“When will this end? And if it ever does, will I be okay?”
These are the questions patients in my therapy practice are asking, and I can’t emphasise enough that it’s normal to feel anxious now. The risk of developing a life-threatening illness alongside the loss of the things that usually anchor us is a brutal one-two-punch that would leave anyone feeling on edge.
How you handle stress makes a difference in how you ultimately cope. You can create positive habits and reduce response patterns that predict post-traumatic stress disorder, in which a terrifying event leads to symptoms such as disturbing flashbacks and severe anxiety. Unfortunately, we can’t will away sadness and fear. Living through such emotions without exacerbating your pain and suffering takes skill.
The hopeful truth is that there are proven steps you can practice to improve your emotional health during the COVID-19 pandemic.
APPRECIATE YOUR INNATE RESILIENCE
Here’s a comforting thought in these dark days. For most of us, “the most common response to trauma is resilience,” said Dr Denise Sloan, a professor in psychiatry at Boston University and associate director of the National Center for PTSD. In fact, the overwhelming majority of people who endure a life-threatening event recover on their own and never meet criteria for PTSD.
When my patients ask me whether things will get better for them, I tell them that trusting they will recover increases their chances of doing so. Expecting the worst actually predicts heightened risk of PTSD, and my clients often notice that they cope with challenges better than they imagine they will. So, I motivate them, as I encourage you, to expand their perspective and consider how they’ve managed during stressful times in the past, and to revisit this reminder of their strength when they’re feeling shaky.
For those who are struggling more profoundly: Research shows that even the most intense feelings of hopelessness eventually pass, especially when you strategise ways to feel better.
PURPOSEFULLY INCREASE YOUR WELLBEING
“If you are obsessed with this pandemic, you need to find ways to distract yourself,” recommends Dr Edna Foa, a professor in psychiatry at the University of Pennsylvania and one of the world’s leading experts in anxiety and trauma. “We are in the middle of the trauma, not post-stress,” she said, highlighting that during a crisis we need to take breaks to soothe ourselves. One study even found that playing Tetris in the emergency room after a car accident appeared to reduce the development of traumatic memories.
While it’s normal to get hijacked by bad news, add positive activities to your routine to offset the pain. Do something you’d normally do if you were feeling optimistic (without turning it into a negative, like bingeing on a new show and losing sleep). While this might simply feel like another chore, engrossing yourself in something you once enjoyed and practicing gratitude improve wellbeing and resilience in a crisis.
Of course, this advice may sound dismissive if a loved one is sick, or you are in financial crisis. But as AJ Jacobs, author of Thanks A Thousand, has written, you can override your negativity bias by slowing down to notice, appreciate and give thanks. That could mean taking a moment to reflect on all the people who’ve provided the dinner on your table, from the farmer to the delivery person. Not only will gratitude offer you a break from your worries, it also helps others. (And remember to tip generously and if you can, donate to those struggling.)
CONNECT AND SHARE
Another key resource now, and always, is perceived social support – the feeling that we can all get through this together. We are all part of a global community going through the same thing at the same time, a rare occurrence in itself. To experience a sense of community, watch clips of people worldwide cheering for health care workers. Confide in others about what you are experiencing and ask others to share in return. Feeling connected protects against PTSD.
“People need to talk to one another, especially if you are seeing horrible things,” Dr Foa said.
If, like so many, you are feeling lonely, it may help to think about your support system more broadly, from the friend who texted you to your neighbours. Participating in a group wellness activity, like virtual mindfulness talks or fitness classes can also improve your sense of connection and mood.
And if you need professional help, there are experts to consult, especially if you believe you are struggling with a psychological disorder. Therapy can make a difference without taking too long.
NOTICE YOUR NARRATIVE
Thoughts powerfully impact your feelings, so much so that your beliefs predict your risk of PTSD. Look out for self-blaming thoughts, like criticising yourself for not having more in your savings account to prepare for layoffs, or, for medical professionals, faulting themselves for not being able to optimally care for everyone. Beating yourself up will only leave you feeling tortured.
Also observe judgments that supercharge your stress, like, “I can’t take it,” and shift into a more encouraging mindset.
One way to move away from negative thoughts is to ask yourself, “Is this helpful?” Self-compassion is a meaningful way to cope with pain and while you’re at it, let go of judging others. Studies show that doing so can significantly reduce loneliness.
BREAK UP WITH OVERTHINKING
Do you feel compelled to review details of an upsetting experience over and over again? Ruminating is a mental habit where you repeatedly think about “Why?” and “What if?” in a way that doesn’t inspire problem solving as much as it leaves you feeling stuck.
If you struggle with these mental loops, now is a great time to work on your exit plan.
One landmark study, which began several weeks before the 1989 Loma Prieta earthquake in California, found that ruminating predicted depression and stress symptoms after the trauma, even more so than being personally affected by the disaster. And not only is overthinking a risk factor for depression and PTSD, it also affects your ability to benefit from treatment.
To process thoughts about the pandemic that replay in your mind, one option is to put your concerns on paper. Expressive writing is one way to reflect without ruminating.
Another technique, especially when your thoughts aren’t useful, is to engage in mentally absorbing activities, like listening to your favourite playlist while doing burpees; working on a crossword puzzle; or grounding yourself by noticing three sights, three sounds and three sensations in your environment, again and again. When ruminating starts, catch it and exchange it for gratitude.
Another way to think of it: If a friend were going on and on in a way that was obviously making her suffer, you’d steer her in another direction, right?
CHOOSE COURAGE OVER AVOIDANCE
It is instinctive to want to avoid negative emotions, but you also don’t want to suppress or push them away. Instead, notice your emotions, specify how you feel and respond with kindness.
Practicing mindfulness and viewing your experience with perspective helps you create a healthy relationship with your thoughts. Try to observe unhelpful judgments before compassionately letting them go, the same way a spam filter sorts junk messages.
Ultimately, it’s key to balance accepting difficult feelings, without multiplying them, while increasing your emotional immune system. Later, when this ends, if you find yourself becoming what Dr Foa described as a “super avoider” – someone who tries to escape thoughts and situations that are no longer harmful – remember that it’s important to face your fears.
Dr Natalia Garcia, a psychologist in Seattle and trauma researcher, who is uniquely empathic to the plight of trauma, has used her own expertise to cope with the sudden death of her two-year-old son. She initially struggled to watch videos of him, but after giving herself a grace period where she focused on getting through each day, she was able to return to those clips. Today, she is surprised by how much she cherishes them. “The only thing worse than losing him would be also losing the memory of him,” Dr Garcia said.
She added: “I can’t say I emerged from the ashes of despair into some majestic phoenix, but I do believe I have experienced growth with exercised intentionality around not letting tragedy be the end all of my story.”
Like Dr Garcia, you can also increase your sense of control by reflecting on what matters most to you. Cultivating a strong sense of purpose based on what you value, and using that to figure out your next steps can give you a feeling of possibility, increasing both your physical strength and emotional recovery. And don’t we all need a sense of possibility right about now?
By Jennifer Taitz © 2020 The New York Times