Coping with …

Anxiety

What to do if you’re anxious or worried about coronavirus (COVID-19)

Anxiety Canada – Mar 11 • 2020

Life is uncertain. We all know it and it can make people anxious. But there are times when world events bring forward even greater uncertainty in daily life, which in turn can make us even more anxious than usual. The coronavirus outbreak is one of these times for many people. How can you manage this anxiety and worry during these uncertain times? Here are a few suggestions.

 

Be self-compassionate

Even people who don’t usually struggle with anxiety are experiencing more worry and anxiety now.

So: don’t be too hard on yourself if you’re experiencing more anxiety than usual.

If you’ve been practicing cognitive behavioral therapy (CBT) you’re probably already experienced at tolerating uncertainty. Give yourself credit for doing the best you can to cope in a difficult situation.

 

Limit the news & unplug from social media

Understandably coronavirus is the lead story for most news outlets. People on social media are likewise sharing information and stories, some of which are accurate but others may have little to do with reality. The general public is interested and wants to know the latest details. Yet when our attention is drawn to something, we are more likely to focus on it and continue thinking about it. As we think about and focus more on coronavirus, the PERCEPTION of threat increases (not the actual risk but our perception of it). By limiting or eliminating contact with media you can help yourself manage your own anxiety and worry. If you cannot eliminate contact with media, control it: Make sure that your information only comes from reputable sources, such as:

If you do watch or read the news, try to limit how often you do:

  • Commit to only checking in a couple of times a day.
  • Set a regular time when you check the news everyday. Standardizing the times you check will help to both think less about it and to reduce fighting with yourself to check.
  • Disable news alerts on your phone so that you get updates when you want them.
  • It can also be helpful to rely on family and friends to provide major updates thereby making it unnecessary to check the media.

 

Stop talking about coronavirus

Water cooler chat with coworkers and sharing the latest details with family and friends will be common. But: it keeps us thinking about it, which will influence our sense of threat/risk.

To counteract this, don’t initiate the conversation and change the subject if it does come up. If you’re comfortable doing so, ask friends and family to not discuss the coronavirus news updates with you.

Not only will this help you feel less anxious, it’ll help others too.

 

Protecting yourself

Good hand hygiene – although COVID-19 is a novel virus, it’s still a virus and handwashing remains one of the best ways to protect yourself. Follow the guidelines of your local public health agency, Health Canada, or the World Health Organization.

Washing your hands for 20 seconds with warm water is sufficient protection. Don’t set a timer as it will establish a false sense of security and certainty. Remember we live in an uncertain world and we need to be able to tolerate some uncertainty.

Stop touching your face – viruses enter our bodies through our eyes, nose and mouth. The coronavirus can also be inhaled if you are standing close to someone who coughs or sneezes without covering their nose or mouth. Similarly, excessive handwashing can lead to dry, chapped and cracked skin which ironically provides another point of entry for the virus. Use moisturizer after you wash to help combat dry skin. Many people touch their faces out of habit. Habits can be changed if you commit to it.

Social distancing – during the period when coronavirus is active it may be reasonable to disengage the usual greeting of handshaking, hugging and kissing and keeping a distance of 1 metre (3 feet) from someone who’s exhibiting symptoms. It’s important to follow the recommendations of your local health authority (and not what anxiety or worry is telling you to do). If the number of cases changes in your area the local health authority will have the most up to date recommendations to follow.

And importantly, to prevent the spread of infection, if you are feeling unwell and have a fever or a cough, please stay home and limit interactions with people in your home.

 

Coronavirus and travel

The coronavirus situation is rapidly evolving. Check with the national authorities for updated travel advisories (e.g., WHO, Government of Canada travel advice). Some travel insurance providers have already stopped providing reimbursement for cancellation due to coronavirus, and it’s likely that other insurance carriers will do the same. If you have to, or are choosing to fly, and you elect to take travel insurance, take the time to read the fine print and ask questions if in doubt.

 

Thanks to Scientific Advisory Committee members Maureen Whittal, Lynn Miller, and Melisa Robichaud for creating this resource.

 

COVID 19 and Health Anxiety

https://www.healthline.com/health/how-to-deal-with-health-anxiety-during-a-pandemic

A great article written by someone who experiences Health Anxiety. Lots of tips for managing anxieties and taking positive action.

 

https://www.anxietyuk.org.uk/blog/managing-my-health-anxiety-through-the-covid-19-outbreak/

A guest post from an individual who has experienced Health Anxiety and how she is managing during the COVID 19 pandemic

 

https://www.bacp.co.uk/news/news-from-bacp/2020/13-march-coronavirus-self-isolation-how-to-look-after-your-mental-health-and-wellbeing-if-you-re-self-isolating/

Article from the Guardian about managing Health Anxiety related to COVID 19

Coronavirus: How to protect your mental health

By Kirstie Brewer BBC News

Coronavirus has plunged the world into uncertainty and the constant news about the pandemic can feel relentless. All of this is taking its toll on people’s mental health, particularly those already living with conditions like anxiety and OCD. So how can we protect our mental health?

Being concerned about the news is understandable, but for many people it can make existing mental health problems worse.

When the World Health Organization released advice on protecting your mental health during the coronavirus outbreak, it was welcomed on social media.

As Anxiety UK’s Nicky Lidbetter explains, the fear of being out of control and unable to tolerate uncertainty are common characteristics of many anxiety disorders. So it’s understandable that many individuals with pre-existing anxiety are facing challenges at the moment.

“A lot of anxiety is rooted in worrying about the unknown and waiting for something to happen – coronavirus is that on a macro scale,” agrees Rosie Weatherley, spokesperson for mental health charity Mind.

So how can we protect our mental health?

 

Limit the news and be careful what you read

Reading lots of news about coronavirus has led to panic attacks for Nick, a father-of-two from Kent, who lives with anxiety.

“When I’m feeling anxious my thoughts can spiral out of control and I start thinking about catastrophic outcomes,” he says. Nick is worried about his parents and other older people he knows.

“Usually when I suffer I can walk away from a situation. This is out of my control,” he says.

Having long periods away from news websites and social media has helped him to manage his anxiety. He has also found support helplines, run by mental health charities such as AnxietyUK, useful.

  • Limit the amount of time you spend reading or watching things which aren’t making you feel better. Perhaps decide on a specific time to check in with the news
  • There is a lot of misinformation swirling around – stay informed by sticking to trusted sources of information such as government and NHS websites

 

Tips on managing anxiety and OCD during the coronavirus pandemic

Have breaks from social media and mute things which are triggering

Alison, 24, from Manchester, has health anxiety and feels compelled to stay informed and research the subject. But at the same time she knows social media can be a trigger.

“A month ago I was clicking on hashtags and seeing all this unverified conspiracy rubbish and it would make me really anxious and I would feel really hopeless and cry,” she says.

Now she is careful about which accounts she tunes into and is avoiding clicking on coronavirus hashtags. She is also trying hard to have time away from social media, watching TV or reading books instead.

  • Mute key words which might be triggering on Twitter and unfollow or mute accounts
  • Mute WhatsApp groups and hide Facebook posts and feeds if you find them too overwhelming.

Wash your hands – but not excessively

OCD Action has seen an increase in support requests from people whose fears have become focused on the coronavirus pandemic.

For people with OCD and some types of anxiety, being constantly told to wash your hands can be especially difficult to hear.

For Lily Bailey, author of Because We Are Bad, a book about living with OCD, fear of contamination was one aspect of her obsessive compulsive disorder. She says the advice about hand washing can be a huge trigger for people who have recovered.

“It’s really difficult because I now have to do some of the behaviours that I’ve been avoiding,” says Bailey. “I’m sticking to the advice really rigidly but it’s hard, considering that for me, soap and sanitiser used to be something comparable to an addiction.”

Charity OCD Action says the issue to look out for is the function – for example, is the washing being carried out for the recommended amount of time to reduce the risk of spreading of the virus – or is it being done ritualistically in a specific order to feel “just right”?

Bailey points out that for a lot of people with OCD, getting better means being able to leave the house – so self-isolating can present another challenge.

“If we’re forced to stay at home, we have lots of time on our hands, and boredom can make OCD worse,” she says.

 

Stay connected with people

Increasing numbers will join those already in self-isolation so now might be a good time to make sure you have the right phone numbers and email addresses of the people you care about.

“Agree regular check-in times and feel connected to the people around you,” says Weatherley.

If you’re self-isolating, strike a balance between having a routine and making sure each day has some variety.

It might end up actually feeling like quite a productive two weeks. You could work through your to-do list or read a book you’d been meaning to get to.

 

Avoid burnout

With weeks and months of the coronavirus pandemic ahead, it is important to have down time. Mind recommends continuing to access nature and sunlight wherever possible. Do exercise, eat well and stay hydrated.

AnxietyUK suggests practising the “Apple” technique to deal with anxiety and worries.

  • Acknowledge: Notice and acknowledge the uncertainty as it comes to mind.
  • Pause: Don’t react as you normally do. Don’t react at all. Pause and breathe.
  • Pull back: Tell yourself this is just the worry talking, and this apparent need for certainty is not helpful and not necessary. It is only a thought or feeling. Don’t believe everything you think. Thoughts are not statements or facts.
  • Let go: Let go of the thought or feeling. It will pass. You don’t have to respond to them. You might imagine them floating away in a bubble or cloud.
  • Explore: Explore the present moment, because right now, in this moment, all is well. Notice your breathing and the sensations of your breathing. Notice the ground beneath you. Look around and notice what you see, what you hear, what you can touch, what you can smell. Right now. Then shift your focus of attention to something else – on what you need to do, on what you were doing before you noticed the worry, or do something else – mindfully with your full attention.

Coping with low moods

Bereavement

The NHS Coronavirus website have uploaded information on the symptoms of bereavement, grief and loss. Most people experience these feelings when they experience a loss. If these feelings are affecting you, there are things that you can do that may help.

Symptoms of bereavement, grief and loss

People grieve in different ways, there’s no right or wrong way to feel. Some of the most common symptoms include:

  • shock and numbness – this is usually the first reaction to loss, and people often talk about “being in a daze”
  • overwhelming sadness, with lots of crying
  • tiredness or exhaustion
  • anger – towards the person you’ve lost or the reason for your loss
  • guilt – for example, guilt about feeling angry, about something you said or did not say, or not being able to stop your loved one dying

 

These feelings may not be there all the time and powerful feelings may appear unexpectedly.

For further information please go to: https://www.nhs.uk/conditions/stress-anxiety-depression/coping-with-bereavement/

Locally, Cruse Bereavement Isle of Man have trained volunteers who offer support in a safe and understanding way. Please contact, https://www.cruseisleofman.org/.

If you’re a patient or family member who has received support from Hospice Isle of Man,

 

Talking about Dying

https://www.youtube.com/watch?v=CruBRZh8quc

Dr Kathryn Mannix talks about the need for society to talk about dying and the process of normal human death, removing some of the myths and stigma. Dying should be something we can talk more openly about.

 

Coping with talk of death and dying

There is lots of talk about coronavirus, death and dying is all around us at the moment. This can bring up difficult feelings and remind you of grief and those who have died in the past. It may also make you feel worried about yourself or a loved one dying. Read more for tips on how to help yourself and others

 

Fear of dying alone

CNN cover the difficult issue of the fear of dying alone during COVID-19.

https://edition.cnn.com/2020/03/29/world/funerals-dying-alone-coronavirus/index.html

 

Funerals and Memorials

When someone dies we usually have a funeral service. At the moment, funerals are changing because of the coronavirus. When groups of people come together, they might catch or pass on the coronavirus. Read more on what you can do to help yourself and others with funerals and memorials.

 

Coping with anger and blame

Feelings of anger and blame are common after any bereavement, when someone has died due to coronavirus there may be additional reasons to feel angry. Coming to terms with anger will take time and may be a difficult emotional balancing act. Remind yourself that these are exceptional times, and that most people have been trying to do their best without the usual rules to help. Read more on how you can help yourself and others around you

 

Feeling guilty

Feeling guilty is very common when someone is bereaved. The need to blame someone after a traumatic or untimely death can be very strong. No-one is perfect and sometimes blaming ourselves can be easier than blaming the person who died or others. If someone has died of coronavirus, or under circumstances affected by the pandemic this can make things worse. Read more on how to help yourself and others around you

Loss of control

Self care

Taking Care of Your Mental Health in the Face of Uncertainty

American Foundation for Suicide Prevention

Human beings like certainty.  We are hard-wired to want to know what is happening when and to notice things that feel threatening to us.  When things feel uncertain or when we don’t generally feel safe, it’s normal to feel stressed.  This very reaction, while there to protect us, can cause all sorts of havoc when there is a sense of uncertainty and conflicting information around us.

A large part of anxiety comes from a sense of what we think we should be able to control, but can’t.  Right now, many of us are worried about COVID-19, known as the “Coronavirus”.  We may feel helpless about what will happen or what we can do to prevent further stress.  The uncertainty might also connect to our uncertainty about other aspects of our lives, or remind us of past times when we didn’t feel safe and the immediate future was uncertain.

In times like these, our mental health can suffer.  We don’t always know it’s happening.  You might feel more on edge than usual, angry, helpless or sad.  You might notice that you are more frustrated with others or want to completely avoid any reminders of what is happening.  For those of us who already struggle with our mental wellness, we might feel more depressed or less motivated to carry out our daily activities.

It’s important to note that we are not helpless in light of current news events.  We can always choose our response.  If you are struggling, here are some things you can do to take care of your mental health in the face of uncertainty:

  1. Separate what is in your control from what is notThere are things you can do, and it’s helpful to focus on those.  Wash your hands.  Remind others to wash theirs. Take your vitamins. Limit your consumption of news (Do you really need to know what is happening on a cruise ship you aren’t on?).
  2. Do what helps you feel a sense of safety. This will be different for everyone, and it’s important not to compare yourself to others.  It’s ok if you’ve decided what makes you feel safe is to limit attendance of large social events, but make sure you separate when you are isolating based on potential for sickness versus isolating because it’s part of depression.
  3. Get outside in nature–even if you are avoiding crowds. I took a walk yesterday afternoon in my neighborhood with my daughter.  The sun was shining, we got our dose of vitamin D, and it felt good to both get some fresh air and quality time together.   Exercise also helps both your physical and mental health.
  4. Challenge yourself to stay in the present. Perhaps your worry is compounding—you are not only thinking about what is currently happening, but also projecting into the future. When you find yourself worrying about something that hasn’t happened, gently bring yourself back to the present moment.  Notice the sights, sounds, tastes and other sensory experiences in your immediate moment and name them. Engaging in mindfulness activities is one way to help stay grounded when things feel beyond your control.
  5. Stay connected and reach out if you need more support. Talk to trusted friends about what you are feeling. If you are feeling particularly anxious or if you are struggling with your mental health, it’s ok to reach out to a mental health professional for support.  You don’t have to be alone with your worry and it can be comforting to share what you are experiencing with those trained to help.

Social isolation

The following is an article from the Australian Psychological Society

Maintaining your mental health during social isolation

To help control the spread of coronavirus (COVID-19) across the country, all Australians
have been asked to practise social distancing. In some cases people are required to, or may choose to, self-isolate. Understandably, the challenges associated with social distancing and isolation, including separation from loved ones, loss of freedom and reduced income, are leading some people to experience feelings of anxiety, boredom, frustration and fear. This paper outlines some useful strategies you can use to maintain good mental health during this unprecedented time of social distancing and isolation. The information in this tip sheet is current as at 20 March 2020.

Stay connected
Positive social connections are essential for our mental health and can help us cope in times of stress. In the current crisis, we are being asked to distance ourselves from others so it is important that we maintain our social networks using available methods of communication. This can be as simple as phoning a friend to share your experience, using videoconferencing technology to check in with a family member, or spending quality time with the people you live with.

Avoid difficult situations
At times, people will be required to self-isolate with others in their household. While this will provide opportunities for social connections, living with someone 24/7 with little or no time away from each other may give rise to arguments and/or tension. There are a number of things you can do to limit conflict with those you are isolated with, including:

  • creating a roster to help you distribute chores equally and fairly
  • identifying and taking part in activities you like doing together such as movies, board games, jigsaws, gardening
  • sharing positive emotions and experiences, rather than anger, frustration and disappointment
  • communicating about your worries and concerns, and seeking support from one another
  • maintaining your sense of fun and positive humour
  • remaining respectful of each other in times of conflict – walk away and take time to calm yourselves, returning to the discussion later and repairing any hurt caused.

Structure your day
While in isolation it is beneficial to plan out your days to restore a sense of purpose and normality to your daily life. Schedule tasks such as cooking and laundry, as well as activities you enjoy to help you stick to your routine. Structuring activities around mealtimes and bedtime can also help you keep to your schedule while ensuring you eat regularly and get enough sleep.

Given the current need to practise social distancing and isolation, many people are also being encouraged to work from home where possible. Working from home can bring a whole new set of challenges and the need to provide structure to your day is even
more important.

Some tips to help you have a sense of normality and work effectively from home are listed below.

  • Change out of your pyjamas each morning – While you don’t have to dress as formally as you might when going into the office, getting out of your pyjamas can help you get in the right headspace to start your day.
  • Set up a dedicated workspace – Choose a space away from noise and with adequate lighting to set up your work desk. If possible, use an adjustable desk chair so you can work comfortably.
  • Set a strict schedule – It can be hard to switch-off from work, so it is important to clearly define your working hours, ensuring you have regular breaks. Disconnect from all work-related accounts (e.g., remote desktops, email) at the end of your
    working day to help maintain a clear boundary between your work and home life.
  • Limit distractions – Being at home can mean you can be easily distracted by other people or tasks (e.g., household chores).  Schedule set times where you can take a break from work to complete these tasks, rather than completing them randomly
    throughout the day where you can lose track of time.
  • Keep in touch – Maintain regular contact with your manager / colleagues (via phone, email or videoconferencing) to ensure you are each aware of your tasks, workload and timelines.

Helping your child through self-isolation
While most schools in Australia have not yet closed as a result of the coronavirus outbreak, many children are spending significantly more time at home, not taking part in out-of-school activities, and some are even required to self-isolate with their families. Below are some ideas on how parents can help their child cope with periods of social distancing or isolation.

  • Set a daily routine – Routines can help children cope with change and help them understand what is expected of them. Work with your child to develop a routine that suits the whole family and includes a range of activities, for example,  schoolwork (literacy and numeracy), physical activity, creative play, family time and limited amounts of screen time.
  • Maintain social relationships – Use technologies (such as FaceTime, Zoom or Skype) to help your child maintain contact with friends and other family members, such as grandparents.  For older children and teenagers, it is important to monitor
    their use of social media accounts as excessive use can lead to increased levels of anxiety.
  • Have fun – For many children, their out of school activities (e.g., swimming, football) have been cancelled but it is important for them to stay active. Harness their interests and have fun with them at home (e.g., play cricket in the backyard or dance to music inside). You can also take this opportunity to spend quality time with your child by teaching them a new skill or game, read with them, or research a new topic together.

Seek additional support when needed

If you feel that the stress or anxiety you experience as a result of self-isolation is getting too much, a psychologist may be able to help.

Psychologists are highly trained and qualified professionals skilled in providing effective interventions for a range of mental health concerns, including stress. A psychologist can help you manage your stress and anxiety using techniques based on the best available research.

 

Self-Compassion in Self-Isolation

An important concept in Compassion Focused Therapy (Paul Gilbert) is trying to treat ourselves as we would a close friend or family member.

For many people, when they are being hard on themselves, or are worrying so much about others that they completely forget about their own needs, or just really need a hug, other people step up to fill the compassion gap. So what do we do when those people aren’t around as much?

Hopefully the following exercises will show you how we can use self-compassion.

 

More information

Isle of Man Government
The Isle of Man Government has developed a collection of resources for the general public, health professionals and industry about coronavirus (COVID-19).

Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention provides reliable information about the coronavirus such as its symptoms, steps you can take to protect yourself, and what to do if you are affected.

World Health Organization
The World Health Organization provides information and guidance regarding the current outbreak of coronavirus disease.

Low Mood

  • While it can be fun to live spontaneously and do things as and when we feel like it, when our mental health takes a hit the likelihood is that we won’t feel like doing a lot! Having a lack of structure can also make it difficult to feel as productive and active as we’d like to, which in turn can impact on mood and how we feel about ourselves.Click below to find out why it is so important to keep busy during this time
  • We are all different, so, never judge your own feelings. If something is a big deal for you, even if its not for others, that doesn’t matter, it’s a big deal for you. Sometimes we really do need a genuinely good cry, these are wee tips to help you cry better, when you need to release your sadness.Click below to find out more

Stress

Worry

Dr Matthew Whalley & Dr Hardeep Kaur of Psychology Tools Limited have published this guide to ‘Living with worry and anxiety amidst global uncertainty‘.

The outbreak of coronavirus disease 2019 (COVID-19) may be stressful for people. Fear and anxiety about a disease can be overwhelming and cause strong emotions in adults and children. Coping with stress will make you, the people you care about, and your community stronger. Those with pre-existing mental health condition should self-monitor closely and if they notice a change in their mood, they should access additional support.

 

The Worry Time Technique

We worry for a good reason, If we worry about getting run over crossing the road, we will pay more attention and be safer on the roads. If we worry about spreading coronavirus, we are more likely to wash our hands more and follow government guidance. When we have an element of control, then worry can help us to keep safe. Read more on The Worry Time Technique

 

OBSESSIVE DISORDERS

PODCASTS

APPS

Dr Russ Harris, founder of Acceptance and Commitment Therapy has devised an app based on his best-selling book ‘the happiness trap’. ACT theory and exercises have proved to be useful in managing a range of difficult emotions and would be valuable in this current climate.  For a three month period he has made this app free, using the below code.