Coping with anxiety and worry during COVID
Stefanie Kroll and Sarah Noble, M.D.
Some of us are worriers — we think about what is going to happen, and uncertainty is very stressful. Some of us would call this anxiety, others would just call it worrying. There are so many factors that can bring on or worsen stress from worrying or anxiety during the stay-at-home period of this COVID-19 outbreak. Recently, we were discussing the number of friends, family and coworkers who may be dealing with anxiety during this time, and we decided that a few ideas and tips might be helpful.
We have brought together some information about dealing with anxiety and worry on top of other mental health issues, and some breathing and self-care techniques that can be helpful.
First of all, this is a stressful situation. Many people are facing financial struggles and job loss. In order to stay afloat, folks are having to apply for financial assistance and perhaps request food donations. Those processes are stressful on their own, even if you don’t mind paperwork typically. Aside from basic worries about sustaining ourselves, our routines are smashed, we aren’t in physical contact with friends and family, and in the best of situations we are still working, but remotely. Many are working to bring us essential services and are in danger of getting the virus (We thank you very much for doing this work!).
When we have underlying difficulties with stress, past trauma, anxiety or worry, the effects can be compounded. If we have anxiety or trauma, we may not generally have a sense that the world is a safe place — maybe we have felt this way our whole lives, that we are not safe. This makes day-to-day living difficult, but it can be hidden under routines and interactions, by building safety into our lives. But when the world is not feeling safe, and our protective actions can’t be used, our underlying feelings come out stronger, and it can lead to a lot of panic and stress.
Our reaction to stress-fight or flight-is natural. It’s how our bodies protect us from dangerous situations. Check out the video link to get a better understanding of it. What happens with stress, anxiety, etc. is that this response gets over-zealous. Instead of acting as a smaller warning to be alert (like when you’re cooking and the smoke detector goes off), it is setting off all the alarms in our bodies (like deploying the sprinkler system!). This is actually an “amygdala hijack,” or this part of our brain taking over those other more cautious, rational parts of the brain that tell us we might be ok, and that give us room to take actions. So it’s this amygdala hijack and fight or flight response that we need to address to feel better.
The fist thing to consider is that you need to take care of yourself more than before. We all have certain ways we let off steam, share laughs, de-stress…and now many of those habits are not available. So we have to reevaluate what is available and make a very intentional shift to using new resources. (More on resources later)
Next, learn about cognitive distortions. These little tricks our brains play on us lead to convincing ourselves that situations are worse than they actually are. Check out this video resource as well on cognitive distortion and try to track your thoughts. Are you doing any of these distortions when you think about how you are, and your current situation? Is everything negative? Is it all or nothing/ black or white? Is it really the worst thing you have faced (perhaps it is, we could not decide that for you)? But if not, then we can acknowledge it is bad. Then from there, we can reflect on our strength, our resources, our ability to cope with difficult situations…and maybe we can even convince ourselves that we have this under control. If we don’t have the solution, then we can remind ourselves of the resources for getting a handle on the situation — see the next section. It is important to note that these are very common practices of our brains! It is hard to convince ourselves to not distort our thoughts. But with some practice, and by recognizing that we are distorting them, we can stop our brains or at least catch them when they run down these paths. This work is great to do with a therapist.
Even though we are staying safe at home, we always have resources if we take stock. Therapy, connecting with friends and family, joining virtual groups to make new communities and connections, online exercise videos, virtual game apps are just some of these resources. Therapy still has a stigma for some folks — some may think there is nothing wrong with them, so why should they seek out therapy? But therapy is the opportunity to have someone get to know you, your thought patterns, your struggles, and help you analyze your patterns — good or bad. Therapists add a level of support where you don’t owe them anything (well, payment, although many have reduced costs and take insurance). You get to tell a therapist everything you want to, without worry of any judgement or anyone else finding out.
Another resource we always have: our breath. Our breathing can be a very grounding force. Taking a deep breath allows you to calm your body, which can also calm your mind. Yoga breathing techniques have been developed for different purposes. We recommend doing one or more of these exercises daily, not just when you’re having a moment of panic, worry or anxiety. By having them incorporated into your routine, you set a baseline of having some control or calm, and it makes it easier to go back to them in moments of stress. If you wait until you’re stressed, it may be too late to start a breathing exercise if you’re not used to it. But if it’s part of your routine, you can easily slide into the practice. Here are videos on breathing practices designed to help calm and focus you: bee breath, box breathing, alternate nostril breathing. If you’re feeling an energy slump, you can try breath of fire for a boost! Read about precautions of doing breathwork if you have any heart issues. I know that yoga claims to health can seem hokey, but there have been a long list of studies showing that many of them really do improve your physical and mental health beyond strength and flexibility, although a review is beyond our scope here. Daily breathing exercises have been shown to reset your sympathetic and parasympathetic nervous systems.
Another mode of self-care that is very important if you’re feeling stressed: vigorous exercise. HIIT videos (High Impact Interval Training) can help you squeeze in a workout in 10 or 20 minutes. You can find beginner and low impact options if you have sensitive joints or are feeling out of shape. The internet abounds with videos — Fitness Blender also has a Facebook community to connect with others about challenges and successes. Is there a time in your day when you need a break and can fit in a short workout? I bet you can find 10–20 minutes if you try. It helps to just fit it into a time of day that woks for you — the important part is to get moving and get your heart rate up several times a week.
Lastly, our patterns of distraction by electronic devices and packed work schedules can really lead us to feel dissatisfied with our activities and life in general. Meditation can help improve your happiness by allowing you to focus your thoughts. It is definitely hard to meditate at first, and I still struggle because my mind is going a million miles an hour. But every effort is helpful, even if you end up focusing only for a minute or two. Check out this article on meditation. It might help you tap into this ancient resource
One of the biggest challenges is making an exercise, meditation or breathing practice part of your routine. The best way is to make it easy by incorporating into an existing part of your routine. For example, when I started taking vitamins, I put them where I prepare my breakfast. When I wanted to start working out in the morning, I put my workout clothes by the bed so I put them right on when I got up. The tiny habit philosophy goes through one method in more detail as well.
With all of these tools and advice, go easy on yourself. Give your best effort, acknowledge that you are working on this, and be patient, not critical. Hopefully some self care during this pandemic will translate to better ways of dealing with life in general. In the meantime, be compassionate and understanding with yourself and others as much as you can.
Sarah is a psychiatrist at Albert Einstein Healthcare Network.
Stefanie is an environmental researcher at the Academy of Natural Sciences of Drexel University and a Yoga Alliance 200 hour certified yoga teacher.
