Making Your Mental Health a Priority During the Coronavirus Pandemic
Posted: March 25th, 2020
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The World Health Organization (WHO) officially declared the COVID-19 viral disease a pandemic on Wednesday March 11th- the disease that has swept into at least 177 countries / territories, infected more than 311,000 and killed more than 13,000 people so far. It's the first time the WHO has called an outbreak a pandemic since the H1N1 "swine flu" in 2009.
We've heard over and over to wash our hands, cough into our sleeves, maintain social distancing, and to take steps to keep our bodies — and those of others — healthy amid the COVID-19 outbreak. But what about our minds?
The disruptions to all aspects of our lives are being felt strongly, with us all individually impacted in different ways. We are in times without precedent, confusing, worrying and stressful.
A poll by the Kaiser Family Foundation found that the key worries related to the coronavirus pandemic were:
You or someone in your family will get sick
Your investments, such as retirement or college savings, will be negatively impacted
You will lose income due to a workplace closure or reduced hours
You will not be able to afford testing or treatment if you need it
You will put yourself at risk of exposure to the virus because you can’t afford to stay home and miss work
You might feel more on edge than usual, angry, helpless or sad. You might notice that you are more frustrated with others or want to completely avoid any reminders of what is happening. For those of us who already struggle with our mental health, we might feel more depressed or less motivated to carry out our daily activities.
Hayley Quinn, a clinical psychologist at Swedish Pediatrics said, “We can't control what's happening. We can't control whether our job is going to be there tomorrow or what this is going to look like even in a month. But it's good to focus on the things you can control.
Experts say maintaining your mental health is as important as your physical health in these times. Whether you actually catch the virus or not, you're impacted by it.
Here are some of the top ways your mental health could be impacted:
Human beings like certainty. We are hard-wired to want to know what is happening when and to notice things that feel threatening to us. When things feel uncertain or when we don’t generally feel safe, it’s normal to feel stressed. This very reaction, while there to protect us, can cause all sorts of havoc when there is a sense of uncertainty and conflicting information around us.
A large part of anxiety comes from a sense of what we think we should be able to control, but can’t. We may feel helpless about what will happen or what we can do to prevent further stress. The uncertainty might also connect to our uncertainty about other aspects of our lives, or remind us of past times when we didn’t feel safe and the immediate future was uncertain.
Anxiety related to the coronavirus is to be expected. A survey of Chinese citizens published in February found that 42.6% of respondents experienced anxiety related to the coronavirus outbreak.
Anxiety UK's Nicky Lidbetter explains, the fear of being out of control and unable to tolerate uncertainty are common characteristics of many anxiety disorders. So it's understandable that many individuals with pre-existing anxiety are facing challenges at the moment.
"A lot of anxiety is rooted in worrying about the unknown and waiting for something to happen - coronavirus is that on a macro scale," agrees Rosie Weatherley, spokesperson for mental health charity Mind.
AnxietyUK suggests practicing the "Apple" technique to deal with anxiety and worries:
Acknowledge- Notice and acknowledge the uncertainty as it comes to mind
Pause- Don't react as you normally do. Don't react at all. Pause and breathe
Pull back- Tell yourself this is just the worry talking, and this apparent need for certainty is not helpful and not necessary. It is only a thought or feeling. Don't believe everything you think. Thoughts are not statements or facts
Let go- Let go of the thought or feeling. It will pass. You don't have to respond to them. You might imagine them floating away in a bubble or cloud
Explore- Explore the present moment, because right now, in this moment, all is well. Notice your breathing and the sensations of your breathing. Notice the ground beneath you. Look around and notice what you see, what you hear, what you can touch, what you can smell. Right now. Then shift your focus of attention to something else - on what you need to do, on what you were doing before you noticed the worry, or do something else - mindfully with your full attention
This is a particularly challenging time for anyone suffering from depression. The lack of social engagement and the disruption of routines can worsen symptoms.
Kathy HoganBruen, a Washington-based clinical psychologist said this pandemic creates a kind of “forced depression” because it disrupts plans for the future that normally give people hope. “It’s like this kind of forced depression. No one knows, ‘Can I go on a summer vacation, can I go to my daughter’s graduation?’ We don’t get to do that planning and daydreaming in our heads right now. Depression is feeling hopeless about the future, and right now, I think that’s how a lot of people feel, rightfully so. If you have underlying depression, that might be exacerbated at this point.”
Everyone should be aware that a crisis like this can result in what are known as distress reactions. Joshua Morganstein, chair of the American Psychiatric Association’s Committee on Psychiatric Dimensions of Disasters writes “Distress reactions include trouble sleeping, difficulty in concentration, a feeling of being unsafe. Anger. Blaming others. A desire to socially isolate. It can lead to risky behaviors such as excessive use of alcohol or tobacco. Interpersonal violence can flare. One common response to disasters is work-life imbalance — working long hours and letting other important duties and needs in one’s life slide.”
One common emotion that might not be immediately obvious: grief. Most people associate grief with death and death alone. And while death is certainly a loss, there are many other life events that can produce feelings of grief related to COVID-19. A big one is loss of safety.
Many things we accept as normal have been turned upside down. This leaves many of us, myself included, feeling like there’s an uncertain future.
“Right now, people are feeling grief over the loss of routines, certainty, and a perception of themselves as being generally healthy and protected,” said psychiatrist Joshua Morganstein, chair of the American Psychiatric Association’s Committee on Psychiatric Dimensions of Disasters.
We need human connection now more than ever. As we distance ourselves physically, it’s important we make it a priority to connect emotionally.
Cynthia Boyd, a geriatrics specialist at Johns Hopkins University was a contributor to a major National Academies of Sciences report on the health consequences of social isolation and loneliness in older adults. The researchers found that even before the coronavirus, about a quarter of older adults fit the definition of socially isolated — which measures routine social contact — and 43 percent said they felt lonely. You can be socially isolated without reporting feelings of loneliness, and you can be lonely without being socially isolated. But both conditions seem to inflict harm on physical and mental health.
“Social isolation has been associated with a significantly increased risk of premature mortality from all causes,” the report found, including a “50 percent increased risk of developing dementia,” a “29 percent increased risk of incident coronary heart disease,” a “25 percent increased risk for cancer mortality,” a “59 percent increased risk of functional decline,” and a “32 percent increased risk of stroke.” The mental health risks are also profound. The researchers reviewed dozens of studies and found a consistent relationship between social isolation and depression, anxiety, and suicidal ideation.
“The health effects of loneliness are astounding,” said Carla Perissinotto, the associate chief for geriatrics clinical programs at UC San Francisco and a contributor to the NAS report. “At any point across the life span, the things we’re most worried about is losing our independence, losing our minds, and heart attack, and these are all affected by loneliness independent of other risk factors.”
For people with OCD and some types of anxiety, being constantly told to wash your hands can be especially difficult to hear.
OCD Action said the issue to look out for is the function - for example, is the washing being carried out for the recommended amount of time to reduce the risk of spreading of the virus - or is it being done ritualistically in a specific order to feel "just right".
Note that compulsive behaviors are only one aspect of OCD. Obsessive thoughts are another big aspect of OCD, becoming so consuming they interfere with your daily life.
Stress during an infectious disease outbreak can include:
Fear and worry about your own health and the health of your loved ones
Changes in sleep or eating patterns
Difficulty sleeping or concentrating
Worsening of chronic health problems
Increased use of alcohol, tobacco, or other drugs
‘Normal’ means of escape from stress, like going to the gym or the movies, or to dinner with friends are off the table. Even the diversion of watching professional sports is currently not an option. Moreover, the things we might be inclined to do to extend comfort, like giving someone a hug, or putting your arm around them, are being discouraged as well.
Researchers typically see a spike in substance abuse during emergencies like the COVID-19 pandemic. “It’s often people coping by using substances … primarily things that are easily available, like alcohol, tobacco, cannabis and non-prescription medications.”
For someone struggling with addiction, fellowship is a big part of the recovery process. Unfortunately, since the coronavirus outbreak began and social distancing became the norm, this process has become more challenging. This typically means physical meetings with other people in recovery. In the Alcoholics Anonymous (AA) program, members are encouraged to attend several meetings per week, during which they’re invited to share their experiences and connect with others in person.
But since the outbreak, meetings like these have become few and far between, leaving people in the throes of addiction without immediate support.
The Centers for Disease Control and Prevention has laid out some of the ways various groups of people could be impacted here.
Children and teens react, in part, on what they see from the adults around them. When parents and caregivers deal with the COVID-19 calmly and confidently, they can provide the best support for their children. Parents can be more reassuring to others around them, especially children, if they are better prepared.
Not all children and teens respond to stress in the same way. Some common changes to watch for include:
Excessive crying or irritation in younger children
Returning to behaviors they have outgrown (for example, toileting accidents or bedwetting)
Excessive worry or sadness
Unhealthy eating or sleeping habits
Irritability and “acting out” behaviors in teens
Poor school performance or avoiding school
Difficulty with attention and concentration
Avoidance of activities enjoyed in the past
Unexplained headaches or body pain
Use of alcohol, tobacco, or other drugs
When caring for children, WHO underscored the importance of helping them to find positive ways to express feelings, such as fear and sadness. “Children feel relieved if they can express and communicate their feelings in a safe and supportive environment”, the UN health agency maintained, encouraging that if safe, they be kept close to their parents and family.
There are many things you can do to support your child:
Take time to talk with your child or teen about the COVID-19 outbreak. Answer questions and share facts about COVID-19 in a way that your child or teen can understand
Reassure your child or teen that they are safe. Let them know it is ok if they feel upset. Share with them how you deal with your own stress so that they can learn how to cope from you
Limit your family’s exposure to news coverage of the event, including social media Children may misinterpret what they hear and can be frightened about something they do not understand
Try to keep up with regular routines. If schools are closed, create a schedule for learning activities and relaxing or fun activities
Be a role model. Take breaks, get plenty of sleep, exercise, and eat well. Connect with your friends and family members
The UN Population Fund (UNFPA) has recommended that breastfeeding women who become ill should not be separated from their newborns. While there is no evidence that the illness can be transmitted through breastmilk, UNFPA urged mothers who are infected to wear a mask when near their baby, wash their hands before and after feeding, and disinfect contaminated surfaces.
As older adults and people with underlying health conditions who are vulnerable, may become more anxious, agitated and withdrawn during the outbreak, WHO stressed the importance of relaying clear instructions in a concise, respectful and patient way, noting that pictures may also be utilized.
“Engage their family and other support networks” to provide information and help them practice prevention measures, including hand-washing, the UN health agency said. And when in isolation, stay connected and maintain daily routines, as much as possible.
“Keep things in perspective…and avoid listening to or following rumors”, concluded WHO.
The UN health agency reminded everyone to “honor caretakers and healthcare workers…[for] the role they play to save lives and keep your loved ones safe”, while assuring healthcare workers that it is normal to feel “under pressure” and emphasizing that stress is “by no means a reflection that you cannot do your job or that you are weak”.
WHO urged them to rest sufficiently, eat healthy foods, get physical activity and stay in contact with family and friends.
“This is a unique and unprecedented scenario for many workers, particularly if they have not been involved in similar responses”, said WHO, with the reminder that “this is not a sprint, it’s a marathon”.
WHO advises that protecting staff from chronic stress and poor mental health will provide them with the capacities they need to perform their duties.
And focusing on the longer term rather than short-term crisis responses, team leaders or health facility managers are encouraged to deliver quality communication and accurate information updates to all staff.
WHO outlined the benefits in rotating workers from higher- to lower-stress functions and in partnering inexperienced workers with those who are more experienced, to provide reassurance.
Maintaining that the buddy system helps to “provide support, monitor stress and reinforce safety procedures”, WHO advocated for outreach personnel to work in pairs and to “initiate, encourage and monitor work breaks”.
Responding to COVID-19 can take an emotional toll on you. There are things you can do to reduce secondary traumatic stress (STS) reactions:
Acknowledge that STS can impact anyone helping families after a traumatic event
Learn the symptoms including physical (fatigue, illness) and mental (fear, withdrawal, guilt)
Allow time for you and your family to recover from responding to the pandemic
Create a menu of personal self-care activities that you enjoy, such as spending time with friends and family, exercising, or reading a book
Take a break from media coverage of COVID-19
Ask for help if you feel overwhelmed or concerned that COVID-19 is affecting your ability to care for your family and patients as you did before the outbreak
Being separated from others if a healthcare provider thinks you may have been exposed to COVID-19 can be stressful, even if you do not get sick. Everyone feels differently after coming out of quarantine. Some feelings include :
Mixed emotions, including relief after quarantine
Fear and worry about your own health and the health of your loved ones
Stress from the experience of monitoring yourself or being monitored by others for signs and symptoms of COVID-19
Sadness, anger, or frustration because friends or loved ones have unfounded fears of contracting the disease from contact with you, even though you have been determined not to be contagious
Guilt about not being able to perform normal work or parenting duties during quarantine
Other emotional or mental health changes
There are many things you can do to prioritize your mental health during this time. We’ve listed some of the top tips below:
Avoid ‘future tripping’- It is healthy to discuss with friends and family how you are feeling and coping. When the conversation turns towards the future “what ifs” that are unknown, keep those discussions to a minimum. Try to touch base with a friend or loved one once per day
Communicate with your children- Most children will have already heard about the virus, so parents shouldn’t avoid talking about it. Not talking about something can actually make kids worry more. Look at the conversation as an opportunity to convey the facts and set the emotional tone. Your goal is to help your children feel informed and get fact-based information that is likely more reassuring than hearing things from other sources
Connection- Reach out to friends and family for support, virtually if necessary. Social distancing does not have to mean social isolation, especially with modern technologies available to many of us. Connecting with our friends and loved ones, whether by high tech means or through simple phone calls, can help us maintain ties during stressful days ahead and will give us strength to weather this difficult passage
Create Safety- Do what helps you feel a sense of safety. This will be different for everyone, and it’s important not to compare yourself to others. It’s ok if you’ve decided what makes you feel safe is to limit attendance of large social events, but make sure you separate when you are isolating based on potential for sickness versus isolating because it’s part of depression
Empathy- “Be empathetic to all those who are affected, in and from any country”, WHO highlights first, warning against stigmatizing anyone who has or had the virus
Faith- Virtual parishes, which the Pope and other faith leaders are offering, can help maintain religious connections
Get Outside- Get outside in nature– even if you are avoiding crowds. I took a walk yesterday afternoon in my neighborhood with my daughter. The sun was shining, we got our dose of vitamin D, and it felt good to both get some fresh air and quality time together. Exercise also helps both your physical and mental health
Gratitude- Create an attitude of gratitude, focusing on the things that you do have. Start each day writing out a list of the top 10 things you are grateful for, and share it with friends
Help Others- Research shows that helping and volunteering can boost mood and reduce anxiety. Start with your neighborhood and then look around in your local community. Examples include: walking someone’s dog, offering virtual homework support, or doing a grocery run
Limit Access to News Outlets- Being concerned about the news is understandable, but for many people it can make existing mental health problems worse. “The sudden and near-constant stream of news reports about an outbreak can cause anyone to feel worried”, said WHO. Limit your media consumption and focus on accurate, evidence-based sources. 15-30 minutes per day should be enough time to keep you engaged and informed without increasing your anxiety
Limit Social Media- Mute key words which might be triggering on Twitter and unfollow or mute accounts. Mute WhatsApp groups and hide Facebook posts and feeds if you find them too overwhelming. While social media is a good way of staying in touch while exercising social distancing, as well as keeping informed, it can be a source of increased anxiety and conflict. Therefore, if all becomes too overwhelming, you should take a break from it
Maintain Routines- This includes wake-up times, meals and snacks, work or study periods, exercise, and relaxation. Create a daily schedule for yourself
Maintain Your Treatment Routine- Be sure to continue your treatment regimens. Consider developing a plan for telehealth sessions with your provider if you (or your provider). Many 12 step meetings are also available via online conferencing platforms like Zoom
Medication- For anyone who is worried about access to prescribed medications, you can ask your health care provider about getting 90-day supplies vs. a 60 or 30-day supply. If this is not possible, we encourage you to refill your medications as soon as they are allowed
Mindfulness Practices- Many of the relaxation apps that are available have a free option. Headspace, CALM, and Buddhify are good examples. There are yoga videos available on YouTube. Add this to your nighttime routine, or try 5 minutes after each meal
Practice Acceptance- Accept that the news coverage will not answer all your questions or address all your worries. Accept uncertainty. Trust that officials around the globe and the medical community are trying their best to address the situation
Physical Wellbeing- Things like getting good sleep, eating regularly, staying hydrated, exercising and avoiding alcohol and drugs.. When we take care of our body, with good sleep in particular, but certainly food and water, our ability to think clearly, our ability to solve problems, our ability to manage our emotions, are all optimized
Put Yourself First- You may be familiar with this analogy - Just like airline passengers are told by flight attendants, should the oxygen mask drop mid flight, you need to put on your own oxygen mask first
Reach Out For Support- Talk to trusted friends about what you are feeling. If you are feeling particularly anxious or if you are struggling with your mental health, it’s ok to reach out to a mental health professional for support. You don’t have to be alone with your worry and it can be comforting to share what you are experiencing with those trained to help
Reflective Listening- This is an excellent communication technique, where you listen to what a person is saying and repeat it back to them. You may help validate their concerns, and show them you understand their concerns, which can help put them at ease. Talking to another person about worries and fears can help, and just knowing that others share them can validate your own fears and worries
Separate what is in your control from what is not- There are things you can do, and it’s helpful to focus on those. Wash your hands. Remind others to wash theirs. Take your vitamins
Start A New Hobby- Invest in a health outlet. This is the time you’ve been waiting for to get back to sewing, an instrument, or your art! There are lots of tutorials online to learn a new skill. Try to aim for at least 15 minutes per day, and build up to longer time periods
Stay In The Present- Perhaps your worry is compounding—you are not only thinking about what is currently happening, but also projecting into the future. When you find yourself worrying about something that hasn’t happened, gently bring yourself back to the present moment. Notice the sights, sounds, tastes and other sensory experiences in your immediate moment and name them. Engaging in mindfulness activities is one way to help stay grounded when things feel beyond your control
Tolerance- Many people are probably at wits end right now. As nerves fray, we may start sniping at one another, damaging important relationships. It’s important to remember we are all being impacted, and to be a little more patient and tolerant with each other
Unwind- Make time to unwind. Try to do some other activities you enjoy
It’s too early to know how long this crisis will last or what its ultimate toll will be. But one thought may be comforting: Everyone is affected by this. A crisis can also bring out the best in people. People around the world have a history of collective action and resilience in hard times. This is a time for communities to find common purpose, even if people are forced to stay apart.
Coping With Coronavirus: Managing Stress, Fear, and Anxiety - National Institute of Mental Health (NIMH)
Coronavirus: COVID-19 Is Now Officially A Pandemic, WHO Says - National Public Radio (NPR)
Coronavirus Disease 2019 (COVID-19): How To Prepare: Manage Anxiety & Stress - Centers for Disease Control and Prevention (CDC)
Coronavirus: Mental Health Coping Strategies - National Alliance on Mental Illness (NAMI)
COVID-19: Mental Health In The Age Of Coronavirus - United Nations (UN) News
NAMI Updates On The Coronavirus - National Alliance on Mental Illness (NAMI)
Mental Health Experts Offer Counsel On Staying Calm During Coronavirus Pandemic - The Washington Post
Taking Care of Your Mental Health in the Face of Uncertainty - American Foundation for Suicide Prevention