COVID-19 Mental Health Toolkit: Coping with Anxiety, Worry and Panic (Part 1)
By Dr Liza Chervonsky, Clinical Psychologist and Director of Inlight Psychology in Bondi Junction.
The outbreak of the coronavirus (COVID-19) has brought with it a number of disruptions and changes to people’s lives. There is great uncertainty and many are worried about their physical and mental health, finances, career, families, and friends. Part 1 of this mental health toolkit focuses on causes of stress, anxiety, worry, and panic, and strategies to manage these emotions, within the context of COVID-19. Part 2 (coming soon) will focus on managing social isolation and issues related to work/career changes.
Before we go into specific areas and strategies, it is worth considering two important general factors that contribute to and maintain anxiety:
Imagining worst case scenarios and over-estimating the likelihood of those negative outcomes (catastrophic thinking).
Under-estimating your ability to cope, survive, recover, or endure your anxiety or catastrophic outcome.
Generally, any strategies that help reduce catastrophic thinking and increase your sense of coping and safety will likely help improve your anxiety. Below, you will find a number of different ways to address these two factors and help reduce your anxiety levels.
Be wary of the effect that media has on your anxiety. There is continuous news coverage of COVID-19 at this time. It is easy to be tempted to check the news frequently for any updates on the situation. However, be wary of the effect this is having on your anxiety levels.
Remember, many news websites make their money by having you click on their articles. For this reason, news articles will often contain anxiety-inducing headlines designed to grab your attention. They tend to focus on tragedies, negative outcomes, and deaths related to COVID-19. This can create the perception that worst case scenarios are much more common and probable than more positive outcomes. Furthermore, even when news articles do write about a "survivor" of COVID-19, it is often written in a way that makes it appear as if this is a rare outcome. All of this can lead to catastrophic thinking and further exacerbate anxiety. It is important to remember that the statistics show that for most people their chance of death is very low. However, even for those who are more at risk, their chance of survival is still much higher than their chance of death. Try to also remember that experiences of the disease vary greatly and there are many people that experience limited or manageable symptoms. In fact, partly why there has been difficulty in containing the disease is because there are so many people that show few or mild symptoms of the disease.
Be wary of the source of the information. Even seemingly reputable news websites can sensationalise a story or exclude important information about a situation or event. The Australian Department of Health website is a regularly updated and reliable source of information regarding COVID-19.
Try to maintain a healthy level of skepticism when reading about personal accounts or comments on unofficial websites, especially from people you don't know. Popular websites such as Facebook or Reddit often contain misleading or fabricated stories. Don't be fooled by the number of likes or upvotes. Comments are often posted to create effect rather than to reflect the truth.
Be mindful of negative thinking that might involve something like “I bet I’ll be one of the unlucky ones”, “It’s sure to get me”, "I'm going to die".
Try to remind yourself of the true probabilities of the negative outcomes. For most people, the chance of death is very low. Furthermore, even in high risk populations, the chance of survival is still much greater than the chance of death.
If you have a tendency to expect the worst (even outside of COVID-19), try to ask yourself how many times the worst outcome has occurred in other situations. Remember, anxiety often makes us overestimate the chance of a negative outcome. But once the situation has passed and a negative outcome doesn't occur, we tend to forget what we worried about and move onto something else that is worrying. This is in part due to the brain being wired to remember negative but not neutral information, as neutral information is not as important for survival. So when it seems like bad things happen more frequently than neutral or positive ones, bear in mind that being able to remember more negative than neutral things in the past is likely due to the way memories are stored in the brain, rather than a true reflection of how things have been.
Feeling like something is likely to come true does not change its actual likelihood. Emotional reasoning is when we tend to estimate the probability of something based on how we feel. Be mindful that no matter how anxious you are about a situation and no matter how much it “feels” like a bad situation is likely, the objective probability of that situation does not change.
An important note: The points outlined above are to help reduce catastrophic thinking about death and other negative outcomes. Although the risk of death is low, it is still very important that we remain sensible and follow the rules and guidelines implemented by the government to slow down the rise of new cases and prevent the transmission and spread of the virus.
Mental processes and attention related to anxiety
Are you being present? With the uncertainty present in today’s world, it is easy to find yourself pondering over and wondering about the future. However, be aware that anxiety is fueled by negative thinking related to the future. In fact, so much of anxiety is driven by thoughts like “something bad is going to happen, disaster is about to strike, danger is just around the corner”. Another unfortunate aspect of anxiety is that your anxiety isn’t very good at differentiating between an actual negative event and an imagined one. If you go over unlikely negative scenarios in your mind (e.g. dying from the virus, ending up homeless), your anxiety will react as if it is happening already.
Bring yourself back to the present by using grounding strategies. This can include naming and describing things you perceive with your senses (e.g. 5 things you can see, taste, touch, smell, hear). Another strategy is to practice mindful activity, where you try to focus your attention on the specific activity that you are engaging in. For example, you could do slow walking, where you carefully pay attention to the sensations in your feet as they lift off and then come back onto the floor. This takes up a lot of attention and helps bring you right back into the present.
Try to be objective about your present. Ask yourself questions like, “Right in this moment, am I safe? How would I objectively describe my current state of wellbeing? Has anything bad happened right now? Am I currently well? Is my family currently well?”
Remember that the only place you have control in is in the present. This is the only place in which you can take action. The more you think of negative or catastrophic outcomes in the future, the more helpless you will feel. Bring yourself back to the present moment and ask yourself, is there anything I can do right now that will help with the situation or make me feel better?
Try out mindfulness. Living by the principles of mindfulness and practicing mindfulness meditation can help you stay more present focused. For more information about mindfulness, click here.
Are you engaging in productive problem-solving or unproductive worry? This is a very important question to ask yourself. Often people engaging in worry believe that they are doing something useful and productive. This is part of the reason why it is so hard to disengage from worry. After all, why would you stop worrying if you believed that what you were doing was important and necessary? Consider the next few points to work out whether you are engaging in problem-solving or unproductive worry.
Problem-solving is when you are actively engaging in working through a problem. It is focused on the problem and potential solutions. It is generally time-limited and is not repetitive in the thinking process. You could ask yourself the following questions to work through problem solving:
What is the specific problem?
Is there anything I can do right now about the problem? (e.g. brainstorming some solutions, weighing up pros and cons of different solutions, choosing a solution).
Problem-solving in relation to COVID-19 could involve things like: Planning a routine at home, finding ways to remain in contact with friends and family during social isolation, figuring out what exercise to do at home, finding a way to work from home.
You are more likely to be engaging in unproductive worrying if:
You are struggling to outline the specific problem, the problem keeps changing, or you thinking about unanswerable questions.
You are craving a level of certainty, control, or perfection and there is no available path to you to achieve this (e.g. you are trying to achieve something unattainable).
There is nothing you can do about the situation right now.
What to do if engaging in unproductive worrying:
If you cannot do anything right now and you do not have control over the situation, try to accept what cannot be controlled in this moment or postpone the worry for another day. Sometimes, by the time you come back to the worry, you can find that the worry is no longer that important. Other times, postponing the worry to a later day can be useful if you are expecting to have more information or control over that situation at that later point in time. In this case, it makes sense to wait until you have more resources to manage the situation.
Believe in your ability to cope with problems as they arise. Sometimes, worry can be disguised as over-preparing. The more you over-prepare for the future, the more you undermine your confidence in your ability to cope with the situation in the moment. Try to hold off on planning ahead unnecessarily and see if you can cope with and manage the problems as they arise. You might be pleasantly surprised by how well you can cope with a situation without having to worry or plan in advance.
Have you been overly focused on bodily sensations? When there is so much information circulating about common and not so common symptoms of COVID-19, it can be hard to resist checking your bodily sensations. For those who were already very tuned into their bodies, the knowledge of COVID-19 symptoms can bring with it added anxiety and distress.
There are a number of important factors to consider when experiencing sensation-related anxiety.
Sensation-related anxiety can occur when one misinterprets ambiguous or neutral sensations as dangerous and life-threatening. The cycle often looks something like this:
As you can see from the model of above, one of the most critical parts of this cycle is the misinterpretation of symptoms. If you interpreted your sensations as neutral and unimportant, you could try to focus on them all day and you would not feel panicked. In fact, you would likely feel bored and struggle to maintain focus on them for long periods of time. You can try this out now by paying attention to a neutral sensation that doesn’t bother you (e.g. focusing on the sensations in one of your finger). You’ll notice that it is actually quite difficult to remain focused on it if there is no perception of it being important or dangerous to you.
There are a number of strategies to help with bodily-related anxiety:
Practise moving your attention out of your body. Look around the room, use your senses to take in your surroundings, or use touch or movement to distract yourself from sensations inside yourself (e.g. playing with your pet, mindful walking, or hugging pillow).
Practise moving attention towards a different part of your body that feels “safe”. Notice any changes in your anxiety as you focus on the other part of your body. Try to take in that feeling of safety that comes from attending to another part of your body.
Remember that anxiety symptoms are not dangerous and cannot harm you. Although it can feel very uncomfortable, these symptoms will pass.
Engage in distress tolerance strategies to ride out the wave of anxiety – for further info click here.
Try to objectively describe your sensations, as they are right now. Try to notice whether you are seeing your sensations as they are right now or if you are describing them as they might be in the future. For example, present moment description looks like: “I am feeling a tightness in my chest and my anxiety is at a 5/10 right now”. Future description looks more like “This is a sign that my symptoms will turn into something very serious and I may be moments from death right now”. Importantly, this kind of thinking makes a prediction about what these symptoms will become and can cause further misinterpretation of your current experience and anxiety.
Try to work out what came first – anxiety or a strong symptom. Was your symptom relatively mild prior to the onset of your anxiety? Did the anxiety exacerbate your experience of the symptom? Were you reading anything or thinking about anything stressful prior to the onset of the symptom? How would you react if all you felt was the mild symptom and it did not turn into this stronger symptom that you are feeling now? Do these symptoms come and go with your anxiety? These are important questions to work out what role your anxiety plays in the experience of your symptoms.
Avoid reading endlessly about symptoms or using "Dr Google". The main symptoms are clearly outlined on government websites. Try to avoid searching the deepest part of internet to see if someone else has a similar sensation to you.
Try to have faith and trust in your body. The body is designed to protect you and is engaging in numerous processes every day (that you are not aware of) to keep you healthy and in balance.
Please note, the information above is specifically about sensation-related anxiety. If you are concerned about your symptoms please refer to official sources for more information about COVID-19 and when to speak with your doctor.
National Coronavirus Helpline - 1800 020 080
Refocusing on what is in your control and how you can cope. Remember that anxiety and feelings of helplessness can be fueled by thoughts of not being able to cope or feeling like you don’t have control in a situation. While there is some uncertainty in the situation, there is still a lot that is in your control:
There are direct actions you can take that can help minimise your risk and risk to others. This includes practicing good hygiene, ensuring social distancing, limiting public gatherings, and self-isolating. These guidelines are also updated frequently so please see Department of Health for further information.
If you have experienced changes in your financial situation, work, or lifestyle, try to engage in productive problem-solving and focus on the positive steps you can take (rather than the ones that are not available to you in this moment). Make a plan, even if it cannot be implemented immediately.
Try to engage in positive and helpful strategies. There are numerous ones outlined in this article and many are available for you to use right now.
General anxiety management strategies
Here are some more general anxiety management strategies. These can be particularly useful in keeping your general levels of stress and anxiety down. Consider these strategies to be more preventative, rather than reactive to the anxiety. However, if you are already feeling anxious, these strategies can of course continue to be helpful.
Practise relaxation exercises and activities - e.g. deep and slow breathing, relaxation meditations, stretching, having a bath, listening to music, lighting some nice scented candles, mindful activities.
Engage in regular exercise – one of the best ways to reduce overall stress is by engaging in exercise. Even if you are in isolation, there are many creative ways to engage in exercise. Exercise can also help burn off some of the extra energy generated by anxiety.
Mindfulness - to help develop your skills in remaining objective and present.
Engage in a healthy level of distraction – it’s important that you don’t consume your time with reading or talking about COVID-19. Try to engage with other interests and perhaps even use this as a time to expand your interests and hobbies.
Seek social support and continue connecting with others (within the current social restriction rules) – now more than ever it is going to be important to keep connecting with others and ensuring you have a good social support network.
Minimise your use of maladaptive coping strategies, including the use of alcohol and drugs. These substances may reduce your anxiety levels temporarily, but they often have a negative rebound effect, which can lead to even greater anxiety and distress.
Remember that all things have a beginning and an end. Your anxiety will pass, the restrictions will pass, and all of this is temporary.
Remember that human beings are very adaptable. We will get through this period together and will find a way to continue. The times are uncertain right now, but there are many intelligent and hard-working people working on the situation right now. Progress is being made every day.
Seek professional support
If you are feeling like you are not coping, please don’t hesitate to seek out professional help. Psychologists are trained in helping people learn to manage and cope with anxiety, stress, worry, and panic.
Please check back soon for Part 2, which will be focused on managing social isolation and working from home.
Dr Liza Chervonsky is a clinical psychologist and director of Inlight Psychology in Bondi Junction. She offers in-person and telehealth (video call) appointments to clients looking for help with anxiety, stress, panic, mood disorders, anger, emotion regulation difficulties, relationship or family difficulties, social difficulties, and personality disorders. If you would like to learn more about Dr Liza Chervonsky and her team at Inlight Psychology, click here. If you would like to book an appointment, please don’t hesitate to contact Inlight Psychology on 8320 0566 or firstname.lastname@example.org.