How do you deal with your patients’ anxieties regarding the novel Coronavirus, when fears are real and you, the provider, may be coping with your own new level of worry?
We read daily the details of disease progression and the devastating toll physically, emotionally, and economically, with many of our nation’s health care providers assuming the greatest risks. While a sense of sadness and loss are common (and will become increasingly so as meaningful events and interactions are limited, and social isolation continue), anxiety is the predominant theme. Even our most basic tasks, like grocery shopping, are fraught with urgency and angst. A new survey by the American Psychiatric Association, conducted March 18-19, 2020, revealed that 36% of American adults believe Coronavirus is having a serious impact on their mental health.
During the past several weeks, there has been a plethora of digital psych newsletters headlining dealing with coronavirus yet offering little truly useful information for attenuating this anxiety. I’m sure much will be forthcoming, but what do we do in the interim? Consider that when your patients are asking you about testing, statistics, and other aspects of COVID-19, they are also likely seeking reassurance, comfort, and guidance. In addition to your usual queries, I suggest a couple questions to inform next steps:
- How have you been coping with the changes in your life since coronavirus?
- How are you doing with your _________ (eating, drinking, sleeping, etc. It’s helpful here if you know the patient and their vulnerabilities)?
These questions can shed light on how a person is functioning, how anxious they are, and also how resourceful. It may be useful to ask yourself these questions too!
What next, for our anxious patients? A provider can (and may need to) increase current psychotropic medication, or initiate one, but this seems inadequate to address the extreme emotional nature of this pandemic, and certain patients may not be good candidates for anxiolytics. I contacted recently retired clinical psychologist, Dr.
Louise Miracle, for suggestions. She provided practical and actionable information, and referred me to a short CNN Health video for a concise summary: https://www.cnn.com/videos/health/2020/03/25/mental-health-during-coronvirus-cnn-lon-orig.cnn. I found this a very helpful resource. If you recommend it to patients, you might suggest they replay it and write the information down, which helps with learning the steps. A summary follows.
5 Things You Can Do to Take Care of Your Mental Health During Coronavirus
- Avoid Information Overload
- Reduce exposure to information about the virus.
- Find just a few trusted sources, like the CDC and local news.
- Limit frequency of checking news, and limit phone notifications.
- Practice social media self-discipline, consider uninstalling apps.
- Name Your Fears and Prepare
- Specify your fears (write them out).
- How realistic are they?
- Try not to overestimate the likelihood they will occur, or
- underestimate your ability to deal with them.
- If fears are more practical, think about an action plan. Consider options and be prepared for those scenarios.
- Think Outside of Yourself
- Actions can counter anxiety.
- Consider helping someone else.
- Volunteering can minimize stress and depression.
- Seek Support Wisely
- Seek support but avoid those as anxious as you.
- Consider professional help if you continue to struggle with anxious thoughts.
- Keep a Routine
- Maintain a consistent sleep schedule (important in a time of stress to physical and mental health).
- Try to include consistent activity and exercise, which is known to reduce anxiety.
The second section above is really the critical piece here and represents the rudiments of Cognitive Behavioral Therapy. Dr. Miracle points out that anxiety is exacerbated by two common default coping mechanisms, avoidance, and distraction. They provide temporary relief but can perpetuate the idea that what we are afraid of is overwhelming and impossible to tolerate. What we need to do instead is write down as bluntly as possible what exactly the fearful thought is, challenge it through some rational self-questioning, and replace it with a more reasonable thought. Research shows these anxious thoughts must be uncovered then confronted.
If someone has ongoing struggles with anxiety and/or depression and it’s getting in the way of their functioning, a referral to a mental health professional may be in order. In addition to the above, I would add a couple things. Now is a great time to take a moment to be mindful, and pause to notice the beauty around us, in the natural world, in the kindness and caring of others, and in our loved ones. Look for bits of joy and express gratitude. And remind ourselves and our patients we have a common purpose in this brief sacrifice, for the greater well-being of all humankind.
