Commentary: Managing anxiety in the time of COVID-19

By Neil S. Kaye, MD

Anxiety is normal. It is the body’s way of protecting us, an alarm system that triggers when we sense danger. 

Anxiety can have a host of symptoms: rapid or pounding heart, shortness of breath, sweaty palms, shakiness, impaired sleep, fear, a sense of doom, and impaired focus, attention and concentration. 

It would be easy for anxiety to take center stage in the world of COVID-19. Even if you started off being relaxed about the situation, a simple trip to the store for groceries reveals emptied shelves and you start to wonder: “Maybe this is serious?  Should I be hoarding supplies?” You might even ponder, “Is this going to kill me?”

Worrying is not useful.  Worrying about the virus can become an obsession.  Anxiety is understandable. While you can’t control what will happen, you can control how you react to it, while keeping yourself as safe as possible

Educate yourself, but limit your coronavirus news consumption. There is such a thing as too much news; constantly reading coronavirus updates isn’t going to help your anxiety. Try to limit your news intake to once a day and stick to reliable sources. 

Neil S, Kaye M.D.

The CDC web page, Share the Facts, at www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/share-facts.html, will help you to understand the actual risk to yourself and people you care about. When you share accurate information about COVID-19 you can help make others feel less stressed and more connected.

Risk management: Knowing facts is helpful because you can learn to view the situation rationally, rather than just emotionally.  This “risk management” strategy puts things in perspective.  You acknowledge the risk and affirm your power to take steps to protect yourself.  Delaware DPH and the CDC have issue daily advisories for staying safe.  Follow the advice of the experts!

Recognize how you “catastrophize.” When you worry, your mind is playing a game with you by using your imagination (pretending) that the worst-case scenario is a reality. In essence, you are telling yourself a “worry sentence,” such as, “What if I get the virus and die?”  Anxiety causes a person to imagine the worst possible scenario or outcome, even if this is statistically the least likely course of the illness. 

Your brain is a problem-solving computer.  When you feed it a “what if” question, it goes into overdrive to start to generate solutions.  That causes you to obsess and ruminate.  Your brain is trying to solve the “what-if” scenario for you. This tendency is the process that steals your peace of mind.  Understanding what you are doing can empower you to stop doing it so much.

Remember to partake in activities that brings you joy and to talk with people you trust about your feelings.

Keep living! Develop a routine and stick to it. 

Create a calendar for each day the same as what you would have done prior to the shelter-in-place orders. 

Plan time for work, reading, exercise, Internet, TV, games, and socialization.  All of these activities become time slots on your calendar.  The more packed the calendar, the better!  Busy people simply don’t have time to worry. 

Go for a walk. Getting outdoors daily for sun and fresh air is reaffirming of life. 

Stay hydrated and get adequate sleep on a regular schedule. 

Stay connected with friends and family.  Discuss your concerns and be supportive of each other.  Try to listen empathically, without judgment, and without needing to give advice or to “fix” the other person’s problem.  Just be a good listener.

Avoid negative thinking. Once chronic worry sets in, it tends to hijack any other agenda you have for your life. It can overwhelm you.  Your life starts to revolve around your fears. It’s dangerous to think: “If I expect the worst, I’ll be prepared.”  This belief encourages you to constantly expect the worst outcome and reinforces anxiety.

Cognitive restructuring can help this type of thinking. That means you change how you think. Try telling yourself something encouraging, rather than allowing yourself to panic. Another form of cognitive restructuring involves reframing.  For instance, reframe the idea of shutdowns and quarantines as being cautions, rather than crises.

Find ways to relax.

Breathe!  Always remember that the best thing to do when you ever feel anxious is to take a long, slow, deep breath through the nose, trying to fill the abdomen first, and then the lungs.  Then, a long slow exhalation through the mouth, trying to expel the air from the top of the lungs first and ending with the abdomen contracting to push out the final air.  Try to take more time to exhale and a shorter time to inhale; this will help to lower the heart rate caused by anxiety.  Repeat this cycle of deep breathing for 3-5 cycles. 

Deep breathing, meditation and yoga can all help. There are many on-line videos and apps to help guide you.  Find one you like and put it on your calendar! 

Talk about your fears. Keeping that “overwhelmed” feeling inside makes it worse.  Sharing your fears and anxieties with loved ones may help you to realize you are not alone and normalizes the feelings.

If talking to others isn’t your thing, journaling is a good outlet.  Writing things down, helps you cope with your emotions. 

Practice good grounding techniques, such as the 5-4-3-2-1 Method

5: Acknowledge five things you see around you.

4: Acknowledge four things you can touch around you.

3: Acknowledge three things you hear.

2: Acknowledge two things you can smell.

1: Acknowledge one thing you can taste.

Don’t underestimate your resiliency. Although dealing with a pandemic is unique, we each have had other times we have lived through a crisis and survived. Remember that you have more strength and coping skills than you imagine.

• This is especially important if you are self-quarantined. Stay connected to family and friends by phone, video-chat, or text. 

Practice good hygiene. Exercise, eat right, get enough rest, avoid tobacco, alcohol, illegal drugs, and practice good hygiene. The best practice is to wash yourMhands frequently using warm water and soap or use an alcohol-based hand sanitizer with at least 60% alcohol.

Learn exactly how to wash your hands, according to the CDC here: www.health.com/condition/infectious-diseases/how-to-wash-your-hands

Avoid touching your eyes, nose, and mouth.

Wear a mask when in public. 

Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

When should you consider contacting a professional?

Learn to recognize signs of serious distress:

• Feeling hopeless or helpless

• Feelings of numbness, disbelief, anxiety or fear

• Changes in appetite, energy, and activity levels

• Difficulty concentrating

• Difficulty sleeping or nightmares

• Physical reactions, such as headaches, body pains, stomach problems

• Worsening of chronic health problems

• Anger or short temper

• Increased use of alcohol, tobacco, or other drugs.

Call your healthcare provider if your feelings overwhelm you for several days in a row.

Congratulate yourself that you’re doing the best you can in this time of uncertainty and remember, we will get through this together!

Neil S. Kaye, MD, DLFAPA  is a practicing psychiatrist in Hockessin and Past President-Psychiatric Society of Delaware. He is also a member of the Medical Society of Delaware’s Committee on Ethics and Government Affairs Committee