Small Enough to Actually Do: Five Evidence-Based Self-Care Steps for Clinicians

Most clinicians don't need to be told what self-care is. We teach it, we assess it and we write it into treatment plans, and the gap between knowing and doing is where most of us live.

I see it in myself and in the clinicians I supervise and teach - and my urge is to hand people a bigger menu of strategies. That scattergun approach of "try this then" usually gets it the wrong way round. If the barrier is follow-through, the answer is to make the step smaller and the trigger more specific, rather than to add another item to the list of things that now feel too overwhelming to try.

This post covers five small options that have research behind them. None takes more than half an hour, and most take about five minutes. I've left out the familiar advice on mindfulness, gratitude and sleep hygiene, and I've been honest about how strong the evidence is for each step, because we'd want that from anyone else.

1. Put an if-then plan on it

An if-then plan ties a behaviour to a specific cue, so you don't have to rely on remembering or on motivation. The format is "If [situation], then I will [action]." Psychologists call these implementation intentions, and a meta-analysis of 94 independent tests found a medium-to-large effect on whether people achieved their goals (Gollwitzer & Sheeran, 2006).

The difference is easy to see. A goal intention says what you want: "I want to take proper breaks." An if-then plan adds the when and the what, so the situation itself becomes the prompt to actually do "the thing". That matters because most of us make our self-care decisions when we're tired, busy and already thinking about what's next on the never-ending to do list, and the overwhelm often cancels out the one chance you have to make a difference to that feeling.

To write an if-then prompt, start with a cue that already happens in your week, such as a cancellation, the end of your last session or the drive home. Then choose an action small enough that you'd still do it on a bad day, and write it down in if-then form.

• "If a client cancels, then I'll walk around the block before I touch admin."

• "If I finish my last session, then I'll drink a glass of water before I open my notes."

• "If I notice it's 2pm and I haven't eaten, then I'll stop and have ten minutes away from my desk to eat."

• "If I reach for my phone to check email at night, then I'll write tomorrow's list and close the app."

There are limits, of course, as to how successful this can be. The goal has to matter to you, because the plan helps you act on something you already want - ambivalence about the 'why' will always get in the way, so attach the action to something meaningful to you. Most of the research wasn't done with clinicians, and an if-then plan won't fix a workload that leaves no room for the action in the first place. That's a question for the system you work in, and we'll come back to that in another post.

How strong is the evidence? Strong, from a large meta-analysis, though it covers goals in general rather than clinician self-care specifically.

2. Write tomorrow's list before bed

If your mind rehearses unfinished work at 11pm, five minutes of writing a specific to-do list may help you fall asleep faster. Scullin and colleagues (2018) monitored 57 healthy young adults overnight in a sleep lab. Half spent five minutes before lights out writing what they needed to do over the next few days, and half wrote about tasks they had already completed. The to-do list group fell asleep about nine minutes faster, and the more specific their list, the faster they fell asleep.

Most of us have heard the opposite advice, that you should switch off and not think about tomorrow. The researchers tested two competing ideas: that thinking about the future would increase worry, and that writing it down would offload it. The results favoured offloading. A reasonable reading is that an unfinished task keeps nagging at us until it has somewhere to go, and writing it down gives it somewhere to go (that isn't your dreams, nightmares or looping brain).

For clinicians, the useful part is that you can include the things that tend to loop: the report that's due, the call you need to return, the email you're dreading. Write the next (small) action for each, not just the worry.

The study is small, the participants were healthy 18 to 30 year olds, and there was no group that did no writing at all, so we can't say how much of the effect is the to-do list and how much is the completed-tasks list making sleep harder. It's an inexpensive thing to try, but I wouldn't offer it as a treatment for insomnia just yet.

How strong is the evidence? Early. One small, well-controlled lab study, with non-clinician sample.

3. Talk to yourself like a colleague

When you're anticipating something stressful, silently referring to yourself by name, or as "you", can take some of the heat out of it. Kross and colleagues (2014) ran seven studies with 585 participants in total. Using one's own name and non-first-person pronouns during introspection increased self-distancing. In the stress studies, which involved making a good first impression and giving a speech, people who used non-first-person self-talk were rated as performing better, showed less distress, and appraised upcoming stressors as more of a challenge and less of a threat. After the speech, they also engaged in less maladaptive processing of the event. A meta-analysis within the paper found that none of these effects depended on how socially anxious people were.

Think of it as the internal version of what you'd do for a colleague. If a friend said they were dreading a difficult conversation, you wouldn't say "I'm so worried about this." You'd say, "What's the worry here? You've done hard conversations before." Moving from "Why am I so nervous about this?" to "Alice, what's the worry here?" borrows that same perspective.

Later work from the same group found that distanced self-talk reduced emotional reactivity when people thought about negative experiences of varying intensity, whether the events were in the past or the future, and including in people who scored high on measures of emotional vulnerability (Orvell et al., 2021). That makes it a reasonable thing to try before a hard session, a presentation or a conversation you've been putting off, and again afterwards when the replay starts.

The studies tested socially stressful situations in controlled settings. They didn't test it on a clinician managing a complaint or a crisis, so I'd treat it as a low-cost experiment rather than a proven fix - but it's something I find super helpful for my own practice.

How strong is the evidence? Moderate for reducing stress around social situations, with the studies cited here coming from one research group and run in lab settings.

4. Prescribe nature

Twenty to thirty minutes in a place that feels like nature (a park, a backyard) gave the biggest stress-hormone drop for the time spent, and sitting worked as well as gentle walking. Hunter, Gillespie and Chen (2019) asked 36 urban dwellers to spend at least ten minutes, three times a week for eight weeks, somewhere outdoors that gave them a sense of contact with nature. Participants chose the time, the place and the duration, and provided saliva samples before and after at four points in the study.

Salivary cortisol fell by 21.3% per hour of nature experience, over and above its normal daily decline. The efficiency of that drop, per minute spent, was greatest between 20 and 30 minutes. After that, benefits kept accruing, but more slowly. Activity type made no difference to the cortisol response, so sitting counted as much as strolling. Aerobic exercise was ruled out, so this isn't evidence for a brisk walk or a run.

This is a big part of why we run our Escapes at Eight Willows Retreat in Margaret River. It sits among bushland in the wine region, and time outdoors is part of how we think about professional development rather than an optional extra - time in nature IS our pedagogy. We spend a lot of our working lives indoors, in small (often windowless) rooms, holding other people's distress, and being deliberately outside is one of the simplest things we can build into a program for tired clinicians.

This study didn't compare nature with another activity. Each person acted as their own baseline: the researchers took a saliva sample before and after each nature experience, and used the "before" samples to estimate how much cortisol falls anyway through the day, so the 21.3% is on top of that natural decline. That separates nature from the clock, but not from the break itself. Other studies have made that comparison. The Japanese forest studies summarised in the same paper found cortisol around 12 to 16% lower after 15 to 30 minutes in a forest than in a nearby urban setting. The sample here was also small and self-selected: 36 volunteers, 92% of them women, recruited mainly from a university community in Michigan, who wanted to spend more time outdoors, and the study ran over one summer. So it gives us a sensible dose to try, not proof that nature beats other ways of taking a break.

How strong is the evidence? Moderate. Reasonable for working out a dose, but small, self-selected and without a comparison activity. Forest-versus-urban studies point the same way.

5. Go on an awe walk

An awe walk is an ordinary walk with one change: before you go, you decide to look for things that fill you with wonder. Sturm and colleagues (2022) randomly assigned 60 healthy older adults to take a 15-minute outdoor walk every week for eight weeks. The awe group were oriented at the start, in a brief conversation of about three minutes, to look for awe on their walks, and the control group simply walked. The awe group reported more joy and prosocial positive emotions during their walks, and outside the walks they reported greater increases in prosocial positive emotions, such as compassion and gratitude, and greater decreases in daily distress.

The fun part of this research is that researchers also asked everyone to take selfies on each walk. People in the awe group gradually took photos in which they were smaller in the frame and more of the world was visible, and their smiles became more intense. The authors describe this as awe encouraging a "small self": a healthy sense of proportion between you and the wider world.

This suits us because clinicians spend so much time attending to a narrow band of problems - a specific medical problem or examining other people's inner worlds - that we can forget to look at the outer world around us... how incredible it is in its small details, and how small we are in comparison. A tree, a pink sky, the light on a building, a stranger's dog: anything that makes you stop and take it in counts. The instruction to look is the active ingredient, since both groups were walking. Headphones stay home, I'm afraid.

The participants were healthy older adults, mostly White and highly educated, and the sample was small, so we can't be sure it generalises, and anxiety, depression and life satisfaction didn't change in either group over the eight weeks - but if Gen Z's "silent walking" viral trend is correct, then it's life changing! Either way, it costs fifteen minutes and a bit of intention, so I think it's worth testing for yourself.

How strong is the evidence? Moderate. A randomised design, but small, in healthy older adults, and with no change in anxiety, depression or life satisfaction scores.

How to start

Pick one idea to trial, and use the first step to make it stick: write it as an if-then plan.

Step	Time	Try it when	Evidence
If-then plan	2 minutes to write	A good intention keeps slipping	Strong
Bedtime to-do list	5 minutes	Work loops at 11pm	Early
Distanced self-talk	Seconds	Before or after something stressful	Moderate to strong
Nature dose	20 to 30 minutes	You've been indoors all day	Moderate
Awe walk	15 minutes	You want a reset, not a workout	Moderate

For example: "If a client cancels, then I'll spend the gap on a 20-minute bench break outside before I open my notes." That one plan combines steps 1 and 4, and it only needs a cancellation to start.

What individual steps can't do

Individual strategies help, but modestly, and they shouldn't be the whole answer. A meta-analysis of 20 comparisons from 19 controlled studies, covering 1,550 physicians, found that interventions aimed at individual physicians had a small effect on burnout (SMD −0.18). Interventions aimed at the working environment, most often changes to workload and scheduling, had a larger one (SMD −0.45) (Panagioti et al., 2017).

The practical point is that if you try these steps and still feel stretched, that tells you something about the load you're carrying - and possibly the organisation you work within. It doesn't mean you've failed at self-care. We'll look at what teams and workplaces can change in a future post.

The next blog will be close to this theme too - I'll cover the four ways researchers say we recover from work: psychological detachment, relaxation, mastery and control, and how to work out which one you're short on.

If you'd like to work on this with colleagues, our Resilience in Practice Escape runs from 9 to 12 March 2027 at Eight Willows Retreat in Margaret River. Find out more about the Escape, or read what to expect at Resilience in Practice webpage.

Dr Alice Morgan is a clinical psychologist and Clinical Director of Starling Health Collective in Melbourne, offering clinical supervision, EMDR consultation and trauma-informed professional development for health professionals. She also has a Masters of Public Health.

Key references

Gollwitzer, P. M., & Sheeran, P. (2006). Implementation intentions and goal achievement: A meta-analysis of effects and processes. Advances in Experimental Social Psychology, 38, 69-119.

Hunter, M. R., et al. (2019). Urban nature experiences reduce stress in the context of daily life based on salivary biomarkers. Frontiers in Psychology, 10, 722.

Kross, E., et al. (2014). Self-talk as a regulatory mechanism: How you do it matters. Journal of Personality and Social Psychology, 106(2), 304-324.

Orvell, A., et al. (2021). Does distanced self-talk facilitate emotion regulation across a range of emotionally intense experiences? Clinical Psychological Science, 9(1), 68-78.

Panagioti, M., et al. (2017). Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis. JAMA Internal Medicine, 177(2), 195-205.

Scullin, M. K., et al. (2018). The effects of bedtime writing on difficulty falling asleep: A polysomnographic study comparing to-do lists and completed activity lists. Journal of Experimental Psychology: General, 147(1), 139-146.

Sturm, V. E., et al. (2022). Big smile, small self: Awe walks promote prosocial positive emotions in older adults. Emotion, 22(5), 1044-1058.