (or both) tries to hone the edges of the other. The insignificant edges. These weren’t relevant to your love or friendship in the beginning - and neither should they be now. Especially now. 

So go ‘back to basics’, and rediscover the source of your love. Appreciate them. Dwell on the positives. Moreover, let them know! Love begets love...and you know the next bit.... you've got to love yourself too! Nobody is more critical of you, than you. So at this time, give yourself a break - notice your positives, notice what you're giving, how hard you're trying, and who you are. Look at yourself through loving eyes.


Acceptance. Accept where people are at with whatever they are thinking, feeling or experiencing right now. It might be ugly, it might be depressing, it might increase your own anxiety. But it’s their experience and it’s important. Don’t judge it, don’t invalidate it and don’t minimise it. Show you get it, and show it’s okay to feel the way they do. Self-care alert: you don't get out of this one lightly either-  show acceptance of your own internal experience too. Validate yourself and accept that whatever you’re feeling right now is okay.​


Curiosity. Don’t assume you know what your children, siblings, parents, friends, colleagues, neighbours are thinking and feeling. Even if you notice they are struggling, don't assume you know what the reason is, or assume their journey right now is the same as yours. Ask them how they are doing, follow the threads of their communication to piece together the picture of what it's like for them - their trials, their stresses and their positives. Similarly, don't forget to share your own experience….’warts and all’. Remember, a bit of vulnerability is what helps us connect as humans.


Empathy. (Not sympathy!). Sympathy is about looking in on someone's experience and feeling sorry for them. Empathy is different. Empathy is about standing in someone else's shoes (metaphorically!), and allowing yourself to feel what they must be feeling...and then showing them that you get that experience, and that you really, truly, deeply care about it. Empathy is a game changer - it's the lifeblood of maintaining healthy minds and healthy relationships. Show empathy to someone today and you'll see the power of it unfold before your eyes. Show it to yourself, and you're really on a winning streak.


Share the gift of PLACE. There’s literally no time like the present!



The Purple House Clinic will remain open during national lockdown & regional restrictions.