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Advice on coping with anxiety related to COVID19

The following document outlines ways to reduce feelings of anxiety related to COVID19.
14-March-20

Coping With COVID19 Anxiety

The WHO Director-General, Dr Tedros Adhanom Ghebreyesus, addressing the Munich Security Conference on Feb 15, 2020, said, “We’re not just fighting an epidemic; we’re fighting an infodemic.”

A Lancet editorial on the 22nd of February of this year pointed out that the rapid dissemination of trustworthy information (transparent identification of cases, data sharing, unhampered communication, and peer-reviewed research) is what is needed most during this period of uncertainty. However, the author went on to state that the “ease through which inaccuracies and conspiracies can be repeated and perpetuated via social media and conventional outlets puts public health at a constant disadvantage”.

Not only does the contamination of media outlets with mis-information put public health at a disadvantage, it also creates anxiety and potentially panic. The anxiety associated with COVID-19 travels much faster than the virus itself.

As the Lancet editorial puts it: There may be no way to prevent a COVID-19 pandemic in this globalised time, but verified information is the most effective prevention against the disease of panic.”

The nature of COVID19 anxiety

Anxiety is a normal human response to a threat, and it is particularly likely to occur when the threat is unpredictable and uncertain. Emotions such as anxiety are important as they orient us towards a threat and help us decide what to do next. However, the features of the COVID19 outbreak and the non-stop media cycle with the accompanying saturation of social media channels have resulted in levels of anxiety that, for many, are not correctly calibrated to the threat. Our emotions can bias us in terms of the information we respond to and the decisions we make - our emotions can lead us astray. For example, with COVID19, we have already seen, in some countries, the rise in suspicions of certain ethnic groups and this has resulted in xenophobic behaviour.

There are a number of features of the way that our minds work that can serve to increase our anxiety in the current situation. One of these is called the “availability bias” where we give more weight to events that we can immediately experience and recall. The non-stop media cycle perpetuates this bias as it exposes us continuously to anxiety provoking events associated with the spread of the virus. The availability bias is not the only factor influencing anxiety in the current circumstances. We tend to believe things that we hear repeatedly, whether or not they are true, and we also remember things that elicit strong emotions. In addition, the emotions we experience significantly influence the information that we attend to. For example, research has shown that if we are anxious we pay much more attention to anxiety provoking events and and we also overestimate their likely future occurrence.

So, it is clear that the characteristics of the present outbreak (especially uncertainty and unpredictability), the non-stop media cycle, the saturation of social media, and the particular ways in which our minds work can create a hyper-vigilant state in which our anxiety drives us to seek out more and more information. This, in turn, increases our anxiety in a self-perpetuating cycle that can prove disabling.

The following are methods that you can use to counteract the development of inappropriate levels of anxiety:

  1. Information, but not too much of it.

It is important to stay informed as the situation develops. However, checking your phone every five minutes to see what the rates are or whether there is some other new development can only serve to increase your anxiety. Take breaks from watching, reading, or listening to news stories. Try to do some other activity you enjoy and keep life as normal as possible. It is also better to educate yourself from a small number of solid news outlets and reliable sources than to be overwhelmed by information, much of it dubious, from social media. Reliable websites include those of the Irish Department of Health (Department of Health - Coronavirus COVID-19), the HSE (https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/ ), the World Health Organisation ( WHO - Coronavirus Disease COVID-19 outbreak), the European Centre for Disease Prevention and Control ( ECDC - Coronavirus (COVID-19)) and the US Centres for Disease Control and Prevention (CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html).

  1. Gain a sense of control

In addition to being important in preventing the spread of the virus, washing your hands, coughing the right way, decreasing person to person contact and even actively socially isolating yourself can provide a sense of control that helps reduce anxiety.

  1. Connect with loved ones

Relationships are important in reducing stress and increasing happiness. As the outbreak proceeds, increasing social isolation is likely to become the norm. However, we can use technology to maintain links with our friends and loved ones. This can be particularly important if we are feeling overwhelmed; connecting or reconnecting with someone who is not overwhelmed by fear and anxiety can help to put things in perspective. For many of us, our main concern is for elderly parents and other relatives. One useful approach here is to print out information and guidelines from reputable websites such as the HSE and the Department of Health and make it available to them in paper form.

  1. Look after your general health

Take care of your general health. Breathe deeply, especially when anxious, stretch and meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep and moderate alcohol intake.

  1. Manage anxiety through meditation, breathing and naming

Make time to unwind and remind yourself that strong feelings will fade. Deep slow breathing activates body systems involved in rest and digestion and by giving our bodies the message that it is safe leads to a feeling of calm. Naming your anxiety (e.g. I’m feeling really scared right now, I can feel my heart racing and I feel a little dizzy) creates space between the emotional feeling and the thinking part of your brain. In this space, you can get some distance and observe the emotion rather than letting it flood you completely. This supports your ability to think about how to respond and how to shift out of the unpleasant heightened emotional experience. Learning and practicing meditation is a highly effective way of managing anxiety. The Centre for Positive Psychology and Health will, over the next few days, post directions for practicing meditation.

  1. Consider the common good

We in Ireland have a long tradition of the community gathering to support the individual. In traditional farming communities, for example, this took the form of a “Meitheal” where neighbours gathered together to support one another. A good modern example is #selfisolationhelp which is trending on Twitter. The hashtag allows people to volunteer to assist others (e.g. buying groceries, walking the dog etc) who are self-isolating or in need of help because of COVID19. It is likely that our individual liberties will have to be curbed through quarantine restrictions and similar strategies designed to reduce the spread of the virus. We know, from research in positive psychology, that participating in meaningful activities, especially those that support the common good is a major contributor to our sense of well-being and happiness.

  1. Talk to your children

When children are faced with stressful situations, they react, in part, based on the reactions of adults they see around them. When parents and caregivers deal with the COVID-19 outbreak calmly and confidently, they provide the best support for their children. Parents can be more reassuring to others around them, especially children, if they are better prepared. The following are helpful strategies:

  1. It is important to take time to talk to your child about the outbreak, answer any questions they may have and share facts about the virus in a way that your child can understand.
  2. Children model their behaviour on adults especially in times of stress. You can be a good role model by looking after your own physical and psychological health.
  3. Children need reassurance that they are safe. This applies even to older children and teens. Let them know that you understand their worries, that it is ok to be upset and that your primary focus is on their safety.
  4. Sharing how you deal with your own anxiety can be helpful in teaching children how to cope.
  5. Just as it is important that we adults manage our exposure to media coverage of the outbreak, it is also important to manage our children’s exposure. Children may misinterpret what they hear and can be frightened about something they do not understand.
  6. Help your child to maintain a sense of structure. This will be particularly important if our schools are closed for a period of time.
  7. Be mindful of how you talk to other adults when children are present. Assume little ears are always listening, especially when a conversation has heightened emotion.
  8. Ask children and teens if they have any questions – try to create a dialogue rather than a monologue. Children respond well to such prompts and it can give you the chance to assess their understanding and surface any particular anxieties they may have.

The US National Child Traumatic Stress Network provides useful information on how best to understand and respond to children’s needs at this time. https://www.nctsn.org/sites/default/files/resources/fact-sheet/outbreak_factsheet_1.pdf

  1. Maintain a sense of hope

The race is on to develop effective vaccines and new treatment approaches will emerge as knowledge about the virus and its effects increases. Whereas, significant numbers of us are likely to be infected, the impact on most of us will be modest. When we look back on previous acute outbreaks such as the SARS, MERS and AIDS epidemics we can see that, like those, this too shall pass.

Professor Ciaran O’Boyle

RCSI Centre for Positive Psychology and Health

12/3/2020

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