MANAGING ANXIETY DURING COVID-19
The Coronavirus outbreak has brought a rollercoaster of emotions for many of us. This article, written with my colleague Sarah Venis, outlines what is happening in your body when you feel anxious, and some techniques to manage anxiety and take care of yourself during this period.
ANXIETY IS UNDERSTANDABLE
There is a trend to see some feelings as ‘good’ and some as ‘bad’ and that it is our job to avoid ‘bad’ feelings. Sometimes it can feel that if only you were good enough at managing your feelings, or doing meditation or yoga, you wouldn’t feel anxious or stressed again. We then can become anxious about being anxious, and as a result make ourselves more anxious. Try being a bit kinder to yourself when you find yourself feeling anxious; imagine what you might say to a friend who was feeling anxious.
THE FIGHT, FLIGHT, FREEZE RESPONSE
Unfortunately, our brains can’t tell the difference between a sabre-toothed tiger and a stressful news alert or Facebook post. When there is real danger, or when we believe there is danger, our bodies go through a series of changes called the fight/flight response. Our bodies are designed to physically respond when we believe a threat exists, in case we need to either run away, or stand and fight. Some of these changes are:
An increase in heart rate and strength of heart beat. This enables blood and oxygen to be pumped around the body faster. An increase in the rate and depth of breathing. This maintains oxygen and carbon dioxide levels.
An increase in sweating. This causes the body to become more slippery, making it harder for a predator to grab, and also cooling the body.
Muscle tension in preparation for fight/flight. This results in subjective feelings of tension, sometimes resulting in aches and pains and trembling and shaking.
When we become anxious and afraid, our body sets off an automatic biological “alarm”. However, in this case it has set off a “false alarm”, because there is no immediate danger to ‘fight’ or run from. Use the practical tips below to manage this response. (The Centre for Clinical Interventions has some really useful information sheets on panic here, if you want to find out more).
MANAGE YOUR PHONE ALERTS
Because our primitive brain can’t tell the difference between a physical threat and a ‘breaking news’ alert, it is a good idea to get triggers to a manageable level. You might deactivate alerts and choose when you will check the news. If watching/reading the news is upsetting, factor in a 10-minute ‘buffer’ after watching or reading it, and do the breathing exercise below. If WhatsApp groups are a bit much, mute them and choose when to look at them.
KNOW THAT FEELINGS PASS IF WE GIVE THEM SPACE
Practice accepting and make space and some time for your feelings of anxiety. Let yourself have those anxious feelings and see if you can sit with the core feelings that usually lie underneath the anxiety, like fear, anger, loss, sadness. It is important to remember that feelings pass – if we give them space. We can worry that starting to feel something will make more bad feelings come, but this is not true. Pay attention when you feel the physical signs of anxiety – shortness of breath, palpitations, stomach churning – and take time to sit and allow the emotions underneath it some space. If the anxiety builds into a panic attack, most evidence now recommends you riding it out and letting it happen – efforts to stop it will make it worse.
If you can, write down what you are feeling and thinking, write it out, or record it on your phone, let yourself express it.
BRING YOURSELF INTO THE PRESENT - TELL YOUR BRAIN YOU ARE PHYSICALLY SAFE
Our brains are adapted to react to our fears of danger by pumping us full of adrenalin and other chemicals designed to help us escape, for instance by fighting, fleeing or freezing. These adaptations are great if you need to jump out of the path of a car or run from danger, but unhelpful if you are worrying about your financial situation or about becoming sick. When you are giving space to your anxiety and feelings, it is important that you send your brain the message that you are physically safe at the moment. This helps stop your brain overloading you with stress chemicals.
You can do this by becoming aware of your surroundings
Feel your feet on the ground, feel the ground pressing up on your feet, feel the seat underneath you. Become aware of your breath – do NOT take in a big breath, this can activate your stress response. Instead, notice your breath, whether it is shallow or deep, how your body moves as you breathe. If you can, notice your out breaths, and try pausing for just a moment at the end of each outbreath and counting it ‘1, 2, 3’ etc. Let the in breath take care of itself, just focus on the outbreath and if you can, slightly lengthening each out breath.
Slowly look around, using your peripheral vision to look all around yourself. This tells your brain that you are not about to be attacked, that you are ok.
Focus on something external to yourself – a cushion, a flower, a glass. Really look at the object and notice it as if you are going to draw it.
Notice your breath again – what is it doing now?
Become aware of sensations in your body – just be curious about them.
Soothe yourself – for instance, gently massage one hand with the other hand, gently squeeze each forearm with your other hand. Find a cosy blanket to wrap yourself up in. Let your body feel safe.
Your aim in doing this is not to push your feelings away, but to help you feel safe enough to be sit with what you are feeling and let it pass through you.
BALANCE FEELINGS AND THOUGHTS
When you hear yourself telling yourself something that feels catastrophic, give it space, acknowledge that you feel scared, and then try noting down something that you control. You can also spend a few minutes thinking and writing down one thing that made you smile or feel happy in the past 24 hours, or one thing that you feel grateful for.
USE BREATHING TO CALM YOURSELF
You probably already know that we breathe in to obtain oxygen and we breathe out to expel carbon dioxide. The body naturally maintains optimal levels of oxygen and carbon dioxide, and this balance is in part maintained through how fast and how deeply we breathe. Anxiety causes an increase in our breathing rate, as part of the physical fight or flight response to a perceived threat. Continued overbreathing can leave you feeling exhausted or “on edge” so that you’re more likely to respond to stressful situations with intense anxiety and panic. Gaining control over your breathing involves both slowing your rate of breathing and changing your breathing style. Use the following steps to develop a better breathing habit and calm your system down and stop the fight or flight response:
Ensure that you are sitting on a comfortable chair or lying on a bed.
Take a breath in for 4 seconds (through the nose if possible).
Hold the breath for 2 seconds.
Release the breath taking 6 seconds (through the nose if possible), then pause slightly before breathing in again.
Practise!
SET A ‘WORRY PERIOD’
Set aside 30 minutes a day when you will worry – put it in your diary. If worries come up throughout the day, note them down briefly and try to mentally set them aside. When the worry period arrives, look at your worries, and - only if you still need to worry about them - write them down or worry about them in that contained period of time. (Note: don’t plan your worry period just before bed, and don’t do your worrying in bed!) While you are worrying, make sure you are comfortable, remind your brain that you are safe, and afterwards practise the breathing exercise above to minimised your fight-flight response.
IF MANAGING OR REDUCING SOCIAL MEDIA IS DIFFICULT, INCREASE SELF-CARE INSTEAD
There is lots of advice to disengage from social media and the news to avoid anxiety. But if you are feeling anxious and cut off from the world it can feel impossible to do that, and like you are being asked to give up something you feel you are relying on. Instead, focus on building in moments of self-care into your day. Whatever has worked for you before is a good place to start – things like a hot bath, doing an online exercise workout, reading a book on the sofa, watching an old box set or rom-com, snuggling with a pet. If you focus on ensuring you build in times of self-care into your day, you will naturally have time when you are not on your phone, so you are not trying to give something up, but add something in, which feels much easier to our anxious brain.
Note – one practical thing you can do while online is to try to only take seriously information from trusted sources like the World Health Organization, the NHS, or UK Government advice. Information from dubious sources can be inaccurate and create needless anxiety.
FOCUS ON WHAT YOU CAN CONTROL
This is a helpful grounding exercise:
Take a sheet of paper, draw 2 concentric circles.
Place out all the things you are worried about in the relevant circle. Get it all down! For example: you cannot control whether people are angry with runners on the local community page; you can control whether you are a courteous runner and good “ambassador”.
Take a breather and congratulate yourself for facing your fears. Grab yourself a cuppa & a piece of cake (or whatever was left in the supermarket) to celebrate.
Revisit your sheet, prioritising your Sphere of Control, add suggestions for ways you might address some of them. What could you do right now / in the next 24 hours / week / longer term?
FACTOR IN SOCIAL TIME WITH FRIENDS AND FAMILY - IF IT IS HELPFUL
Connect with friends and family on the many digital platforms available, OR by phone. Can’t make that dinner date you set up months ago? Consider doing it online and eating together. Further resources to help you manage your mental health:
The Mental Health Foundation has some top tips on how to manage your mental health during a crisis like coronavirus
BBC News has aggregated some advice from the World Health Organization and from social media
Calm, a mindfulness app, has made some of its stress-reduction exercises and resources available for free
Useful COVID-19 resources
ANXIETY MANAGEMENT
Exercises to ground you during the outbreak, and some information on how anxiety works.
Rewiring the Anxious Brain - Neuroplasticity and the Anxiety Cycle - great video on YouTube explaining what anxiety is and some ways to rewire your anxious brain.
FACE COVID. In this brief animation, Dr Russ Harris, author of The Happiness Trap, illustrates how to use Acceptance and Commitment Therapy to deal with the Coronavirus crisis and the fear, anxiety and worry that goes with it.
MENTAL HEALTH FOUNDATION
The Mental Health Foundation has some top tips on how to manage your mental health during a crisis like coronavirus. These include:
OTHER RESOURCES
BBC News has aggregated some advice from the World Health Organization and from social media.
You can also contact the Samaritans on 116123.
Text ‘SHOUT’, The UK’s first 24/7 text service for anyone in crisis anytime, anywhere on 85258 (free).
Let’s talk about… Anger
The recent lockdown due to COVID-19 has triggered many feelings, including anger. A recent Lancet article looked at previous quarantines and found increased anger levels in people in quarantine and frontline health workers alike.
What is Anger?
Anger is a natural feeling: everyone feels it sometimes, whether it’s irritation, frustration or rage. Anger can be helpful, like a warning light in our car, telling us that something is wrong, that a boundary has been crossed, that there are feelings we need to deal with or changes we need to make. It can spur positive change or self-awareness. But anger can also be harmful, if it gets in the way of us leading our day-to-day lives, or becomes explosive or frequent.
We often associate anger with openly aggressive or destructive behaviour, but anger can also be quiet, involving withdrawal, passive-aggressive behaviour, or anger seeping out in our interactions.
Why do we feel anger?
These are a few of the reasons:
Unmet needs. Anger is often a sign of unmet needs, for example the need for safety, the need for clear rules, the need to be heard, the need for control.
Boundaries or values feeling violated. Our mother-in-law drops in frequently without asking; someone behaves in a way which is not aligned with our values; we don’t feel heard. Sometimes, these can tap in to experiences from our childhood or earlier in our lives which are triggering. We can often feel that we are totally right or justified in our anger when a value which we hold dear is violated.
Anger as a proxy for other feelings. Sometimes fear, sadness, shame, anxiety are really what you are feeling – but these feelings can be hard to express. Anger can be a proxy for other, powerful but scary/overwhelming feelings.
Being shaped by an angry environment. You may have learned that anger is an appropriate response to many situations; parents may have modelled angry behaviour, be it overt or passive-aggressive. Children are like sponges, and learn from caregivers’ behaviours.
Not learning to tolerate distress. We learn to contain our feelings through our caregivers being able to contain them when we are little – to comfort us and help us process them. If this didn’t happen, certain feelings might be difficult to tolerate and feel overwhelming: anger can be one of these feelings.
Unhelpful ways of thinking. Black and White thinking, for example, means we are either right or wrong, and grey areas are uncomfortable. Or ‘shoulding and musting’: sometimes by saying “I should…” or “I must…” you can put unreasonable demands or pressure on yourself and others. (More on unhelpful ways of thinking).
What is the impact of anger?
Anger triggers our body’s ‘fight or flight’ response: our body gets ready to run from a threat, or fight it. Our adrenal glands flood your body with adrenaline and cortisol, our heart rate increases, we sweat more, and our mind is narrowly focused on the threat. This is incredibly helpful when the threat is a bear, or an out-of-control car: less so when it is someone not socially distancing appropriately in Sainsbury’s.
Long-term, frequent anger can have a lasting impact on your body. Prolonged release of stress hormones can destroy neurons in areas of the brain associated with judgment and short-term memory, and weaken the immune system. Anger can also affect your relationship with significant others in your life, or colleagues, and beyond. Lastly, anger can also bring its own guilt-cycle: feeling bad about yourself, anxious, depressed, low self-esteem.
What can you do about anger?
These are a few of the things you can do:
Know your triggers. List the things that usually trigger anger, and the physical warning signs that you are going to get angry. Be aware that these situations may be triggering when you go into them, and be prepared to manage your anger. Where appropriate, consider limiting your exposure to these situations.
Connect with why you are angry. Own it: know why you are angry, check in with yourself on whether there an any alternative ways of looking at the situation, and whether your anger levels are proportionate to the situation.
Check that it is definitely anger. Many of us feel anxious, sad, or powerless in the face of COVID-19 and its impacts. Anger might be easier to feel. Check in with yourself, and connect with those feelings. You can use some of these tactics here to manage anxiety.
Recognise what you can and cannot control. The ‘locus of control’ exercise can be useful for this.
Communicate your needs, clearly, respectfully and assertively. Here are some great resources on assertiveness.
Take time out: remove yourself from the situation, cool down, and think things through. For example, if your discussion with your partner is spiralling out of control, it is OK to ask for a breather.
Distract yourself. Sometimes you can’t change what is happening. Distract yourself by listening to music, looking for every blue thing in the room, doing housework.
Write it down: sometimes, writing down what is going on can help you dissipate the feelings.
Breathe and relax. Take slow, deep breaths or progressively tense and relax each of your muscle groups. Breathe out for longer than you breathe in: this activates your parasympathetic nervous system and deactivates the fight-flight response.
Do something physical: don’t smash up the crockery (!), but pile up the sofa cushions and give them a bash; do some star jumps and press-ups; go for a run or walk. All of this gets rid of the chemicals flooding your body.
I like this coping strategies sheet, which expands on some of these tips.
Seek help if you need it
If you are worried that you have a problem with anger, consider seeking professional help from a counsellor or psychotherapist. This is a problem you can tackle, so don’t lose hope. This information sheet has some useful questions to help you determine whether this is the case, and the BACP website enables you to search for help. Many counsellors are working online in this period.
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References
Brooks et al (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet, 395 (10227), pp 912-920. https://doi.org/10.1016/S0140-6736(20)30460-8
The Centre for Clinical Interventions, Government of Western Australia, provides many excellent resources which I link to in this article: https://www.cci.health.wa.gov.au/Search