By Dr. Nikki Scheiner
Back in December 2019, when most of us were looking forward to festive celebrations or planning their summer holidays, few people had heard of coronavirus or its scientific name, COVID-19. Today, most people rarely talk about anything else. Coronavirus has the power to strike fear into most of us, whether we have the virus or even know anybody else who is currently suffering with it. This article explains why we are scared, what increases our fear and what we can do to reduce our collective and individual anxiety.
What is anxiety?
Whilst worry that helps us take sensible precautions is productive, some people experience levels of anxiety that disable them. This level of anxiety is an over-estimation of a threat or danger – in this case the virus – together with the belief that there is nothing we can do about it. Fear has the power to spread faster than any virus; it is infectious and – if unchecked – may lead to mass panic.
When the danger itself is invisible and affects whole communities, as with coronavirus, our fear and anxiety understandably increase. Whatever the level of your anxiety, you need to remember that, as a species, human beings are problem solvers. That means that whatever the situation confronting us, we can reflect (rather than react) and come up with techniques and strategies to improve out circumstances and those of others.
Here are my 12 Top Tips for managing your anxiety.
Top Tip 1: Facts, facts, facts
We make decisions about our daily lives based on information we have. In psychological terms, this is called the ‘availability heuristic.’ The challenge we are all currently facing is that facts are pretty scarce. We need clarity in order to reduce anxiety. Many of us don’t even know the difference between coronavirus and COVID-19. So, let’s start with that.
What is the difference between COVID-19 and Coronavirus?
Coronaviruses are a group of viruses that target our respiratory systems. Corona is a descriptive term reflecting the crown-like spikes on the surface of the virus. Covid-19 is a new strain that has not been previously identified in humans. Because it is previously unknown, it is known as a ‘novel’ coronavirus. That means that we need to develop novel solutions, medically, socially, emotionally and psychologically.
Top Tip 2: Check the source of your news
People who have anxiety or health anxiety typically spend hours online with ‘Dr. Google. If this describes you, you may well think that you are looking to disconfirm your symptoms, to reassure yourself that you do not have the disease. All the psychological research and my own clinical experience suggest that the outcome is actually the opposite: your anxiety will draw your attention to anything that seems to confirm that you are at risk.
You might then scroll through Twitter for your news, or perhaps share alarmist texts with friends and colleagues: ‘surging rates, soaring cases, a tsunami of illness.’ Don’t be surprised if your anxiety levels also soar!
Avoid any message you receive that starts with, ‘Please share this with friends…’ or ‘An NHS colleague advised…’. These texts are doing the rounds and are full of worrying misinformation. The Government is not going to ask you to share its views with a friend! Other myths are also spreading faster than the virus. A woman in China, convinced that consuming garlic would fight off the virus, consumed 1.5 kilos over 2 weeks… and ended up being admitted to hospital with a severely inflamed throat. People in Tunisia are reportedly spending their weekly wages on garlic – the price of which is increasing massively. The truth is that, sadly, garlic is not a cure or vaccination for the virus. Similarly, if you want a hot bath, have one, relax and enjoy it. But don’t tell yourself that it is a new cure for coronavirus because that’s just another myth.
The antidote to all of this is for you to decide the news you will access. For example, you may rely on the 5.00 p.m. government briefing with the Prime Minister and his medical advisers, Sir Patrick Vallance, Chief Scientific Adviser, and Professor Chris Whitty, the Government’s Chief Medical Officer. Or you may prefer accessing information through Government or the World Health Organization websites. Whatever you choose, make sure it is reputable.
Maybe start your own Whatsapp group or join one where you know that the members are informed and trustworthy.
Top Tip 3: Limit the amount of time you spend every dayresearching the virus.
Unless you are an epidemiologist or virologist, do not spend hours trying to find out information about the spread of the virus or new cures. You will not end up more informed, simply more anxious!
Spending the same amount of time Meditating or practicing Mindfulness will be a far more effective way to reduce your anxiety.
Top Tip 4: Keep a routine
The closure of schools, offices, transport systems, shops, theatres and gyms, presents us all with the need to adjust. This takes motivation and effort. But there are things that you can do to minimize the burden of adjustment. Chief amongst these is to try and maintain your routine. If you tell yourself that you can get up at 11.00 a.m. every day and slouch around in your tracksuit bottoms, aka pyjamas, you will soon become institutionalized. Patients in hospital for an extended periods of time often lose their independence because their food is cooked for them, their bedlinen changed, their clothes washed. On discharge, they struggle to resume their independent lives.
We too need to continue to get up, washed, dressed and then continue our routine. If not, we will simply become more anxious and then struggle to get on with our normal lives once the threat of the virus has passed. So, get up within 30-45 minutes of your normal time, avoid daytime naps and then go to bed at your regular time.
Top Tip 5: Maintain a healthy diet
Anxiety can make you eat less or alternatively, eat more. If you find that your anxiety has reduced your appetite, monitor yourself. Take responsibility for ensuring that you are continuing to keep hydrated and nourished.
Conversely, beware of the pitfalls of boredom and frustration. The new restrictions on movement are not an excuse to indulge in mid-morning or mid-afternoon snacks to our usual diets. Just because the Government has said that it is OK for take-away businesses to stay open does not mean that we should comfort ourselves with pizza or sugar-based foods. Your anxiety will reduce if you follow a healthy diet, eating as much fresh food as possible. If we are working to keep ourselves physically health, we are more likely to feel psychologically robust as well.
Watch your coffee and tea intake: anxiety will increase with your caffeine consumption.
Similarly, watch your alcohol consumption: stay within government guidelines and don’t treat every day as the weekend when you might start drinking alcohol at lunchtime.
Top Tip 6: Exercise
Exercise has always been one of the best ways to manage mental health difficulties. Excess cortisol and adrenalin produced when we are anxious or fearful can be absorbedwhen we exert ourselves. At present, there are still parks where we can exercise. And dogs that need to be taken for a walk.
Get creative: use household items as free weights, run up and downstairs as cardio, follow YouTube keep fit sessions in your own home, dance round your bedroom. Prioritisekeeping fit and minimizing the physical symptoms of anxiety. Progressive muscular relaxation and diaphragmatic breathing will further reduce anxiety.
Top Tip 7: Structure your day
Both the Chinese and Hebrew words for ‘Crisis’ contain within them the word ‘Opportunity’. The current outbreak offers all of us the opportunity to learn something new. Anxiety, as well as depression, will feed off a lack of activity: if you do nothing all day, at the end of the day, you will have achieved nothing and will just ruminate on your empty day.
Instead, follow a structure. Add a new skill to your repertoire. If you are linguistic, you could set yourself a daily or thrice weekly task of studying a new language. Or using the Internet to learn a new skill – how to bake, sew, cut hair, fix a puncture, draw portraits. If you are interested in writing, you could compose short stories, poems, start a novel. Or start a book-club with your friends. All the things that you have said to yourself before that you would love to do, ‘if only I had the time.’
Work on the basis of a week at a time. Goals need to be specific (for example, 15 minutes a day of language learning or tidying or drawing), not abstract (for example, ‘I want to be happy’). Devising weekly goals help us to set realistic targets, increasing the chances of success. Achievement will both boost our confidence and inspire us to continue to make progress at a time that may feel that the world is standing still. If we are not successful with our goal, we can modify it to make it more manageable and achievable for the next 7 days.And the best thing is that there is no need for fear of failure, because there are no other people to judge our efforts!
Top Tip 8: Keep in touch with family and friends
Social distancing may keep us physically safe but also runs the risk of making us emotionally vulnerable: isolation may increase loneliness. The way to prevent this outcome is to set up regular remote contact, whether by telephone, WhatsApp, House Party, Zoom, Skype, Google Hangouts Meet – the means are numerous.
Top Tip 9: Altruism
Doing something for others has the added benefit of making ourselves feel better too. There is a lot of ‘buzz’ around at the moment about people helping those who are elderly or those with medical conditions that make them more vulnerable by doing shopping, running errands etcetera. Remember that a ‘phone call is also an act of kindness. You may not care very much about one of your elderly relatives, but any irritation you feel when you get into a disagreement with them about religion or politics will be far outweighed by the benefit that your contact provides them.
Top Tip 10: Avoid catastrophizing
If you are anxious, there is a good chance that you have developed what is called a cognitive bias of catastrophizing, in other words a tendency to predict or fear the worst outcomes. The best way to stop yourself doing this is to ask yourself the following 3 questions:
‘What is the worst that could happen?’
‘What is the best that could happen?’
‘What is the most likely that could happen?’
And then, once you are aware of your thinking patterns, you can monitor yourself, noticing your negative tendency and interrupting this unhelpful train of thought. You could also download the free apps CALM or HEADSPACE or www.hellotomo.co.uk ( free for the next 6 months) to help reduce stress and anxiety.
Top Tip 11: Manage your disappointment
In my clinical opinion, the way that we deal with disappointment is a good indication of the state of our mental health and our ability to be resilient – to ‘bounce back.’ Just about everyone is experiencing some type of loss, even if they are not ill, whether it is a missed holiday, not being able to take A’ level exams after working for them for 2 years, not seeing friends, postponing a wedding, the loss of a job, a cancelled operation – the list goes on.
So that leaves us with a choice, something that remains under our control at a time when we feel that a lot has slipped out of our control. We can either say, ‘That’s awful, that sucks’ or we can think about how we can restructure our disappointment and find reasons to be grateful for what we do have. Patients who have suffered with depression know that keeping a Daily Gratitude Log is a powerful tool in fighting a sense of loss.Little things: a child’s laugh, Spring blossom, bird song, making a delicious cup of coffee are all reasons to be grateful. And all free!
Top Tip 12: Consistency – not Complacency
We need to carry on doing whatever we have been asked to by the Government, not just for the first week or two, but consistently for the duration of the crisis. This is a challenge, but an important one. Knowing that we are actively contributing to the good of everyone will empower us and reduce the thoughts that we have no control over outcomes.
And finally: Laughter
Laughter has always lightened the burdens of modern life. Humorous memes and videos are being shared on the Internet and passed round between friends. If something has helped make you laugh or smile, share it. It may help. But if someone tells you that they are fed up with being bombarded by videos and texts, cut them some slack!
And remember: This too shall pass.
Keep well and keep safe.
Dr. Nikki Scheiner
Dr. Nikki Scheiner is a Consultant Psychologist, founder, and clinic director of The Functional Symptoms Recovery Clinic in London’s Harley Street