The COVID-19 pandemic has caused widespread uncertainty and anxiety about the future. Millions of people around the world are experiencing significant life changes, whether from job loss, personal or family health problems, changes to daily routines, isolation, or anxiety about the news.
I have noticed in the recent weeks that emotions, like the virus, is spreading from person to person. Fear and anxiety have risen in the general population in the face of the evolving COVID-19 pandemic, and more notably, in the clients I have seen in the recent weeks.
Some stress and anxiety are expected in the face of uncertainty. In limited doses, these emotions are completely normal and healthy. Anxiety is a necessary emotion system set in place to warn us of true dangers. Getting rid of anxiety altogether would be dangerous: like sending someone with no pain or heat receptors in their hands in the kitchen to cook. As I often say to my clients: "I would be more concerned if you weren't worried." But when these feelings grow out of control, or when they start to have a negative impact on a person's life, they may need to be addressed. This out of control feeling leads to anxiety disorders, setting our danger sensitivity detectors too high and thus interfering with day-to-day living.
Anxiety Reduction Strategies
How do we manage anxiety, stress, and maintain mental wellness during the pandemic?
For one, we can use the facts we have learned from reliable sources (WHO, CDC, local public health authorities) to help balance out the fear. Currently, we are armed with the knowledge that only 10%-20% of those infected with coronavirus require hospitalization, and that of those hospitalized, the death rate for people up to the age of 64 is likely lower than the original 2%-3% originally set forth by early data from Wuhan, China. The thought of becoming infected with coronavirus can still be terrifying for some, even if the odds of requiring hospitalization and dying from the illness are low. But look at it this way, although the statistics are not as low as the flu, they are not as high as Ebola. It is important to validate clients’ fears, but also reassure them that even if infected by the virus, they are more likely to not require hospitalization.
Facts aside, it is important to reflect on the idea that feelings and anxieties do not reflect truths or facts. Learning to separate feelings from facts allows us all to approach situations from a more rational standpoint. During my therapy sessions I teach clients mindfulness-based cognitive behavioral therapy (CBT) techniques that allow them to visualize their thoughts and worries as clouds floating by in the sky. This allows them to gain more distance and relief from their anxiety and gives them a tool to use outside the office in times of stress.
Additionally, in sessions I teach diaphragmatic breathing as well as relaxation techniques such as visualization or guided imagery that help with stress reduction and can then be utilized outside of the office. Guidance on yoga, mindfulness, and meditation are all widely available to people, even during these times of social distancing via social media, apps, video sessions, and YouTube tutorials.
As social beings even during these times of social distancing requirements, I encourage my clients to stay connected with others during this time of physical separation from others. Reaching out to others via telephone or video-call can be a highly rewarding event, especially for those who feel socially isolated because of quarantine or shelter-in-place directives.
Also, connecting with nature remains a valuable tool that is available to us all, even as we physically isolate from others. It is not only therapeutic for our mood to go outside and enjoy nature but connecting with nature stimulates our spiritual self and provides physical benefits. The stress reduction benefits of mindfulness, meditation, or yoga, boost our overall wellness-mind, body, and spirit. The opposite is an over stressed hormone system that weakens the immune system and make us more vulnerable to disease and illness.
Furthermore, I have encouraged clients in the recent weeks to limit their exposure to social media and news coverage. Social media and 24-hour news cycles often highlight the less probable but more highly emotional stories of the most severe outcomes of COVID-19, and these stories tend to be the most salient to us all as we ponder “How will this pandemic look for me, and the world?” I suggest clients to limit exposure to once a day or less, and for a prescribed time period, an hour or less, as a starting point to anxiety reduction.
In response to the COVID-19 pandemic, the World Health Organization, the US Centers for Disease Control and Prevention, as well as public health experts around the world have strongly recommended that individuals and organizations take action to prevent and limit the transmission of COVID-19. This recommendation makes accessing needed psychotherapy services that are necessary for mental wellness challenging due to the social distancing or shelter-in-place directives.
To increase access to services and create flexibility during this difficult time, I have turned to tele-mental health options. Turning to tele-mental health options (as Medicare and Medicaid relaxes policies to allow us to reach our clients while still helping to “flatten the curve”) has helped me and other clinicians to reach clients most paralyzed by fear and prevent appointment cancellation for clients that are in the greatest need for mental health services at this time.
Finding Greater Meaning
Finally, I have encouraged clients in the recent weeks to use this time of adversity to find or create meaning in life, to find the good, to find the blessings, or find the wins-whichever term works best for you. When clients find it difficult to find these things, I encourage them to use this time to create meaning, create wins, and so on. Anxiety and depression are bullies that
tend to paralyze us with fear. This fear attempts to rule our life, causing us to cease living life to the fullest and preventing us from moving forward with life goals.
I encourage clients to live their life to the fullest, even during these uncertain times. Make new goals, explore current goals or engage in activities you have thought about doing for years but never had time to achieve. Acceptance and Commitment Therapy (ACT) techniques teach that it is OK to be anxious and worried, but we have a choice about how much we allow this anxiety and worry to control our life. We have a choice to move forward with life. Remember, our society and all of mankind for that matter has survived wars, epidemics and pandemics of viral disease for thousands of years. We will survive this as well!!
It is my duty as a mental health professional to arm my clients and others with the best tools possible to help them survive this pandemic. Hand-washing and social distancing are helpful on a population level, but on a personal level, I am here to be an emotional guide in response to the panic and fear clients, coworkers, colleagues, friends, and family are experiencing during this crisis.
When this is over, my hope is that we will all be able to reflect on the idea that true wellness stems from the ability to live in an uncertain world partnered with our emotions, not ruled by them. I invite you all, as I do with my clients, to begin to make friends with your anxiety, and use it is a tool for self-exploration and growth, rather than as a barrier to living a meaningful and purposeful life.
Stay Well, Be Empowered, Live Boldly and Fully!!
Dr. Terra