Abrupt changes to “normal life” are now being experienced by the majority of the world’s population, with over 4 billion people now under some kind of order to stay at home in an attempt to curb the spread of coronavirus and reduce COVID-19 deaths by flattening the curve. There are justifiably concerns for societies, economies, businesses and especially healthcare workers, as many of them struggle to access adequate personal protective equipment, designed to keep them safe while they work to save lives.
But what about those of us who are doing as much as we can by staying at home and who are not on the front lines, as so many are? Experts are increasingly worried about our mental health too, as many of us try to adjust to “the new normal.”
A recent review article aiming to predict how we might fare, looked at the psychological impact of previous periods of quarantine due to infectious diseases. These included diseases caused by other coronaviruses such as SARS and MERS, as well as other infectious diseases like Ebola. The analysis combined data from 24 research papers and found that many of the studies reported negative psychological effects such as anxiety, confusion, insomnia, anger and post-traumatic stress symptoms.
“The reason we experience fear and anxiety is because our brains evolved to notice and pay attention to threats,” said Dr. Lauren Hallion, Assistant Professor of Psychology at the University of Pittsburgh. “In prehistoric times, those threats were sometimes predators, but they were sometimes diseases and viruses like the one we’re experiencing now. If your brain is afraid and doesn’t want to let you pay attention to anything but coronavirus (COVID-19), it is doing exactly what it is supposed to do to keep you, your loved ones, and your community safe,” said Hallion.
Essentially, coronavirus does have the potential to hurt us, so of course we are going to think about it. But anxiety is different to fear, which is a more acute feeling of being afraid.
“During fear (panic), we might notice that our heart is racing, we’re feeling short of breath (like we aren’t getting enough air) even though we aren’t sick, or we’re feeling dizzy or lightheaded. We also talk about “anxiety,” which are longer-lasting feelings of being worried, tense, irritable or cranky, having trouble sleeping, and feeling like you can’t concentrate on anything but coronavirus (COVID-19),” said Hallion.
Although some people may be very in tune with how they are feeling and able to identify different emotions, some may not be able to so accurately pinpoint why they are feeling a certain way or what to call it.
“We aren’t supposed to feel okay at a time like this. Fear is there to keep you safe and the most important thing is to recognize that fear and anxiety are healthy and appropriate right now. That means that a lot of us aren’t going to be able to concentrate on our normal work right now, especially if our normal work doesn’t involve coronavirus (COVID-19),” said Hallion.
Although normal, anxiety is, however undoubtedly not a pleasant feeling and many of us will be looking for ways to try and alleviate symptoms during the coronavirus outbreak. But how can we do this effectively?
“At times like this, science tells us that the best strategy is to work on accepting those emotions. When I say acceptance, we don’t mean being okay with things that are happening right now. We mean understanding that yes, things are terrible and scary right now, and that you and others might feel afraid, angry, sad, and feel unable to concentrate on anything else. Those emotions are normal and they are there to help you. Science tells us that accepting and understanding those emotions as they come is the healthiest thing you can do,” said Hallion.
Hallion suggests that engaging in activities that are important to us is another strategy that science shows is helpful when things become “too much.” She suggests that going for a walk or a run if permitted, (while keeping 6 feet of distance), calling loved ones, or finding ways to volunteer for your community without leaving your home, are all strategies that can help at this time.
“It’s important to remember that you are not personally responsible for what happens, and you cannot control what happens. However, there are things you can do to keep yourself and others safe. Some of those things include staying 6 feet away from all people that you don’t currently live with and avoiding public places (including grocery stores) as much as possible. Once you have done everything you can do, you can also take a moment to notice that and congratulate yourself for it,” said Hallion.
What about for anyone who feels like they, or someone they care about could do with some extra help at this time?
“There are a lot of resources out there for people who are struggling, but it’s important to make sure these are coming from a trustworthy source. Psychologists are hard at work creating and organizing these resources to make them easier to access and to make sure we are getting help to everyone who needs it,” said Hallion, mentioning a website from the Anxiety and Depression Association of America, as an example.
As well as these resources, people are increasingly turning to apps to help them manage their anxiety, with popular meditation and mindfulness app Headspace offering free subscriptions to healthcare workers and teachers. But these apps are not supposed to be a substitute for professional help when needed. How might someone know the difference between a “normal” anxiety response to a difficult time and a more severe response that warrants seeking professional help?
“This is slightly hard to tell in the current environment,” said Jessica Gold, MD, MS, assistant professor in the department of psychiatry at Washington University in St. Louis. “That is because one of our most common checks is, ‘does my response feel out of proportion to the situation?’ – and for the most part, all of our responses can feel normal right now because the situation is so abnormal,” she added.
“The other, ‘is this interfering with my day to day life?’ which can also feel hard to gauge because our day to day is so different and upended. However, you are still sleeping, showering, eating, and doing work, school, or interacting with others and any change to feeling able to do these things (to the same amount or in your typical routine or schedule) would be a warning sign you should talk to an expert,” said Gold, stressing that irrespective of this, people should seek help even if they feel it might help them.
But what about people who were already dealing with diagnosed mental health conditions before the pandemic hit and may be feeling extra strain due to the current situation?
“It is absolutely possible that preexisting mental health conditions can be exacerbated by COVID-19 and self-isolation. Previous studies suggest those with preexisting mental health disorders might be at higher risk for poor mental health outcomes,” said Gold, who is also an advocate for appropriate mental health support for healthcare workers at this especially difficult time.
Gold suggests that people with preexisting mental health conditions should be aware of any previous poor coping mechanisms such as alcohol use, eating disorders and self harm and pay attention to urges (for example, to use drugs or drink alcohol) and warning signs for worsening symptoms or relapse.
“People with existing mental health diagnoses should also not stop therapy or medications simply because you are not leaving the house as often. In fact, you might need to rely on them more (like increasing your dosage, or going more regularly to therapy). Your providers are part of your support system if and when you need one,” said Gold.
With the length of stay-at-home orders increasing, as countries grapple with increasing cases and deaths from COVID-19, it is likely fair to say that many of us will be feeling differently to normal and may want to take steps to try and preserve our mental health. And it appears that the first step to that is quite straightforward.
“Feeling overwhelmed and anxious right now is completely normal. It is important to be aware of that and allow ourselves space for feelings and even forgive ourselves for them,” said Gold.