Mental Health Matters: A Therapist’s Thoughts on Coping in the Age of COVID-19
By: Sara Morrow, MSc, LMFT
As I write this, I am sitting in the corner of my bedroom, which has now become my make-shift therapy office. I have a new chair and a folding desk, both purchased to accommodate this new “space.” I communicate with my clients via a computer screen now. My partner and I have been trading spaces while we work to get a “change of scenery” once in a while. Sound machines are blasting throughout the apartment. The dog is a very content co-therapist at my feet. If you had told me in January that this was going to be my day-to-day, I don’t know if I would’ve been able to fully believe you or grasp what it’d mean. I own the fact that I am someone who deals with anxiety. I need structure, rhythm and planning in my life. The COVID-19 pandemic has totally upended that for me (and probably you too). I often say: “uncertainty is anxiety’s best friend.” I don’t know who I borrowed that saying from, but it’s very apropos in this situation! Given that we do not know when this will end, how do we cope with the uncertainty and anxiety?
I am eternally grateful to the medical professionals, scientists, grocery employees, delivery drivers, and many others who are doing what they do to make life possible right now. As a therapist, the least I can do is share some ideas about coping in the time of COVID. We have to take care of our mental health during this time too.
Soothe your Nervous System
Our bodies have a built-in mechanism to deal with threats and emergencies. Our nervous system is comprised of the Sympathetic Nervous System (SNS), involved in arousal, and the Parasympathetic Nervous System (PNS), involved in rest and digest. The Limbic System, which is commonly thought of as the emotional part of the brain, responds to threatening stimuli by initiating a cascade of internal events activating the “fight, flight, freeze” of the SNS. Evolutionarily this has been critical for human survival: in the short-term, it can help with performance and problem-solving (Anzia, 2020). The problem is that our nervous systems can go into overdrive and in the long-term, this is not beneficial for our health. It is fair to say that COVID-19 is a novel threat, and many of us have a very active SNS right now! We need to help our SNS calm down and actively engage our PNS in order to initiate relaxation. Here are some ways to do so:
· Diaphragmatic Breathing: this is a great way to get your PNS going. Try breathing in through your nose, expanding your diaphragm as you do so. Then, breathe out through your mouth, contracting the diagram. Pace your breathing by making your exhale longer than your inhale. For example, I might breathe in for a count of 5, and exhale for a count of 7 (Linehan, 2015).
· Grounding Techniques: With fear and anxiety, our minds are often overactive and future-oriented. By “grounding” ourselves, we can come back into the present. You can use your five senses to do this: what is something you can see? Hear? Smell? Taste? Feel?
· Initiate the Mammalian Dive Reflex: when we are immersed in very cold water without Oxygen, our heart rate slows down. We can mimic this by dunking our faces in ice cold water and holding our breath for 30-60 seconds or by using an ice-pack over our eyes (Linehan, 2015). Our PNS is activated by doing this.
· Name your Emotions: ever wonder why talking about how you’re feeling is helpful? When you name an emotion, effectively putting an affective state into words, it decreases the activity in the amygdala, which is a brain area very involved in SNS arousal (UCLA, 2007). Talk to a therapist, friend, or keep a journal about how you are doing.
Boundaries
In psychology terms, a boundary is a limit that a person puts in place to protect their mental, interpersonal, and/or physical space (Hereford, n.d.). Boundaries matter right now. You may wonder: “what do you mean boundaries? I’m not even seeing anyone!” Beyond interpersonal boundaries, we can set limits around the amount of COVID related information we are exposing ourselves to. I encourage you to create a boundary around any or all of these: amount of time spent reading or watching news about the pandemic, the types of sources you are getting information from, time spent on social media, and time spent engaging in “COVID talk.” In a longitudinal study examining the link between acute stress symptoms and media exposure of 9/11 and the Iraq War, results indicated that prolonged exposure to media (in this case TV), led to a higher likelihood of acute stress symptoms (Silver et al., 2013). This doesn’t mean you have to cut out information completely; it’s important to stay informed. Get your information from trusted sources that don’t have monetary or political stakes in their reporting. Just limit the time spent engaging with this information.
With many couples working from home right now, it makes sense that there may be increased tension as each of you navigates the use of space. Do you need to implement some alone time to re-charge? Can one parent watch the kids for half an hour while the other takes a (socially distanced!) walk? Maybe even closing the bathroom door and taking a hot shower will do the trick.
Back to Basics: Sleep, Diet and Exercise
This may seem obvious, but pay attention to sleep, diet and exercise. These can get disturbed easily when we don’t have to wake up as early to commute or when snacks are within an arm’s reach at home. Many gyms are closed now which may demotivate us to maintain our fitness routines. Maintain sleep hygiene by going to bed and waking up at the same time each day. Try to do an at-home workout (YouTube has many!) or take a walk when there aren’t as many people outside. Try to stick to three meals a day. Adhering to these routines helps to build structure, which many of us need to curb anxiety.
Connect
We need to practice social distancing as much as we can to contain the virus and slow its spread. However, isolation is very hard for humans since we are social beings. In fact, it is very linked to health; a lot of data show that isolation increases the risk of death more than other leading health causes (Holt-Lunstad, 2015). Therefore, try to reach out to people via phone or video platforms. I have seen people get very creative with virtual video dinners and/or happy hours or even by playing online games with friends.
Loneliness has been a big problem in the U.S. even before the age of COVID (Simpson, 2020). If you know someone who lives alone and may not have many connections, check in on them with a call or an email. If they are elderly and don’t use email as much, write them a letter and mail it using “snail-mail.”
Start a Mindfulness Practice
Sorry to sound like a broken record, but mindfulness is good for us! This is the deliberate practice of focusing on the present moment without judgement (Linehan, 2015). We know this is beneficial for our wellbeing because there is countless data to support it. It is known to help in the following ways: decreased depression symptoms, decreased anxiety, lessened emotional reactivity, decreased symptoms of physical pain, greater sense of well-being, and decreases in distractibility (Linehan, 2015, p. 162). Of particular note during this time, mindfulness practice has also been shown to help boost our immune systems’ ability to respond (Linehan, 2015)! If you need a place to start, try these practices from UCLA’s Mindful Awareness and Research Center
Now is as good a time as any to try it out. Be patient with yourself as you start!
Self Compassion
This is a very difficult situation. How might you talk to a friend or loved one during a difficult time in their life? With criticism and harshness or with kindness and patience? How would you like to be treated? Rather than being our own worst enemy, now is the time to be our own best friend. Neff & Germer (2017) summarize research on self compassion: higher scores on the Self Compassion Scale (SCS) are associated with greater levels of well-being and lower scores of depression and anxiety. By the way, I highly recommend Dr. Kristin Neff’s work; she is one of the big names in the self-compassion research. Her “Self Compassion Break” practice is very helpful.
Therapy
If you are thinking about initiating therapy to deal with stress but are afraid to go in person, I’d encourage you to try out tele-therapy as an option! A lot of therapists are offering telehealth during the pandemic. It’s a great way of getting some extra support during this time. Myself and my colleagues at CCRC are all equipped to do video sessions in a HIPAA compliant way. Don’t hesitate to reach out for help. If you are a medical provider caring for COVID patients, I especially encourage you to reach out due to the potentially traumatic nature of your work.
My hope is that some of this is helpful to you. This is a time of great uncertainty and we are all navigating our way through it at the same time. There seems to be a lot of content on social media advocating self improvement and using our time at home well. It is 100% ok if you subscribe to this. It is also 100% ok if you do not. In fact, maybe you are on a roll with your reading project on Monday, but on Tuesday you can’t even get through one page. Confession: I was really in the zone writing this piece last week but then couldn’t write for days because I was emotionally spent. I judged myself over the weekend. But maybe, just maybe, I am doing the best that I can right now. I’m sure that you are too. Please take good care of yourself and be safe.
References:
Hereford, Z. (n.d.). Healthy personal boundaries and how to establish them. Retrieved from http://www.essentiallifeskills.net/personalboundaries.html
Holt-Lunstad, J., Smith, T., Baker, M. & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 227-237.
Linehan, M. (2015). DBT skills training manual (2nd ed.). The Guildford Press.
Neff, K. D. & Germer, C. (2017). Self-Compassion and psychological wellbeing. In J. Doty (Ed.) Oxford Handbook of Compassion Science, Chap. 27. Oxford University Press
Silver, R., Holman, A., Pizarro-Anderson, J., Poulin, M., McIntosh, D. & Gil-Rivas, V. (2013). Mental and physical health effects of acute exposure to media images of the September 11,2001, attacks and the Iraq War. Psychological Science, 1623-1634.
Simpson, B. (2020, April 03). How to prevent social isolation from making loneliness worse. Johns Hopkins Bloomberg School of Public Health. Retrieved April 13, 2020 from https://www.jhsph.edu/covid-19/articles/how-to-prevent-social-isolation-from-making-loneliness-worse.html
University of California - Los Angeles. (2007, June 22). Putting feelings into words produces therapeutic effects in the brain. ScienceDaily. Retrieved April 13, 2020 from www.sciencedaily.com/releases/2007/06/070622090727.htm
