April 9, 2020

Coping With Coronavirus Anxiety and Stress

Effective ways to alleviate coronavirus fear and anxiety

This article, written by Monica Starkman, M.D., associate professor of psychiatry emerita, first appeared on the Psychology Today website on March 31, 2020.

The most powerful solicitor of anxiety is fear of bodily injury. The next most powerful is a sense of continued threat. We are experiencing both of these now during the coronavirus pandemic. We fear severe illness and possible death, both right now and continuing into the future.

But we have prior experience with this.

On September 11 and in the following days, we lost our personal sense of safety. There was continuous coverage of national security deficits. There were urgent attempts to overhaul government agencies. In later months, there were frequent increases in alert levels for potential threats. At that time, we also experienced deeply that our collective selves, as a nation, had been damaged.

The most powerful way to decrease anxiety is social support. After September 11,  we did develop a stronger sense of national unity. We talked more openly with strangers because we recognized we were experiencing similar unspoken feelings. We displayed flags, even if we had never done so before. In this togetherness, we found solace.

After a time—a longer time than most of us realize—we did regain our sense of safety, although it came with some permanent changes in our routines, like airport checks.

Now, again, we have lost our sense of personal safety. This is a deep and grievous loss. Our nation is undergoing an attack, this time by the "invisible enemy," COVID-19. Daily, we are assaulted by the news of increasing numbers of people becoming ill, critically ill, and dying.

As after September 11, feelings of insecurity and loss of personal safety will be with us for an extended time. Even after control is achieved over the pandemic, it will take time to fully re-establish our usual sense of safety.

Yet, as with September 11, there are things we can do right now to help ourselves, and each other, cope.  

For social support, this time, we can't be going out and talking to friends and strangers. But we can use our highly-developed social media and virtual groups to help ourselves and others.

In addition, for personal coping, we can use simple yet powerful tools scientifically shown to be effective.

Methods to help manage and reduce anxiety

Recognize it is normal to have anticipatory anxiety     

Worries about the worst possible outcome, that we and our loved ones will sicken and die, are common. Instead of trying to suppress this thought, add to it the alternate possibility of the best outcome: Everyone develops no symptoms at all. In addition, imagine other possible outcomes, like coming down with mild or moderate symptoms, which are uncomfortable but not dangerous. That is, in fact, the most likely result if one becomes ill with the virus.

Allow yourself 15 minutes a day for thinking about and worrying about the virus. Writing down your feelings and worries can be additionally helpful: It is a way to "externalize" anxious thoughts and vague feelings of unease through the motor act of writing.

When this worry time is over, continue the rest of your day and pay less attention to worries. If such thoughts do occur, let them be, and at the same time remind yourself that tomorrow you will have another opportunity devoted completely to worrying. You don't have to try to suppress these thoughts, which is neither an easy nor healthy thing to do. By reminding yourself of the next worry time, you increase the likelihood of them not intruding into the rest of your day.

Connect to the present

Watch or read the news once a day to stay up-to-date on the current situation and recommendations. But once is enough.

Keep in mind that right now, regardless of what is happening to others elsewhere, you are OK. Connect yourself to the present moment. The fancy word for this is mindfulness, but practicing it can be simple. For example, feel your fingers tapping as you communicate on social media. Pay attention to the taste of the food in your mouth. Feel the tickle under your nose as you exhale.  

Use your breath 

This technique automatically triggers the autonomic nervous system to reset in a way that fosters calm and relaxation. For three cycles: take a deep breath, inhaling deeply through your nose to the count of four, then exhaling to the count of six.

Exercise—and dancing

Exercise is a classic recommendation to alleviate the mental and physical components of anxiety. In addition, It is useful for helping with low mood, which many are experiencing at this time of the pandemic. Exercise has been shown to be effective in depression. (The fictional psychiatrist in the novel, The End of Miracles, puts it this way: "Exercise is like fertilizer for the brain.") In mild-moderate depression, some studies have shown exercise alone to be equal in effectiveness to anti-depressant medication. So, in these gloomy times, use exercise to keep the mood positive.

Can't get outside to your neighborhood or gym? Consider walking in place as you watch TV. Even better: Enjoy dancing as vigorously as you can to your favorite genre of music. Salsa and samba music, for example, are particularly good at keeping you moving at a good pace.

Stimulate the brain's pleasure centers

Deep in our brains are small regions specialized to experience pleasure. Keep these pleasure centers stimulated and activated by engaging in activities that give you pleasure. For example, listen to favorite kinds of music, adding some new pieces for novelty to the old standbys.

Use your eyes

Here is a simple exercise to help with relaxation. First, look up with your eyes open. Then, keep looking up as you slowly close your eyelids. Next, take a deep breath in, and let your eyes—under the closed eyelids—relax into their normal position, and let your breath out. You will feel your body relaxing. Breathe normally, and enjoy this feeling of relaxation for as many minutes as you'd like. You can add visualizing yourself in a calm setting you enjoy: for example, ocean beach, country meadow, looking up at the sky. Then, slowly open your eyes. You will likely continue to feel relaxed even after you start moving about.  

Reading for freedom and connection

The reality is that our world is indeed constricted, and our daily connection to others is sharply reduced. Reading memoirs and autobiographies lets others communicate with us and tell us about themselves. Reading fiction is a way to expand our limited social world into a different world constructed for us by the novelist. The book's characters are new people for us to meet. We vicariously enter their environment; we witness closely their relationships, their deepest feelings, their challenges, and the solutions they find. Through our empathy for them, we keep participating in what it means to be a human being who lives in a social world with connections to others.