Coping with Fear and Sadness During a Pandemic

Don't Give in to or Fight your Feelings: Learn to Manage Them

Second Version 4/13/20

William C. Sanderson, PhD

Professor of Psychology

Director, Anxiety & Depression Clinic

Hofstra University

 Doctoral Student Contributors (listed alphabetically):

Vinushini Arunagiri

Allison P. Funk
Karen L. Ginsburg

Zakieh B. Klurfeld

Jacqueline K. Krychiw

Anne R. Limowski

Olenka S. Olesnycky

Zoe Stout


For more information about coping with the COVID pandemic, including access to direct services for COVID related psychological distress see: https://sites.google.com/view/sandersonhofstra/covid-coping-resources


COPING WITH FEAR AND SADNESS DURING A PANDEMIC       WEBSITE:  PsychRescue-COVID19.com

Second Version: 4/13/20 (First Version 4/6/20)                                    PDF COPY:  click here

We would like to make this document available to as many people as possible to serve as a self-help guide to assist individuals in using the science of clinical psychology to cope with common negative emotional reactions that we are all likely to experience as a result of the COVID crisis.Thus, we ask that you forward this document or the website address provided above to anyone you believe may benefit from it (including posting on social media and listservs).

Unfortunately, as a result of this pandemic, we are all serving in an enormous social experiment that will allow researchers to determine the impact of chronic fear, countless losses, social isolation, and significant disruption of people’s day to day lives.We are concerned that if this is left unattended, the mental health impact of these factors may be disastrous. The good news is that we have effective strategies to help individuals manage negative emotional states.

All of the strategies that we are outlining in this document are taken from evidence-based psychological treatments for individuals with anxiety disorders and depression. Thus, there is no reason to expect that these strategies cannot be equally useful for those suffering from similar emotional states secondary to the challenges associated with the COVID crisis.

Typically, when we produce a paper in academics, we spend months planning, writing, and reviewing it before making it available to others.Given the current rapidly evolving crisis we do not have time for that.As a result, we are doing something highly unusual - releasing a work in progress that is likely to develop over the next several months as we learn more about the impact of the COVID crisis on mental health. The first version, released last week on 4/6/20, was produced in two days.The second version was produced in nine days. We know it is not perfect, but still believe it can be useful and thus is worth releasing before it meets our standard -- but is too late.

Please note that the second version has been substantially improved.Most of the areas covered in the first version have been edited, many new areas have been added (these are noted in the table of contents).And perhaps equally important,the document and website have been formatted to provide an easier reading experience.


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Copyright © William C. Sanderson, PhD - New York, USA, 2020

Table of Contents (The listings below link to the respective section)

INTRODUCTION

I. FEAR, ANXIETY, WORRY

        Understand Fear and Change the Way You Think About It

        Take Control of the Input that Fuels Pandemic Fear: Reduce Media Consumption

Develop Accurate Risk Perception: Examine Your Thoughts

Existential Acceptance (sounds more complicated than it is)

II. SADNESS AND DEPRESSION

Hopelessness:This is Never Going to Get Better

Helplessness: There is Nothing I Can Do to Make a Difference

Non-Bereavement related loss: It’s Okay to Grieve the Loss of Jobs, Social Life, Old Life

Social Disconnection/Loneliness: Feeling Particularly Isolated Lately?

Loss of Reinforcement

Loss of Meaning

Rumination: Thinking About Something Over and Over Again?

Resilience and Posttraumatic Growth 

Gratitude: An Antidote to Depressive Thinking

III. MANAGEMENT OF OTHER NEGATIVE MOODS THAT MAY ARISE FROM COVID CRISIS

Guilt: Feeling Like You've Done Something Wrong or Haven't Done Enough?

Shame

Unrealistic Personal Expectations:It’s Definitely Time to Adjust Expectations

Frustration: When Achieving Your Goals is Difficult

Claustrophobia: Feeling Trapped and Stir-Crazy?

Chronic Stress: Coping When You’re On Edge

Managing Conflict: Reducing Irritability and Communicating Effectively

IV. GENERAL MOOD REGULATING STRATEGIES LIKELY TO BE NEGATIVELY IMPACTED AND NEW CHALLENGES

Lack of Sunlight

Establishing Sleep Hygiene

Lack of Physical Activity

Blurred Boundaries: Challenges Working from Home 

Assertiveness: Setting Boundaries with Electronic Communications

Changes in Eating Habits: Reaching for Comfort Food

Zoom Fatigue: Feeling Drained From All Your Video Meetings? 

V. USEFUL ARTICLES ON A RANGE OF COVID RELATED ISSUES        

Advice to manage psychological distress

Information To Help With Your Anxiety Provoking Thoughts

How To Manage The Psychological Effects Of Social Distancing And Quarantine

How To Deal With Grief: Missing The Way Things Were

Parenting advice to help you and your children cope

Self-care for Parents

A Parent’s Guide to Meeting the COVID-19 Challenge

Supporting Kids during the COVID-19 Crisis

How to Speak to your Kids about COVID-19

Advice to manage relationships        

How To Keep Quarantine From Ruining Your Marriage

What To Do If Your Family Or Friends Aren't Taking Coronavirus Seriously

Advice to manage bereavement during covid (loss of a loved one)
Very practical how to advice to help manage the COVID crisis

How To Open And Handle Packages Safely

How To Get Food

How To Stop Touching Your Face

How To Make Your Own Cloth Mask

Virtual pleasurable activities

Visit Museums

Watch Animals

Go To Disney

Ride A Roller Coaster

Practice Yoga, Meditation, Social Distant Dancing, Etc., Through Live Streams

Explore 32 National Parks

Take A Free Online Course From Ivy Leagues (Yale, Princeton, Harvard)

Tour Nasa’s Space Center Houston

Watch Broadway Shows

Take Free Guitar Lessons

Watch Concerts

Take Free Cooking Classes

Amazon Prime Is Offering Free Tv Shows For Kids

Self-care advice for mental health professionals

---> If you need professional help: Referrals <---

*** Submit a question/comment for our work group to respond to in the next version *** 

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Introduction

 I have spent the past 37 years studying anxiety (fear) and depression (sadness) along with my doctoral students. Specifically, we are interested in:

 

  1. What causes these feelings (everyone has them from time to time)
  2. What purpose they serve (they evolved because they were useful - and are still useful)
  3. What factors lead to them becoming a significant problem for some individuals (we have a lot of knowledge about this)
  4. When they become a problem, how to help people manage and reduce these feelings so that they do not interfere with their life (there are scientifically proven ways to do this).

This knowledge is particularly relevant in the current landscape– the COVID-19 Pandemic. Clearly, COVID represents a potential physical and medical threat for everyone. However, our concern, based upon what we know about anxiety and depression, is that the mental health effects will become the greatest challenge for most of us—not the physical/medical effects—and our emotional responses can potentially have a long lasting impact beyond the current pandemic. Unfortunately, as a result of this global crisis, we are all serving in an enormous social experiment that will allow us to determine the impact of chronic fear, social isolation, and significant disruption of people’s day to day lives.See David Brooks very recent article validating the reality of this in the U.S.: The Pandemic of Fear and Agony.

Specifically, the present environment is triggering our underlying psychology in a way that is unprecedented– with potentially serious consequences for our anxiety and depression. We already know that about 25% of people in the U.S. suffer from an anxiety disorder at some point in their life, and that figure is about the same for depression. Our brains simply were not built for this type of threat. Imagine if you turned a light switch on and off all day, 24 hours/day, 7 days/week. It’s not built for that much use.Eventually it would break– much earlier than if used “normally.” This is what is happening to our psychological mechanisms involved in anxiety and depression: they are being triggered 24/7, way beyond the purpose they evolved for.

Unfortunately, this pandemic is likely to stick around for quite some time. So we offer the following, science-based suggestions, to help MANAGE fear and sadness. The starting point is that of course, anyone not having some increase in their anxiety and sadness probably has an emotion system that is not working as it should. As best we can tell, EVERYONE has had increases in these emotions—as would be expected—because there is some level of validity to these reactions (COVID is legitimately a threat to us thus provoking fear and our lifestyle changes are depressing!). That being said, there are factors that may contribute to these reactions that can be dealt with. The metaphor I will use here is a volume control.When you turn something on it is set at a certain volume. You can then turn the volume higher or lower.What we are detailing in our guide is what triggers turn these negative feelings on, how they get “turned up higher” then necessary, and solutions to how they can be “turned down”—but not off —so the experience is more manageable.

In our guide you will find a summary of many common ‘pandemic-related’ issues that we have observed and how they push the buttons of well-known processes that are generally involved in increased anxiety and depression -- and psychological/emotional distress in general.   Unhelpful ways of dealing with them are discussed -- these are ways that often make the problem worse even though the person’s effort is well-intended..  Solutions to best manage negative reactions follow each of these.  We hope you find this information useful.

Fear, Anxiety, and Worry

Understand Fear and Change the Way You Think About It

Let’s start with a basic premise: You should feel vulnerable, and therefore fearful, given what is going on in the current environment (from here on in I will use the word fear to refer to anxiety and worry as well even though we make distinctions between these it is not relevant here). In fact, fear is your greatest ally right now– because when channelled appropriately, it is protecting you and everyone else who may come into contact with you.When channelled appropriately, you wash your hands more than ever, social distance, and avoid going out as much as possible. You struggle in the supermarket feeling like you can’t breathe because you may be wearing a mask. But the anxiety keeps you from taking it off.

These behaviors are the most important things that we can do to decrease the spread and overall negative impact of coronavirus. But let’s be honest, we only substantially changed our behavior when we became fearful. The more vulnerable we feel, the more likely we wash our hands, socially distance, and avoid going out unnecessarily, etc.

This is a gift brought to us from our evolutionary history: Fear, when appropriately triggered, directs us in a way that protects us from threats in our environment. So let’s start by embracing our appropriate level of fear and thanking our evolutionary ancestors who responded to their fear with protective behaviors and survived and ultimately passed this on to us. Because this primordial archetype located deep in our brain is our best weapon against those things that may harm our survival.

Despite knowing COVID-19 was headed our way at least three months ago, we had to experience the vulnerability in the moment to change our behavior. Let’s not look back now with regret– we’re just behaving like humans based upon the way they are built. That’s true of our leaders as well which is why there was such a disappointing level of preparation for this crisis that was whistling while it approached.But that’s another story. The bottom line is we all needed the fear to lead us on the correct path. SO DO NOT STOP BEING FEARFUL (if you were hoping for a guide on how to get rid of all of your fear right now, you have come to the wrong place).

However, that being said, what can be modified substantially is our level of fear. Many are at a panic level of fear as though COVID is a tiger ready to make us its lunch. For most of us who are in fact not that vulnerable to COVID, the following should become our guiding principle, perhaps a mantra:

COVID-19 will pass, humankind will survive, almost all of us will still be alive in its aftermath.

 

The scientific evidence clearly supports this statement. For an existentialist, this statement is reason to celebrate! But not a reason to ignore our fear. Because it is our fear, once again, when channeled appropriately as detailed by the CDC, that will guide us to protect ourselves and others. And that will lead us out of this mess as quickly as possible!

Keep in mind that while fear has received much of the early attention as COVID descends upon us in New York, and the U.S. in general, I believe sadness will be the one that needs to be dealt with over a longer course of time. That is, as we feel more safe and less vulnerable (e.g., as the curve flattens), we will still need to engage in many behaviors that will be more likely to trigger depression (e.g., social distancing, social withdrawal, not going to work, lack of pleasurable group social activities). Although that is perhaps not immediately salient as I write this on April 5, 2020, I do believe sadness/depression will replace the national mood of fear.

Below we will cover some of the triggers for fear, unhelpful responses, and solutions.

With regard to fear, I’ve tried to paint a different picture of our vulnerability above. Hopefully, this will provide a new lens to view the nature of this threat. But unfortunately, there is something working against us, and more than anything, in my opinion, it is fueling our fear.

Take Control of the Input that Fuels Fears: Reduce Media Consumption

Our most important suggestion to reduce fear and psychological distress in general: Reduce total media consumption (television, social media, print media) to a maximum of one hour per day.

Do not watch any television news. Zero if possible.

Proceed with extreme caution with following social media postings about COVID.

Proceed with extreme caution with the print (including internet) media but read enough to stay informed.

See this article for how media use increased anxiety significantly in China during the COVID crisis..

PS:Media use, and social media use in particular, has been shown to be bad for mental health in general.So this is not a surprise.

You can spend your one hour per day on the following to keep informed:
Johns Hopkins Coronavirus Resource CenterNew York Times Coronavirus Section: Latest Updates

See below for details about this and how it distorts our risk perception.

Trigger: 

The media– all of it (television, newspapers, social media) to varying degrees manipulates our risk perception in the worst way: It increases our sense of vulnerability. There is an old saying in the media: If it bleeds, it leads, a statement that is used to describe the relative attention the media plays to articlesThe idea is the more horrific the story (e.g., the more frightening), the more likely it will be the headline and receive a lot of timeor space in the way the media source covers it. Why? Because the more horrific the story the more people watch, buy the newspaper, click on links, retweet postings, etc.With respect to the present issue, the best I can come up with related to If it bleeds it leads is: If it doesn’t cause fright, it won’t be on tonight!

Are we all sadists looking for these stories? Not really. But once again, thanks to evolution, our mind is built to pay attention to threats (those that did not deal with them well and were eliminated from the gene pool). So the media just gives us what we want, so to speak, or at least what our minds want.They just want to make money and need eyes on their product. If people would follow positive stories in the same way as horrific stories, that’s what they would give us. But do you think a major news organization is going to devote a full day to coverage of someone engaging in charity work? No. But they will spend a whole day and more on a school shooting. In fact, they will cover 5 minutes of actual news (real information) about a school shooting for a full day as a story emerges– so you can be watching for hours and learn nothing new. Newspapers, internet print media, social media all work in the same way. Activity picks up when something bad is happening.

Here is the real problem: you may have known the above informationalready. But if you watch, follow, etc. it still affects you. I remember reading a book in college, Captains of Consciousness (1976) by S. Ewen. The main idea of this book is that advertising co-opts our consciousness and leads us to be materialistic (e.g., want and buy their products). I doubt Ewen would have ever anticipated the level of media that exists now—there are more media devices in the phone in your pocket than existed in an entire person’s home in the 70s—but I think his title, and premise, applies now. The media are captains of our consciousness– beyond advertising. It shapes what we believe in the most fundamental ways (there is substantial literature on this, but I do not want to digress, so trust this statement for now).

So what does this have to do with fear in general, and more specifically COVID? The coverage is 24/7 -- with the most horrific scenes (people dying on ventilators, overfilled morgues, stories of the sickest patients, etc). And of course our eyes are glued on that (take a look at the front page of your newspaper whether it be in print or online and see if I am correct). There are not stories interviewing tens of thousands of people who had no or mild symptoms—overwhelmingly the typical course of COVID—or even people that were fairly sick. Only the most extreme cases are covered.

Develop Accurate Risk Perception:

Examine The Logic of Your Thoughts and Beliefs

So what does the above do to our thinking, or more specifically, the way we process information and form our beliefs and attitudes about things.It makes you feel more vulnerable, in almost all of our cases out of proportion to the actual danger it poses to us.

Let’s follow up to the discussion above about risk perception which is a crucial concept related to the experience offear.It is actually quite simple: for the most part, the more dangerous you believesomething is,the more fear you experience.A growling dog creates more anxiety than a dog wagging its tail when it approaches you while you are for a walk.

Now this sounds very simple - almost like a computer program: Actual risk = level of fear.But it’s not so simple in humans.People have a somewhat buggy risk perception system in their brain.Our brain does not work like a computer at all, where objective data creates objective responses.

Have you ever texted while driving (73% of drivers reported they have)?Or drove 10 miles over the speed limit on a highway (89% of drivers reported they have)?In either case you are significantly increasing your chance of dying.And I am assuming that I am not informing you for the first time that your demise will eventually come -- hopefully not until you live a good, long life.

So think about it, is the text you are sending (increases the risk of crashing by 23 times) or the extra speed you are adding to your trip to save a few minutes (10 mph increases doubles your chance of dying in a car accident) worth it? Absolutely not in almost all cases.But we do it nevertheless -- on a large scale -- so much so we need police enforcement to try to reign it in.

Let’s take one more example.The current estimate of deaths from coronavirus in the U.S. is somewhere between 100,000-200,000 (which is of course terrible and we should do all we can to prevent and minimize this number). But to put it into context, it is estimated that more than 600,000 people will die from heart disease in 2020. One of the things I have the most trouble with the media on is the “scoreboard” of new cases of coronavirus on deaths which is displayed on a continuous basis by most -- if not all (I haven’t checked) local and cable news stations.Imagine if the same was done for heart disease (approximately 1,644 deaths/day).It would definitely raise our fear level quite a bit in my opinion.

But the fact is, despite the significant risk of heart disease as the number one killer in the U.S., most people do not worry about it too much on a regular basis -- if they did they would be eating celery sticks rather than potato chips and walking 20,000 steps per day rather than watching television or sitting in front of a computer. These are proven ways to significantly lower your risks of dying from a heart attack.

My point here is not that we should not care about coronavirus -- we should care a lot -- especially since our behavior can significantly reduce the incidence of new cases and the number of deaths of vulnerable individuals.As I described above -- that is the best way to channel appropriate levels of fear -- to let it compel you to stick to the difficult preventive behaviors). That is a collective, worthy goal.And to date (4/11/2020) in New York -- the modification of our behavior has in fact made a difference, as has been reported during the last several days!

But my point is that thanks to our buggy risk perception system we often do not see all threats objectively (see Ropeik’s book for a detailed explanation of this: How Risky Is It, Really? Why Our Fears Don't Always Match the Facts).Our risk perception is not actual risk = level of fear.It is much more subjective than that, spun in ways that defy the logic provided to us through evolution, which was designed for much more specific threats (predators, humans from other groups, etc.).

Coronavirus is a major threat.But like most threats, it is not the same for everyone.Of course, if someone is engaged in behaviors that significantly increase their likelihood of exposure (e.g., nurses, physicians, cashiers, first responders, etc.) then yes, the risk is greater of contracting coronavirus.And all of these individuals deserve our enormous gratitude for taking care of the rest of us in different ways, whether it be healing those who are sick, or making sure we can access food at the supermarket.Let’s not forget their bravery and commitment to service when the pandemic has passed.Unfortunately that is a common human tendency as well, one which we should not be proud of.

But the fact is - as an imminent threat to our existence -- fortunately for most of us even if we get sick with coronavirus we will survive.That is overwhelmingly the case.

Examples of the way the media distorts our thinking - and distorts our risk perception in particular:

Black and White Thinking: You see COVID in extremes: either you do not get it, or you end up on a ventilator. There is no middle ground or shades of grey.

Selective Attention: You only focus on the worst cases. If a celebrity announces they are COVID positive but only have mild or no symptoms, you forget about him or her. But if a celebrity is very ill, that is the example that sticks in your brain.

Catastrophizing: You only focus on the worst outcome and personalize it: you are going to end up hospitalized with COVID just because that is a possibility. You lose the distinction between possibility (anything is possible) and probability (what is likely to happen based upon knowledge of base rates).

Emotional Reasoning: Because you feel anxious about this highly contagious virus that everyone else is anxious about, you assume it is dangerous– just because you feel it is. Watching media that displays cases and deaths like a scoreboard continues to exaggerate your anxiety further even though proportionally these are relatively low numbers compared to the entire population.

Unhelpful Reaction:

You believe you need to know as much about COVID as possible so you watch hours of television news, read newspapers, and follow social media articles with a bias towards the worst case scenarios as mentioned above. Basically, you are continuing to feed these irrational extreme beliefs and the cycle above continues.

Solution:

Stimulus Control: Limit media consumption to 1 hour maximum per day. Select reliable resources such as those contained in the suggestion box at the beginning of this section. Many people react to this by saying they can’t do it because they must keep informed. I have them write down each day what they learned that is new. Other than the numbers of people affected (which is not very useful since we are behaving as though the problem is endemic– that is, as though everyone has it), there is no other information they can report on. So overconsuming media just for this purpose serves no role.

Cognitive: Our thoughts have a huge impact upon producing and reducing all of our moods and emotions (see cognition and emotion).Correct the way you read the news with an eye on the distortions described immediately above. Once you realize you are processing information in a selective, biased way, it should allow you to see things more accurately and less anxiety provoking.In the world of clinical psychology, this is known as cognitive reappraisal -- one of the most effective ways demonstrated through science to modify emotions (see this link for a brief article on learning to do cognitive reappraisal). Want to read more about working with your potentially distorted or exaggerated thoughts related to the pandemic -- see the following link.

So, what is accurate risk perception?Remain fearful to some degree - there IS a danger lurking out there - keep focused on the right behaviors even though it is difficult.But being in a state of continuous panic as though a tiger is around the corner will only lead to suffering with no purpose. Once you have done what you can, you need to try to keep the real risk in mind (which as noted above may differ for different individuals - but most are not considered “vulnerable” to dying from coronavirus - just do the math of number of deaths/total population of U.S.).This is a perfect lead into my next section - which is that once you modify your risk perception you will find that although your level of panic may be less - you still do not have the certainty of safety that you want. And that can further increase your fear.Let’s talk about it in the next section on existential acceptance.

PS: Risk perception boot camp for those interested in more.View David Heymann’s (world renowned infectious disease expert) TED talkon this topic. Abstract: The covid19 outbreak is consuming media outlets, and there is so much misinformation and misunderstanding. This talk answers basic, straightforward information. As you know, wefeel that panic and hoarding are caused by fear of the unknown and media hype; this talk is an excellent antidote.What happens if you get infected with the coronavirus? Who's most at risk? How can you protect yourself? Public health expert David Heymann, who led the global response to the SARS outbreak in 2003, shares the latest findings about COVID-19 and what the future may hold.

Existential Acceptance
(sounds more complicated than it is)

You may have never thought much about it before the COVID crisis, but much of your behavior is geared towards staying alive even before the current circumstances.You eat, drink, look both ways when crossing the street,fasten your seatbelt when you get in the car, avoid walking alone in unsafe neighborhoods, get preventative diagnostic medical tests, etc..This makes sense -- if evolution designed our mind for anything it’s to guide us to survive.In the game of evolution, if you do not survive you cannot accomplish anything else.

That’s true of every species.We’re all built to survive.This skill is not unique.However, humans have a unique quality that no other species has:We know we are going to die at some point. While existential psychologists and philosophers see this as a shadow of our enormous intelligence, and it provides significant advantages such as allowing us to dominate the planet -- one thing it does not provide is psychological comfort.Ignorance is bliss in this arena. The squirrel at the park knows how to survive very well -- and how to deal with threats to its survival-- but it does not know it will eventually die -- so it only experiences fear when it is imminently threatened.Humans on the other hand have an uncanny ability to worry about abstract, potential threats to their well-being (as reflected in our art as we regularly produce and regularly create movies with this as the central theme).It is a compelling topic!

Unfortunately, knowing about our demise leads us to wanting certainty about our ability to protect ourselves from potential misfortune.And there is the problem:The fact is, there is no certainty that you will live beyond this moment.The probability for most of us is that we will be here tomorrow -- almost 100% certain if we are here today and not seriously ill.But since it is possible that something can happen at any moment -- it is not a full 100%.

Keep the following points in mind and try to embrace them. They are true whether you want to accept them or not:

(1)We can never be 100% certain that nothing will happen to us at any point in the future starting with now.

(2) We take risks every day living our lives -- and there is no alternative -- very few of us would want to live in a bubble to maximize our safety and give up our lifestyle.

(3) The best we can do is manage risks, not eliminate them fully.

(4) Humans as a species are extraordinarily successful at surviving - especially in modern

industrialized countries.In the U.S. an overwhelming majority of people survive through the age

of 75 -- and increasing numbers survive well beyond that -- in fact the elderly in our population are

the fastest growing segment (80 and over).

Let’s look at some concrete examples. You fasten your seatbelt to protect yourself from dying in a car accident -- and that is statistically accurate.But it does not guarantee that you will not die in an accident.The only other choice would be to never get in a car but then you would not be living your life the way you want to.And thanks to seatbelts a greater number of people survive. Likewise, you can limit your travel into relatively safe places like movie theaters, but it does not mean an active shooter may not appear and threaten your survival. The alternative would be to never go out in public places which is certainly not a way to have a satisfying lifestyle.

Trigger:

Hypervigilance to specific types of threat information.Threats that receive a large amount of attention (e.g., school shootings, plane crashes) in various forms of media increase our existential awareness that this CAN happen to us. Certainly coronavirus falls into this category right now. This wake-up call to our awareness of the possibility of dying at any moment erodes our ability to engage in the denial of death and increases our feeling of vulnerability, especially to the object that is now the focus, even when the probability has not changed (e.g., a school shooting in Colorado has little bearing on the risk of this happening in New York, a plane crash anywhere in the U.S. has no impact upon the likelihood of the next plane crash.But people react as though it does).

Unhelpful Reaction:

Not only do we overly focus on the threat, but we search for reassurance, trying to find certainty that it will not happen to us.And for example, while we can find information about the probability that we may die from COVID, we will never find 100% certainty, because there are always exceptions even to low probability risks (e.g. it is possible that you will roll a dice 10 times and come up with same number each time, but it’s not very likely.No one can guarantee you 100% that it will not happen. It is possible, just highly improbable.You would probably be willing to risk a lot of money and bet on the notion that you will NOT roll a dice 10 times and come up with the same number each time.I certainly would!).

Solution: 

We must ultimately confront death to move forward with some level of comfort. We must work towards accepting that we risk our survival every day so that we can live the life we want to live. The best way to do this is to (1) acknowledge (accept) this reality, (2) control what you can to protect yourself (wear a mask while you are shopping, eat foods to boost your immune system, wash your hands, etc), and (3) move forward because if you are waiting to eliminate risk you will be stuck in a winless battle.

Indeed, as stated by Leo Tolstoy: Man cannot possess anything as long as he fears death. But to him who does not fear it, everything belongs.Translation:If you are worrying much of the time about dying, you are not creating and living a good life.Consider the following metaphor: When you go on vacation, if you focus the whole time on the fact that it will end, you will miss the experience itself (yes someday we will be back to travelling!).

What does this mean in the current COVID landscape? Knowledge is power.Stay informed.Practice protective behaviors as outlined by the CDC.But then, live your life -- even the muted version that exists right now as a result of COVID.There are many suggestions immediately below of how to create more living and meaning in this new, but fortunately temporary, lifestyle.Keep in mind, as I wrote in the opening section:COVID-19 will pass, humankind will survive, almost all of us will still be alive in its aftermath.Do not deny the possibility of death -- just do your best to attend to managing risk and focus on realistic probabilities.

Sadness and Depression

Sadness (depression) is an emotional response that is primarily triggered by the occurrence of personal losses that are important to an individual and cannot easily be restored (e.g., loss of a job, failing a test) or in some instances are not able to be restored (irrevocable losses). These can be tangible losses, such as the death of a loved one or the break-up of a relationship, and they can be more abstract losses, such as failing to live up to your own expectations, or failing to have the marriage that you expected.

From an evolutionary standpoint, the emotion of sadness makes perfect sense.When you lose something important that enhances your survival and well-being-- the painful experience of sadness motivates you to try to restore it.For example, with regard to the examples provided above: mobilized to find another job, a new relationship, or to do better on an exam-- in order to feel better (relief from sadness is a powerful motivator because sadness is so unpleasant). So like fear, the negative feeling of sadness, when appropriately channeled, can motivate an individual to engage in useful behavior that helps restore (or replace) the loss.

However, the most severe form of sadness occurs when a person experiences -- or perceives an experience -- where the loss cannot be undone.The classic example of this is bereavement - the death of a loved one -- where the loss is clearly irrevocable. However, it can also apply to a situation where a person believes (perceives) the loss is irrevocable -- for example, a person who has a break-up of a relationship and truly believes he/she will NEVER find anyone else.

With regard to the pandemic, what most of us are feeling are the effects of transient losses, but nevertheless, the sadness motivates us to try to “recover” the loss.  For example, if you miss seeing your parents, children, grandchildren, friends, etc. during this period of social distancing and quarantine -- the fact that you experience sadness is in fact because they are important to you.   The sadness is a mirror of important losses.  If you did not feel sad when you were not seeing loved ones who are important to you it would not make sense.  As hard as it is, what is important to keep in mind is that eventually -- perhaps sooner than later at this point -- you will “restore” these losses and go back to your day to day life.  I recommend you try to see it as an injury you are rehabilitating from.  It is painful as you go through it, and you are not “yourself” when injured, but you know eventually that pain is going to go away and you will be yourself again.

When irrevocable loss occurs, or is perceived or believed to have occurred, the individual may go into a period of “resignation”-- an evolved response to preserve energy when using effort would be futile (the loss is irrevocable so the person needs to adjust to this).  (see below for dealing bereavement as well as other types of losses).   However, when the resignation is triggered by PERCEPTIONS of irrevocable losses (e.g., the world is never going to survive this pandemic, there is no way to fix the economy– it will be bad forever, I’ll never see my friends again), it can lead to a state of resignation characterized by hopelessness and helplessness.  

These processes, as will be described below, end up contributing to and maintaining the intense sadness, and people end up in a downward spiral that is hard to escape from. When helping people manage their sadness, we try to build their resilience, their ability to increase their behavior to access what is important to them. The strategies below are focused on this idea.

Hopelessness:
This is Never Going to Get Better 

Trigger:

All of the bad news, especially those which are predictions about the future being bleak because of the impact of the pandemic.

Unhelpful Reaction: 

In the spirit of “staying informed” many people are following the COVID news (online, newspaper, television) on an almost continuous basis (see NY Times article demonstrating huge increase in news viewing), and this erodes any reasonable ability to be hopeful even for the most optimistic individuals.People believe they are doing something good, but in fact learning almost nothing new on a daily basis.So the information and images just become emotional upsetting: fear, sadness, hopelessness.

Following/watching the media more and more, hoping for some good news, but hearing only more bad news will lead to feeling more hopeless about the future and support the idea that things are never going to get better, leading to feeling increasingly resigned and depressed.

Solution:

Stimulus Control: Stop following so much media. This just continues to trigger these feelings of hopelessness. Remember, the media wants eyes on their material. As a result, they tend to present the most dramatic, negatively slanted information because that is more likely to trigger emotions and thus hold your attention or lead you to click on an internet link.

Reappraise: Yes, the news is bad. That’s realistic. That being said, there have certainly been other bad times including wars, terrorism,financial collapses/recessions/depressions, and even epidemics and pandemics. Humans are resilient. We evolved in the harshest conditions and now for the most part control our environment unlike any other species. So while things are bad, it’s not hopeless. The problem with hopelessness is it leads people to think something like “What’s the point of trying!?” and resign themselves to the circumstance.The situationnot getting better becomes a self-fulfilling prophecy.Just knowing that there will eventually be light at the end of the tunnel—there has always been—can change one’s whole perspective. Remember, once you lose hope you lose everything.

Helplessness:
There is Nothing I Can Do To Make a Difference

Trigger:

Helplessness is related to hopelessness (see above). If you feel hopeless, or believe a situation will not change, that means there is nothing that can be done --you are helpless. It feels like you just jumped in the pool in deep water but you do not know how to swim.

Unhelpful Reaction:

When people feel helpless, they believe there is nothing they can do to change their undesirable circumstances. They are convinced of the hopeless feelings about a situation. “The economy is so bad, and there is nothing I can do to improve it.” Or, “This virus is spreading so rapidly– there is nothing I can do to avoid it, so why bother trying.”The helplessness can actually cause the very thing you do not want to happen because you stop trying-- this is known as a self-fulfilling prophecy.You behave as though something is true -- and it happens because of the way you behaved (e.g., if you don’t study for an exam because you BELIEVE you will fail -- you will in fact fail -- because you did not study).

Solution: 

Do what you can that is in the right direction, even if in the most minimal way. I always liked the recycling motto: Think globally, act locally. For example, you alone are not going to fix the economy even if you are a billionaire. But if you can afford to, can you order dinner at a local restaurant that is now offering takeout or delivery? If so, and if many others did so, it may mean keeping that restaurant in business and those individuals employed, and that will allow them to do something similar. What else might you be able to do in a small way that would make a difference (see below: Loss of Meaning) for suggestions.

What often happens with helplessness is people start thinking in an all or nothing way. “If I can’t do it all, then why do anything? If I can’t clean out the whole closet, what is the point of just doing the top shelf?” Instead, try to connect the dots: think globally (big picture), act locally (what can you do that might make even the tiniest difference, but if everyone did so, the scale of impact would be enormous).By connecting the dots you can feel empowered– the opposite of helplessness; “I can buy dinner tonight and contribute to reviving the economy in my own way!” If 100 million others did this it would make an enormous difference, but if everyone acts as though they are helpless then we’re truly sunk! The self-fulfilling prophecy occurs because we BEHAVE as though something is true -- whether or not it is really true! Exhibit A: Toilet paper shortages (people believed there was going to be a shortage and thus bought more than even -- that created the shortage -- not an overall decrease in its availability).

As another example, “I can reduce my food shopping to twice a week.” While you still expose yourself to some risk of contracting the virus, and that may be inevitable because you need to buy food from a supermarket, you are not helpless in reducing your risk by decreasing your exposures as a result of decreasing shopping. Once again, it is not an all or nothing game here. If you are behaving helplessly—“What’s the point, I’m going to get it anyway”—and therefore do not change your behavior, you increase the likelihood of contracting the virus.Do what you can that is a step in the right direction and you will gain momentum moving out of the helplessness trap.

Non bereavement related loss (e.g., activities, work, etc. disrupted)

Trigger: 

The ways in which we once lived our normal day to day lives is lost, and the world is experiencing a collective loss. Social distancing has limited the usual socializing with friends and family, the routine of interacting with coworkers at work, or the hugs of a grandparent. Our day to day routines have drastically changed, and in cases of job loss, some normal day to day routines and sources of income have been completely diminished as well. Playing sports with a group or working out at a gym, once sources of self-care and release, are also lost. We’ve lost normalcy, sense of safety, social connection, personal freedom, and economic stability, to name just a few of the things we’ve lost during the COVID-19 crisis. We are missing the life we had a few weeks ago, and even though we’ll most likely have it again in the future, it's normal to still miss it.

Unhelpful reaction: 

On top of increased fear and vulnerability during the crisis, we may feel sad and down because we have lost our accustomed way of life. One can even say that “our normal way of living” has died, and just like a loss of a loved one, you may be experiencing grief. While it's often common to think of “bereavement” as only related to the death of a loved one (which is also a possibility during this pandemic), grief is also a normal reaction to other types of loss, including a loss of a job, loss of a sense of safety, or loss of your Saturday nights with your friends.

While we are grieving a loss, we go through specific stages of grief, and the order and intensity of these stages can vary person to person. Denial or avoidance may play out in denying that the virus will affect you or that it's a big deal. You may even want to avoid talking about the pandemic all together. In anger, you may get angry at the government for the social distancing and stay at home protocols or angry at people who aren’t taking those protocols seriously. Bargaining is also a stage in grief, “maybe if I take social distancing seriously for the next week, things will go back to normal?!” or “I’ll make sure I’m keeping 6ft apart from people but still go to this party.” Sadness is also a stage of grief, and you may have the blues around the losses you’ve experienced and not knowing when things will return back to normal. 

Solution: 

The last stage of grief is acceptance, which is where we accept what is happening in our lives and figure out ways to cope and move on during this crisis. All of the above stages of grief are normal reactions to what is happening right now in our lives. While these reactions while grieving are common, there are research backed ways to help move forward and work through our grief.

Name your grief. In a journal or on a piece of paper, write down your losses (job, social life, thrift shopping, tag football, a sense of identity). Then write down the kinds of feelings and emotions that come up when thinking about those losses. Think back to another time where you’ve felt that emotion- what helped you cope with it? Try thinking of some coping strategies that can and will help you when you feel down, angry or anxious.

Claim your grief. Look at each loss you wrote down on that list above and brainstorm ways to move forward in that area. If you're grieving the loss of your social life, you can plan out weekly trivia nights over Zoom that can replace the in person game nights you had going with your friends. Your tag football team? - organize at home workouts that your teammates can do collectively and remotely so you can train up for the next season. Some losses may feel impossible to claim, like losing a job for instance. Reading up on new innovations in your field while in quarantine can not only help you cope right now but it may also help you in the long run when you go back to your job or apply to other ones. Try to reproduce what you are missing from your own life.

(Physically distant) Social Support. It’s one of the best ways to cope with grief. Stay connected with family members, friends, and classmates through texts, calls, facetimes, or over Zoom! If you can hear the other person’s voice or see their face, that may help even more than just talking over text. Try scheduling weekly facetimes with a friend, while doing whatever friends do, like playing video games, blasting music with facemasks on, or just talking about what's going on and how we are feeling. It's important to remember that everyone is going through something during this crisis; and while each person may be at different stages of grief or having different responses to the crisis, your social supports may also need your social support! Being there for eachother during this time is not only important, but can also serve as great bonding time! Learn to play chess over Zoom with a friend, watch a Netflix movie at the same time, make funny Tik Tok videos together. Here are some other ideas for techy social distancing.

Social Disconnection/Loneliness: Feeling Particularly Isolated Lately?

Trigger: 

Global quarantine and social distancing regulations have resulted in significantly limited social contact with friends, family, colleagues, and human beings in general.

Unhelpful reaction: 

Social and physical resignation (e.g., not reaching out and/or not responding to others; staying inside) and getting stuck to upsetting thoughts that may arise as a result of limited social contact (e.g., “I’m alone and will be for a while”). -- All of which typically exacerbate feelings of loneliness even more.

Solution:

Validate your feelings. We are social creatures by nature, and thus, it makes complete sense that limited social contact can be extremely upsetting for many individuals. Cancelled plans with loved ones in general can result in feelings of sadness/loneliness, so of course coping with social distancing regulations during a global crisis for an unknown period of time is distressing!!

Tweak your thoughts. Right off the bat it might be helpful to re-label the current guidelines from “social distancing” to “physical distancing.” Just because we need to be physically distant for now, doesn’t mean we have to limit our social connections. Try to change how you’re thinking about the isolating regulations – we need to remember that we are separated now, so we can be together later. Upsetting thoughts are typically the fuel for upsetting emotions - Notice when you’re experiencing upsetting thoughts and try not to get stuck to them (we want your mind to resemble a Teflon pan!!) Shift your attention away from these thoughts and try to think of this as a time to focus on, build, and/or create meaningful relationships. Is there a meaningful and healthy relationship in your life that has been neglected? Rekindle it.

Take action NOW and get creative. Zoom video chats; facetime; Netflix movie parties (you can now watch movies and video chat with others at the same time!!); handwritten letters; video games; virtual exercise classes; texting; online forums; online support groups; virtual game nights; virtual paint nights; virtual book clubs; hugging a stuffed animal; purchasing long distance friendship lamps (you and a loved one can purchase lamps and when one is touched, the other emits the same glow); yelling across the street to your neighbors. Although it is normal to have urges to resign and isolate during upsetting times, it’s not helpful to do so. This is such an important time to connect with others. We agree that it is of course more pleasurable to connect in-person, but right now we have to try and focus on how we can make the best of the situation we are in. When you were younger (or recently, no judgments here!), did you ever wave to passengers of other cars while driving around? If so, remember how exciting it was when someone simply smiled and/or waved back?! This shows how important simply feeling acknowledged by someone else is for our well-being. If you’re feeling lonely and isolated, imagine how nice it might be for someone to smile or wave at you, even if it’s six feet away. Give yourself that opportunity – in addition to building your virtual world, get outside at least for a little bit each day (while following state regulations). Don’t wait. Take action now – get creative and get connected. Most importantly, remember that the National Suicide Prevention Lifelife is there for you 24/7. Call 1-800-273-8255 or go to https://suicidepreventionlifeline.org/chat/ and chat online with someone today.

Loss of Reinforcement: Sources of Pleasure

Trigger: 

Throughout our lives we get different reinforcers or positive responses to our behaviors that make us want to do more things. For example, people go to work every day, to get paid or I may visit a restaurant often because the food tastes good. In these cases, money and tasty food are the reinforcers and working and going to the restaurant is the behavior. These days, we might have lost a lot of our reinforcers, with people losing their income, restaurants closing and not being able to interact socially with people.

Unhelpful Reaction:

It makes a lot of sense then that if we don’t have these reinforcers, we will result to decreasing our behaviors and not do things i.e. socially isolating, which is different from distancing or not seek out or change our lives to find other reinforcers such as not eating anything different for days because you can’t go out to a restaurant.

Solution:

These are totally normal reactions to this loss of reinforcement. What you can do is find creative ways to keep yourself motivated and increase the behaviors you find helpful. You can organize social gatherings online to still get that social reinforcer or try to recreate your favorite meals at home to feel that restaurant experience. These will also help keep your mood elevated and the experience will be positive, so you will be likely to do it again and break the routine or behaviors that might not be helpful for your mental health.

Once you understand how reinforcers work, you can also use it to help motivate you to do the things that you may not enjoy doing such as washing your hands regularly or wearing a mask. Set up a reward system for yourself so that washing your hands becomes a positive activity or is associated with something positive at the end. This is especially helpful with children by giving labeled praises such as “great job washing your hands, I’m so proud of you!” every time they do it (works for your spouses too!).

Loss of Meaning

Trigger:

Many people are no longer actively involved in careers or roles that bring a sense of meaning to our daily lives.

Unhelpful Reaction:

It can be tempting for people to sleep in, skip the normal daily shower, and spend the whole day on the couch watching TV, wearing pajamas. Our days can start to feel meaningless and we can start to feel useless.

Solution:

It’s OK to mourn the loss of your old role. Whether it was going to work, watching the grandchildren, or something else, that role brought you a sense of meaning. However, while it’s true our lives have changed significantly, that does not mean our days are meaningless. Rather than getting caught up in what we can’t control, focus on aspects of your situation that are in your control.

One possible solution is to use this extra time to re-engage with hobbies that you may not have had time for previously. Alternatively, you could learn a new skill or engage in a new practice. Our perspective is different when we are in the moment compared to when we look back at the moment. Think about how things might be different in the future -- how can you spend your time now purposefully? Journaling about your experiences might be viewed as a way to tell your children or grandchildren about this historic moment.

Consider small actions like making a telephone call to someone who lives alone, or sending a text message to a friend you haven’t kept in touch with for a while. These simple gestures might brighten someone’s day, decrease their loneliness, and be tremendously meaningful. Or, if you wish to contribute to the crisis more directly, it could be a good time to dust off the sewing machine you’ve been too busy to use and sew a fabric mask that can be given to a friend or family member. There is also an urgent need to donate blood, which is an excellent way to contribute to those in need.

Rumination: Thinking About Something Over and Over Again?

Trigger:

The perpetual uncertainty and lack of a hard end date of the global pandemic. We dwell on headlines that are written to scare us and obsess over statistics that only tell us one side of the story.

Unhelpful Reaction:

Our minds, understandably, go to the worst case scenarios - “I will get sick” or “What if my loved ones are hospitalized?” or “This will never end.” We replay these negative thoughts over and over again in our minds which in turn exacerbates our emotional distress. We may even think that our increased attention to COVID is helping us and perhaps we will eventually arrive at a solution to a global crisis. However, in reality this increased attention only serves to deepen our sense of distress, agitation, or sadness.

Solution:

The bottom line is – there is no ‘holy grail’ solution to the current problem facing our society, its outcome is largely out of any one person's hands and, our increased repetitive negative thinking about it ultimately hurts us more than it helps us. And even though we might logically “know” that these things are true, we may find ourselves stuck in a cycle of rumination anyway. So what can you do?

First, increase your awareness of when you are (versus are not) ruminating by asking yourself -– “Am I ruminating right now?” Increasing our awareness of our own thoughts can be challenging but is extremely helpful because we can then start to identify specific external cues (e.g., endlessly reading/watching the news, talking with someone who’s a “catastrophizer”), emotional states (e.g., loneliness, boredom), locations or times of day (e.g. alone in your home office or late at night) when you are more likely to engage in ruminative thinking.

Next, do your best to remove or avoid these cues. For example, if you find yourself ruminating more after checking the news for the 3rd time that day, maybe begin limiting your news intake to about 10-15 minutes a day. Or if often you find yourself ruminating after spending multiple hours alone in your home office (or other isolated place in the house), then perhaps it would be helpful to build in some “socializing” breaks throughout your work day, either in person with whoever you are cohabitating with or virtually with friends or relatives. But, if your socializing break is virtual; make sure that you’re changing up your physical location in the house during the call or facetime in order to reinforce that the call is a break versus a meeting.

 

Resilience and Posttraumatic Growth

Many of us are thinking about how we’ll change both during and after the pandemic. In light of this, it can be highly beneficial to think not only about dysfunctional responses, but also about healthy responses. After all, we’re resilient beings who are hardwired to adapt to changing conditions of survival, and now is no exception.

As a result, highly stressful life events are often associated with periods of grief and loss as well as with hopeful periods of readjustment and healing. For instance, most individuals report experiencing at least one positive change after a potentially traumatic event with the most frequently reported positive change being developing stronger personal relationships.

Two possible healthy response patterns that we might observe are: resilience, defined as maintaining some baseline functioning in the context of disruption (e.g., continuing to show up for work requirements in the new virtual environment), and posttraumatic growth (PTG), defined as improving some baseline functioning in the context of disruption (e.g., finding a new way to approach work itself in the new virtual environment).

PTG does not result from a highly stressful life event itself, but rather from our struggle with a “new reality.” This is because the abrupt, and in the case of the pandemic, ongoing change generates new thinking and functioning patterns. While immersed in daily struggles during the pandemic, we may not view ourselves as being resilient or searching for growth, but instead we may simply be trying to survive physically and psychologically. Therefore, PTG may come as a surprise to some of us during or after.

PTG can manifest in a variety of ways, including:

These PTG processes can be monitored and facilitated while also attending to symptom reduction. The tips below deal with attitudes about coping with disruption.

Trigger:

The pandemic is profoundly disrupting our lives from basic everyday functioning to larger sociopolitical and existential questions.

Unhelpful Reaction 1: 

Expecting that we will purely struggle during this disruption.

Solution 1:

During the pandemic, we may experience periods of feeling disturbed and down; this is perfectly reasonable and normal to expect. However, expecting only to feel this way doesn’t allow for the possibility of even momentary health and wellness. By only expecting negative outcomes, we’re creating an unhelpful self-fulfilling prophecy (if we think it, then we’ll become it). With a curious mindset, we can be open to the possibilities of self-maintenance and growth. This may be tricky to buy into based on how we may have responded to difficult events in the past. However, coping with adversity in the past often better prepares us for our next challenges. This may also be tricky to buy into since we tend to overestimate the stressfulness of situations, and underestimate our abilities to cope. However, we may surprise ourselves with how strong and flexible we can actually be!

Also, we may be able to tune into things that we don't normally get to because of the significant disruption to our daily lives. For instance, now that many of us are working from home, we may be repurposing commuting time in new, valuable ways. In trying to stay active and get fresh air, we may realize that taking daily walks outside (safely), something that we may have not done in the past, makes us feel healthier and happier. This new habit may seem like a small change, but it may become a focal point in our ‘new’ daily life; it may enhance our wellbeing and our connection with nature in the short term, and even improve our mental and physical fitness in the long term. As a result of the relaxed pressure and time drain of commuting, we may also realize how virtually connected we can be by using that time to call others, we may nourish ourselves with more home cooking and sleep, and we may reprioritize our hobbies/interests.

Additionally, focusing on how much more we’ll appreciate life’s day to day activities after being restricted and confined may also help us anticipate and look forward to future positive outcomes.

Unhelpful Reaction 2:

Demanding that we thrive during this disruption.

Solution 2:

 See the section titled “Unrealistic Expectations.” While resilience and growth are possible, expecting this at all times, under all circumstances, is unreasonable. There’s no “right” way to cope with the pandemic, and growth isn’t essential to our survival. Cultivating our own coping resources (personal strength) and capitalizing on when we feel well is a more realistic and sustainable mission. A helpful prompt along these lines is, given this disruption, how can I make things work for me? There will be chances to notice growth both during the unfolding and after the pandemic, and there may be more ability to grow as we continue to get adjusted. In the meantime, be wary of social media posts as these compare our inner selves to others outer selves and use positive filters with regard to the appearance of coping. Focus on what works the best for you since it’s a marathon, not a sprint!

Unhelpful Reaction 3:

Feeling guilty about experiencing resilience or growth during this disruption. 

Solution 3:

Aside from differences in our mindsets, there are also systemic inequities with regard to the privilege to be growth-focused versus survival-focused during the pandemic. If we’re currently healthy, plugged into a support system, and able to work remotely, then we may be fortunate to have more bandwidth than others who are more vulnerable. However, we all have an inner resilience that we can draw from, and we can all offer compassion to ourselves and to others. Experiencing some degree of health does not mean that one has done anything wrong, even when others may be suffering. It’s important to keep in mind that it wouldn’t be helpful to others if one were doing “worse.” In fact, by doing “well,” one gains options of how one may be able to share resources with others, whether these resources are psychological, occupational, etc. While not feeling ashamed of one’s own wellbeing, it’s also important to be sensitive to others as each of us is having a unique experience during this stressful time.

Gratitude: An Antidote to Depressive Thinking

Trigger:

By nature, humans operate with a negativity bias. That is, we tend to focus more on the negative (what we don’t have or what we’ve lost), rather than the positive (what we do have or what we’ve gained). In our pandemic world, nearly everything is a trigger for negativity: articles have been written about mourning the lives we had prior to the coronavirus and quarantine takeover, the news is telling us bleak statistics, and we spend a lot of our attention thinking about all of our worries and the restrictions we’re stuck living with. It’s easy to get sucked down the rabbit hole thinking about all of our limitations, concerns, and the seemingly endless uncertainty.

Unhelpful Reaction: 

Dwelling on the many things that have been negativity impacted by the pandemic. Worrying about potential future problems by coming up with a plethora of ‘what if’ questions that have no answer and leave us feeling even more helpless, anxious, and upset (e.g., what if I never find a job again? What if I can’t get together with people for months? etc.).

Solution:

Practicing gratitude is one way to help lessen the negativity bias. Right now, there are a lot of painful, difficult things in the world that are natural to think about, whether it’s health worries, financial concerns, loneliness, etc. By creating a space for gratitude, we’re working to counter our negativity bias and spread some of our energy and attention to more positive things. Maybe we think, what is there to be thankful for when we are literally in the midst of a quarantining, pandemic world?

For building gratitude in challenging circumstances, I like to think of the quote, “enjoy the little things, for one day you may look back and realize they were the big things”. Our lives are overwhelmingly made up of small, everyday moments. By deliberately looking for simple moments of pleasure each day, we become better able to experience gratitude for the things we have, focusing on contentment rather than loss. Maybe you’re thankful for how the cool pillow feels against your face in bed, or the sound of your dog’s gentle snores. If you’re having trouble thinking of something that you’re thankful for, try using your senses: any smell, touch, view, sound, taste that feels or felt pleasant? Paying attention to these positive moments – building gratitude - is a skill to be practiced, much like exercising a muscle time and time again in order to make it stronger. It may be difficult at first, but with time it will become far easier to identify and connect with these positive moments.

Management of Other Negative Moods that May Arise from COVID Crisis

Fear and sadness, while most prominent, are not the only distressing emotions likely to be triggered by the COVID crisis. We have observed and identified the triggers for others (e.g., guilt, shame) and provided coping strategies for those as well.

Guilt: Feeling like you’ve done something wrong or haven’t done enough

Trigger:

Many individuals may have discovered that they tested positive for COVID after they were in contact with several people and/or may have gotten loved ones sick. Many individuals are not currently able to actively help during this crisis (e.g., regulations urging us to stay at home). Many cannot see loved ones who might be hospitalized, in nursing homes/assisted living centers, and/or are living independently and thus, home alone. Additionally, many individuals might be feeling more fortunate than others who are struggling (e.g., some have had COVID and recovered while others have not recovered, some can afford delivery options for their groceries while others cannot, & some have remained employed while others have lost their jobs).

Unhelpful Reaction:

Self-blaming, punishing yourself (whether intentionally or not), and resigning. Getting stuck to “should” statements (e.g., “I should have stayed home when I knew I could have been asymptomatic”). Questioning “why” (e.g., “Why did my best friend lose her job, but I still have mine?). Continuously thinking about your privilege and/or your lack of ability to do more (e.g., help/visit others).

Solution:

We tend to feel guilty when we think we have done something wrong or think we aren’t doing enough. We also often take a lot more responsibility for negative outcomes than we have control over, leading to heightened and inaccurate levels of guilt. For example, even though we have no control over the current restrictions we are facing, we might feel like we are doing something wrong when we don’t visit loved ones. Notice when this might be happening, try to pinpoint what you’re feeling guilty about, and evaluate how much responsibility you have for it.

If you think you might have infected someone, maybe it would have been a better idea to stay home, even if you were feeling fine, because you can be COVID positive and asymptomatic. But, we are humans and we all make mistakes. So if you resonate with this example, think of it as a learning experience – take the appropriate amount of responsibility for your actions, make reparations for any harm you might have caused, and then forgive yourself. It’s not helpful to keep beating yourself up and focusing on mistakes you’ve made. Instead, “do” more than “think” - take action and get out of your head. If you may have come in contact with others while contagious - you can reach out to them and let them know (maybe even consider apologizing to them), spread the word about the importance of staying at home even if you’re feeling fine, and offer to help others that are sick (after you self-quarantine for 2 weeks). And if this example doesn’t resonate with you, use the same steps in a more general fashion.

If you’re finding yourself continuously thinking about others who are struggling, possibly asking yourself why you might be more privileged than them, &/or feeling badly about not doing more to help – it makes sense to have these thoughts, but it’s not helpful to fixate on them. Once again, if possible, take action (e.g., send a care package to someone struggling; order takeout from local restaurants; reach out to someone who might be lonely, make a donation) and if it’s not possible, that’s okay too.

Finally, remember – we often feel guilty because we are caring beings.

Shame

Trigger:

Shame is a very common emotion that all of us experience as human beings. All emotions have a purpose and shame is a very important one. Shame lets us work and function together as a society. If we do something that might be reputation-damaging or have a heavy cost to society, we will feel shame. It’s an unpleasant feeling so that we don’t do it again. Like all emotions, this helps us function in society and sometimes, it can be over-stimulated and make us do things that might be unhelpful. Testing positive for a transmittable disease can be very shame-inducing because of the costs it has to society, people’s reactions and the damage it can have to your reputation.

Unhelpful Reaction:

During a pandemic, people might feel a lot of shame, especially those who have symptoms or test positive. The shame can be exacerbated by the messages we receive from the media trying to pinpoint ‘who spread the virus’ in which areas, to racially profiling people who are thought to have it. This may make some of us not want to disclose to others around us or feel an intense amount of shame that is damaging to our self-esteem and mental health, which is not helpful. In some cases, people may also do the opposite of the directions such as not wearing a mask as they feel shame that they have the virus and wearing a mask signals to other people that they have it.

Solution:

The most important thing is all our emotions is to identify, accept and acknowledge them. As mentioned several times, these are all normal reactions and most of the time it is the judgements we have that make our emotions more intense. If you have tested positive or come from a group of people that might be discriminated against, tell yourself that it is okay to feel shame as your reputation might be damaged by telling people and then act in the opposite of what the shame might tell you to do. If you feel like not letting people who should know that you have tested positive, do the opposite and tell people. This signals to the brain that you are not feeling shame as you are acting in the opposite of it and the positive responses you might get from people will help build the case that you should actually be feeling happy or relieved about yourself. If you feel that this is too much to do, you can always still balance your emotion with the safety of others. If you don’t feel comfortable wearing a mask as people might think you have the virus, then try to stay at home as much as possible or keep your distance from people.

Another important thing to note is that what you do is not who you are. This helps with the effects that shame can have on your self-esteem. Our self-esteem is built on what things about ourselves create value or self-worth. This is typically based on how those things are measured to what is needed or valued by society. For example, if society values people who are funny and you make a lot of people laugh and think that you are funny, you might have high self-esteem. When we feel shame, it might decrease our self-esteem as shame is tied to how society views us and what it values. However, what you do or have is not who you are and the intense shame you are feeling because of this misperception can lower your self-esteem. One of the ways to deal with this is to untangle those two things. This can seem really difficult to do and you can engage in a few exercises to help untangle both those things. You can make a list on your phone or somewhere accessible, all the qualities you have as a person e.g. caring, funny, sarcastic. And then tell yourself, how does having a virus change those things? Does it make you more or less caring, funny, sarcastic? Probably not. This is a way to keep telling your brain that what you do or have, is not who you are. By engaging in the above activities of talking about the thing that brings you shame and seeing the positive response from people also helps bury that misconception that if you have the virus, you are now a bad person. It shows instead that you are a brave person who should be proud of the fact that you are taking steps to protect others, which is valuable to society.

Unrealistic Personal Expectations: It’s Definitely Time to Adjust Expectations

Trigger:

Media articles and social media postings revealing people who are maximizing the use of all the free time many now have (e.g., learning a language, writing a screenplay, cleaning out the entire house, exercising every day).

Unhelpful Reaction:

Judge yourself by this (unrealistic) standard and feel bad about yourself for not maximizing the use of your time. This will likely lead you to feel less-than others or like a “loser” for being unable to keep up. In response to this feeling, you might go about setting unrealistic goals for yourself (e.g., working out every day, cleaning the entire house in a day, cooking a new recipe every night, etc.) and then feeling even worse when you are unable to achieve these unreasonable standards you’ve set for yourself.

Solution:

Reappraise. Recognize that seeing the reports of those who are maximizing the use of their time probably represent only a small percentage of people. Those are the ones who are writing articles or posting on social media. Those who are not maximizing their use of time are not posting on social media -- Hey, I’m sitting around all day and binge watching the Kardashians! People only post the good stuff (we call it virtue signalling). So you end with a biased perception based upon what you see: You think almost everyone is doing it even if it is not true. And then it affects the way you feel about yourself.

Start small. Rather than setting enormous goals, that likely involve larger life changes to some degree, (who was actually exercising everyday pre-quarantine anyway?) and essentially setting yourself up for failure -- start small. We know that we are more likely to achieve our goals when they are observable, measurable, and specific. So first take some time to decide which of these broad goals are most important to you. From there, break it down into its smallest form (the key here is to make the activity/task challenging enough that you will feel a sense of accomplishment when it is completed but not unrealistic, or too challenging, that it will be too difficult to complete). Lastly, be as specific as possible (i.e., day and time of when you will complete the activity) when you set your goal(s) for the next week. For example, if you decide you really want to learn to cook new recipes your first goal might simply be going online to find one or two new recipes that you’d like to learn how to make. Or, if you already have a recipe in mind, ensuring you actually have all the ingredients you need. Remember, even if the activity/task seems small - picking a day and time (e.g., Monday at 12pm) that you will complete it is key for achieving goals!

Frustration: When Achieving Your Goals is Difficult

Trigger:

Seeing the news or reading articles about the coronavirus pandemic and spread, followed by wanting to buy cleaning supplies and order groceries online to minimize contact with others.You look online, but all of the things you want aren’t available (e.g., Clorox wipes or American cheese). You look at several online stores/delivery services, and keep seeing “out of stock” signs, time after time. Why can’t stores just manage their inventory, and why can’t I just get the things I want/need?!

Unhelpful Reaction:

Get stuck with the idea that this is a never-ending, devastating catastrophe with a definite bad outcome: “If I can’t get any cleaning supplies, then I have no way of sanitizing packages or my space, and I’ll get coronavirus for sure”. Or, overgeneralize and come to the conclusion that if you can’t find specific cleaning supplies, there is no alternative option: “I can’t order any packages because how can I bring them into the house if I can’t clean them if I can’t get Clorox wipes?”. Also, falling into the trap that the uncomfortable feelings that come along with seeing “out of stock” signs are indicative that everything is falling apart: “The world is ending, this is a disaster, I can’t even get everyday items, what’s next?!”.

Relatedly, believing these uncomfortable feelings are indicative of immediate danger, which then leads to falling into an overwhelming spiral in your own head: “I can’t do this, it’s too much, how long can this go on for, I don’t know what to do, I can’t handle this, etc.”. Finally, jumping to conclusions and predicting the (defeated) future: “if I can’t get certain items, then there’s no use in looking for anything else - they probably won’t be available and that would make me feel even worse so I just won’t try”.

Solution:

First, give yourself permission to take a step back and distract yourself with a different activity, with the idea that you will get back to what you were doing once the frustration and other emotions become less intense - which they will. Remind yourself that emotions ebb and flow; they get intense, and then the intensity lessens with time.

Separating facts from interpretations is also a good strategy: imagine you’re in a grocery store and someone bumps into you (in a non-coronavirus world). The fact here is that the person bumped into you. How do you interpret the bump? If you’re having a decent day, you may shrug it off or think the other person might just be a little clumsy or distracted, not putting too much weight in it. If you’re having a bad day - you had a fight with a friend, refrigerator broke and all your food spoiled, put a red shirt in your laundry with all your white clothes and dyed all your clothes pink - you may have a very different reaction to the person bumping into you. You might be enraged - “what a jerk!”, or even snap at them.

Be mindful of your reactions and interpretations, knowing that right now interpretations are likely influenced by the current difficult circumstances. In the example earlier, a fact would be that Clorox wipes and American cheese are not available at the stores I am looking at online. An interpretation might be: “everything is falling apart”. Interpretations are colored by many things - our current feelings, life circumstances, relationships, the weather, etc.… and importantly, our interpretations tend to change. Right now, recognize that things are tense and stressful, and interpretations will likely lean towards the negative.

Lastly, try to reframe the situation, i.e., think about some food items being out of stock as an opportunity to try something new. Maybe you’ve stuck to the same general foods for a while; there are plenty of new foods to try that may make for an interesting experiment and break up some of the quarantine monotony, and who knows - maybe you’ll find a new food favorite.

Claustrophobia: Feeling Trapped

Trigger:

Sitting in front of your computer in the same room all day and night, as well as a lack of day-to-day variety. This is not claustrophobia in the traditional sense of the psychological disorder, but a unique feeling of discomfort related to being “trapped” at home. This may be particularly true for those living in apartments, in cities where ample space is rare, and/or with several other people.

You feel stir-crazy yet exhausted.

Unhelpful Reaction:

If you’re sharing space with others you might find yourself snapping at them. If you’re by yourself you might find yourself struggling to combat negative thoughts about being alone. You convince yourself that the walls are closing in on you and decide that you’re fed up with quarantining, and you think maybe you’ll get together with *just a couple* friends this weekend to help you feel a bit better.

Solution:

First, allow yourself to have some self-compassion around how hard this is— and know that you’re not alone. Most of us are not used to being confined to the same limited amount of square footage for many days at a time, to having the lines between home and work blurred, to be unable to go grab dinner with a friend, and to be uncertain about when any of the aforementioned things will change. If you’re feeling tired yet agitated that is understandable, but it’s also a cue to use any and all resources available to you to change things up. Rearrange your furniture so it feels like you have more space. Create more space by using this time to do all the decluttering and organizing that you’ve been putting off for months. Get outside at least once a day. If you’re in a densely-populated city and the idea of walking around makes you uneasy despite social distancing policies, spend time on your roof if possible. Not an option? Open your window while you do yoga. Do what you can to move your body and get fresh air.

Finally, change your mindset to create meaning in the quarantine. Instead of thinking “I’m being forced to stay inside,” tell yourself that you are choosing to stay inside in the service of stopping the pandemic. Think of a specific person you know who is a member of a high-risk population (a grandparent, a friend with a medical condition), and when you’re feeling antsy tell yourself “I’m doing my part to protect them.” Even if it sounds silly, tell yourself that your Friday night on the couch isn’t just that; it’s an altruistic act. You’re in the middle of a major event in history, and you’re making a difference by making the choice not to go out. When you frame your situation this way, you feel a greater sense of agency and control over your environment as opposed to your environment controlling you.

Chronic Stress: Coping When You Are on Edge

Trigger:

A combination of all COVID-related triggers: being faced with a huge amount of uncertainty, struggling to adjust to new working circumstances (or job loss), being stuck inside without access to many of your regular stress-relief outlets, and generally feeling overwhelmed.

Unhelpful Reaction:

When faced with stressful external circumstances, your body responds by increasing its production of the hormone cortisol. This “stress hormone” is associated with numerous negative health consequences— including lowered immune response. So ironically, the more you worry about the virus, the more you put yourself at risk for stress-related health issues. You might also find that the more you stress about your current life situation, the more you find yourself struggling with sleeping troubles, physical tension, and mood issues.

Solution:

A major tool for combating the negative effects of stress is meditation; in fact, numerous studies over recent decades have demonstrated the benefits of meditation for many facets of physical, emotional, and mental health. Thankfully, you don’t need any fancy equipment to meditate- just yourself, a little bit of time, and ideally a quiet space. Furthermore, there are a ton of free and low-cost resources for meditation available online. Headspace is a science-backed meditation app that is currently providing free access to some of its offerings, linked here. New York-based Ziva Meditation offers a variety of excellent meditation-related tools, and also has a discount for their online program during this time. The app Calm provides users with guided meditations as well as audio recordings of calming music and bedtime stories to help with sleep. Finally, simply Googling “guided meditation” or “mindfulness exercise” will reveal a treasure trove of resources to help you get through the pandemic with less stress and greater well-being.

Managing Conflict: Reducing Irritability and Communicating Effectively

Trigger:

We are spending more time than ever with our families and roommates. Feelings of stress, boredom, and irritability all contribute to more conflict especially while in close quarters.

Unhelpful Reaction:

It’s no surprise that in the current environment we have a tendency to lose our temper, bicker over trivial matters, and have verbal outbursts toward those with whom we share our space.

Solution:

If you’re feeling high strung on a daily basis, self-care can help reduce irritability in the long term. In the short-term, becoming aware of your feelings is the first step to responding more effectively. Once you notice the tension rising, give yourself the freedom to take a short break from the situation. Strategies can vary from counting to 10 before responding, to physically leaving the room and coming back to the conversation later once you’ve had a chance to cool off. It can be helpful to communicate to the other party that the break is temporary with a simple statement like “I’m noticing I’m feeling irritable, and I need a few minutes before we talk about this.” Once you return to the issue, be sure to look at one another, give each other full attention, and minimize distractions (e.g., turn off the television, cell phones away). Using “I” statements (“When X happens...I feel Y”) can help minimize blame and criticism. For example, instead of saying “You’re such a slob!” (critical) try saying “When the sink is full with dishes, I feel overwhelmed.” It’s often helpful to focus on what the other party can do as opposed to what they shouldn’t do. For example, try saying “I would really appreciate it if you would place your dish directly in the dishwasher,” (request) rather than saying “Stop leaving dirty dishes on the counter!” (demand).

Finally, conflict about important matters are best left for times when all parties are clear-headed and distractions minimized. You may wish to say something like, “This is really important to me, let’s talk about this at a later time.” It can also help to specify a time when you will return to the issue, e.g., “Tomorrow afternoon should be free of distractions.”

General Mood Regulating Strategies likely to be Negatively Impacted

by COVID and New Challenges

While most of what we will easily notice are the negative moods that are triggered -- as discussed above.Those have evolved to grab our attention! However, various subtle mood regulation strategies (e.g., sunlight, nutrition, sleep disruption) that are part of our daily life are likely to be disrupted or challenged in the current landscape.We detail these below to put them on your radar screen so that you will attend to these as well.As a result you will have a comprehensive approach to maximize your ability to manage your negative emotions and increase your sense of well-being -- even during the COVID crisis.

However, once the COVID crisis passes, all of the strategies we have outlined in this document can be used to manage negative emotions related to other non-COVID triggers (e.g., day to day stresses).If you have read through this document and learned something new -- that can be a silver lining in this crisis -- as you have now increased your emotional intelligence!Emotional intelligence is defined as the individual’s ability to recognize, understand, and manage one’s own emotions.This has been shown to have many positive outcomes.

Lack of Sunlight

Trigger:

Restaurants, theaters, and other places are closed. Team sports and outdoor gatherings are cancelled. Many people are not commuting to work, where they might spend some time outdoors by consequence.

Unhelpful Reaction:

Staying home means spending more time indoors, away from sunlight.

Solution:

Exposure to sunlight can boost brain chemical levels that promote positive moods. Aim for at least 30 minutes of sunlight a day, every day (weather permitting!). At least in the Northern Hemisphere we are lucky to have warmer weather coming our way. Go outside and read a book or make a phone call. Take a walk while listening to music, an audiobook, a podcast, or just enjoy the sounds of the neighborhood around you. Enjoy nature - go for a hike, or walk near water. If you don’t want to get out of your car, you can drive to a nearby park and roll the windows down while reading a book or listening to the radio. Finally, if getting natural sunlight is still difficult, light therapy lamps can be a great way to keep depression at bay.

Establishing Sleep Hygiene

Trigger: 

Social distancing efforts have interrupted our work/school schedules and have even impacted our sleep. Increased screen time and anxious thoughts at bedtime can keep us awake and cause insomnia.

Unhelpful Reaction:

Staying up and sleeping in later may be tempting. However, poor sleep quality and shifting sleep schedules have negative consequences for our health.

Solution: Getting adequate sleep is crucial to our physical health, immune system, and mental well-being. In addition to getting enough sunlight and physical exercise throughout the day, the first step to better sleep includes keeping a regular sleep schedule. Wake up and go to sleep at the same time every day (including weekends). Most adults should aim for at least 7 hours of sleep a night. Limit electronic screen use before trying to fall asleep, or at a minimum, use a blue light filter. Consider building in a pre-bedtime “wind down” routine. Activities could include reading, taking a hot bath, using soothing scents, drinking decaffeinated tea, and listening to a relaxation script or calming music. If you wake up in the middle of the night and can’t go back to sleep, do not stay in bed trying to fall asleep! This often feeds an anxiety cycle and weakens the association your brain makes with sleep and your bedroom. It may seem counterintuitive, but getting up and doing a relaxing activity until you feel sleepy is the better course of action. In order to strengthen the association between your bedroom and sleep, use your bed for sleep and sex only. The National Sleep Foundation maintains a list of tips for healthy sleep.

Lack of Physical Activity

Trigger:

Gyms are closed, team sports cancelled, working at home has us sitting at our desks even more than before, and weekends are spent on Netflix binges.

Unhelpful Reaction:

It’s easy to fall into a sedentary lifestyle, which can lead to negative emotions and contribute to “cabin fever”. Lack of physical activity is associated with increased depressed mood.

Solution:

Guidelines suggest getting 150 minutes of moderate-intensity aerobic exercise a week, but most people struggle to meet this goal. Like any new habit, start small and be consistent. Commit to a small goal when you’re just starting out, and then add a little bit more each day. Reward yourself for working towards this goal - behavior change is hard! The good news is that even smaller amounts of low intensity exercise can provide benefits. One suggested starting place is to aim for 4,000 steps a day. Some people like to track their activity levels with a fitness watch, but there are plenty of free mobile pedometer apps you can download onto your smartphone device. Fortunately, states with “stay at home” orders still permit getting outside for daily exercise. Call a friend and take a socially distanced walk around the neighborhood together - just stand six feet apart or maybe on opposite sides of the street. Go for a run or hike in nature. On a rainy day, consider playing an activity-focused video game or signing up for a Zoom yoga class.

Blurred Boundaries: Working from Home

Trigger:

We’re quarantined and self-isolating - we’re not going anywhere. We’re all home, and if we’re also working from home, work knows where we are and how to get a hold of us 24/7. We’re also constantly around technology and communication devices (phones, computers), so our bosses and clients have easy access and know we’re likely to see their messages quickly. Work schedules may be changing, and the days of going into the office from 9-5 are over (for now). Work may think, “if you’re home, doing nothing, why not work?” - leading to confusing boundaries. Do you work all day long? Maybe you think, “it seems everyone else at work is always on e-mail or in Zoom meetings, so I should be too”. What about the quality of our work: are we still expected to perform to the same high standard, even in the midst of a pandemic?

 

Unhelpful Reaction:

Withdraw and avoid anything work-related entirely: “if I don’t see the email from my boss or virtual meeting invitation, it’s as if it doesn’t exist”. We know that avoidance, including email avoidance, isn’t helpful and often causes increases in anxiety. Relatedly, avoiding projects because they may not be as strong as prior work that was done at the office under different conditions may also cause increases in anxiety (the project isn’t disappearing). Burnout is also very real, so accommodating work at all hours isn’t a good idea either. Being overly accommodating and working at all hours may make you feel like a top employee at first, but be mindful - you may end up resenting it or exhausting yourself.

 

Solution:

Come up with a reasonable schedule that you feel comfortable with and try to stick to it. That way, you know when you’re “on duty”, and can have guilt-free time off when you’re not. Without these boundaries, you risk blurring all of your time together, and constantly thinking “I should be working right now”. From cognitive-behavioral therapy, we know that our thoughts influence our feelings (as well as behaviors), so thinking that we should be doing work all the time may lead to feelings such as anxiety and guilt, which may then lead to unhelpful behaviors (i.e., overeating) in an attempt to self-soothe. In a pandemic world, the last thing we need is another thing that gets in the way of being able to relax.

 

Let’s say you make yourself a schedule and decide to try it. What happens if distractions arise: the cat knocks over your water, the dog won’t stop barking, the kids need attention, your roommate gets a call and is a loud-talker, sirens blare outside, etc. Maybe the distractions are within your own head: worrying about loved ones, feeling lonely from the quarantine, etc. We’re never in a distraction-free world, and working from home is especially far from it. Remind yourself that you’re doing the best you can, and that it’s okay to feel what you’re feeling; it’s also okay to be frustrated by the distractions. A “win” here isn’t in the outcome of a fully productive day; it’s in the attempt to stick to the schedule and the willingness to keep trying amidst a global pandemic. You may find that by removing some of the pressure of performing perfectly, you’re better able to focus.

 

Since you’re living and working out of the office, in your home, physical boundaries are important too. Try to have a separate space for where you do work and where you spend your time doing other activities. If that’s not possible, try setting up some rules for yourself (i.e., at 5 pm, I will turn off my computer and not check my work email until the morning). This is also a good time to practice being assertive and discussing boundaries with co-workers - a useful skill to build. Remember, this is a hard time, and self-care is especially critical right now (e.g., prioritizing physical and mental health, sleep, etc.).

Assertiveness: Setting Boundaries with Electronic Communications

Trigger:

Socializing with friends and loved ones is critical to maintaining a sense of connection, but “overdoing” these activities can sometimes lead us to feel socially worn out. Additionally, conversations that focus too much on the news, politics, or pandemic can be counterproductive.

 

Unhelpful Reaction:

We might feel obligated to respond to alerts on our mobile device immediately, or fatigued from all the virtual get togethers. Failing to communicate our needs might lead to feelings of resentment.

 

Solution:

Practice assertiveness. We all vary in how comfortable we are speaking up and putting our needs before those of others, but sometimes this is necessary to maintain our well-being. It could help to reframe the situation: unless a situation is truly an emergency, others can probably wait an hour (or more) for a reply. If receiving nonstop notifications is still stressful, consider silencing certain types of alerts or specific conversations. Another helpful strategy is to take regular breaks from your phone by placing it in another room or putting it on airplane mode. In addition, participating in virtual get togethers has obvious benefits, but in some circumstances, give yourself the freedom to “take the night off,” too. It may seem difficult to back out of social gatherings, but a simple assertive statement should suffice (e.g., “I’m feeling tired tonight, so I’m going to skip this one. I’ll be there for the next one!”). It is important to convey to your group that you are grateful for being included and want to be included in the future; then, really make an effort to show up for the next gathering. Alternatively, consider “showing up” but excusing yourself with a similar assertive statement after a set amount of time. Finally, if conversations are too focused on the pandemic or other current events, consider speaking up (e.g., “I’m trying to give myself a break from the news,...”) and then shifting the dialogue to other topics.

Changes in Eating Habits: Reaching for Comfort Food

Trigger:

An increase in stress often leads people to reach for “comfort foods” -- those foods that are particularly pleasant and reinforcing (e.g., cookies, potato chips, muffins, ice-cream, french fries).These foods serve as rewards to our system because of the pleasure they induce and thus they become craved, especially when one is under stress, since they can temporarily offset a negative mood (provide relief - in similar ways to a drug).

Comfort foods tend to be highly processed and contain significant amounts of artificial fats, sugar, and salt. The most common outcome that occurs from eating these foods is an increase in inflammation in the body.Emotional well-being seems to be negatively affected by an increase in the body's general inflammatory process, even though in the short run the foods are immediately pleasurable.Highly processed foods appear to interfere with general metabolic processes that are involved in emotion regulation.

Unhelpful Reaction:

Eating an increasing amount of these foods to manage stress and feel better is a counter-productive strategy.Justifying doing so because of the current stressful situation provides an acceptable rationale to consume even more. Given that this is a prolonged situation (versus having a bad day at work and eating comfort foods on occasion) going this route can lead to daily consumption of foods that increase negative emotions..

Solutions:
Cognitive reappraisal: Do not justify eating excessive amounts of these foods when under stress.Challenge this thought with the notion that this is the worst time to have a poor diet given the overall stress level. You need more help regulating your emotions, not less.

Focus on the silver lining of the current situation and use this as a chance to make a positive change.If you are home much of the time it is easier to plan what you are eating and take control of your food versus when you are at work, school, etc. and on the run when fast-food may be an easier alternative.

Behavioral: Make a meal plan rather than leaving it to how you feel when you are hungry.Having a plan increases the likelihood that you will follow through with your intention. Also, people make the worst decisions about eating when they are hungry.So having it worked out in advance will be enormously helpful and facilitate compliance.

Stimulus Control: Don’t buy the foods you would like to avoid eating. If it is not easily accessible it requires more of an effort to get it (e.g., having to go to the store versus your kitchen cabinet). If you must have some of these, and perhaps as a transition to eating less of them, buy packages that contain a small quantity (e.g., 100 calorie serving sizes that exist for many products) as a way to maintain portion control.

Zoom Fatigue: Feeling Drained from all of your Zoom Meetings?

Trigger:

Countless Zoom work meetings, video chats with friends as a sole source of social interaction, and the novelty of quarantine wearing off.

Unhelpful Reaction:

Emotionally withdrawing from the activities that are now taking place via videoconferencing, and falling into unhelpful patterns that will ultimately make you feel even less engaged. You sleep late, log on to your work meetings without brushing your teeth or putting on real pants, and zone out for the duration of the calls. At the end of the day you decide you’re tired from all of said meetings, so you cancel your scheduled chat with a friend and instead binge-watch The Office for the third time this week.

Solution:

Treat your virtual get-togethers the same way you would treat those events in real life. Although it might be tempting to roll straight out of bed and into your series of Zoom meetings for the day, it’s helpful to remember that if you want to feel normal, you need to behave as close to normal as possible. Get up at your regular time, shower, eat a good breakfast, and use the time that you would normally be commuting to go for a walk. Instead of looking at Twitter or the news during your meeting, stay engaged by asking questions. Get dressed for video calls with friends instead of chatting from your bed in sweatpants, and give the call your full attention as opposed to making dinner at the same time.

Also, help your brain by creating a clear delineation between work-related video calls and social video calls. Designate one specific spot in your home as your workspace— somewhere that you don’t do anything else (i.e., not the kitchen table). When your workday is done, leave that space and have some screen-free time before taking calls with friends in a different spot. It may also be helpful to use different apps for work calls versus social calls; for example, if your place of employment uses Zoom, connect with friends via Houseparty, Skype, FaceTime, or WhatsApp.

Finally, talk about any feelings of burnout with friends or the people in your household, and ask them to help hold you accountable: “I’m having a hard time sticking to my normal routine right now. I’m setting my alarm for x time; can you make sure I get up then?” or “I’ve been feeling pretty tired after days full of Zoom meetings, but I’m excited to FaceTime with you tonight. Don’t let me bail!”

USEFUL ARTICLES ON

COVID RELATED ISSUES

While there are thousands of articles out there on these topics it can get overwhelming.We thought the listed below are particularly good must reads from a variety of sources.

ADVICE TO MANAGE PSYCHOLOGICAL DISTRESS

INFORMATION TO HELP WITH YOUR ANXIETY PROVOKING THOUGHTS

https://elemental.medium.com/if-youre-feeling-overwhelmed-here-s-a-science-backed-way-to-take-control-a9650718365c

https://www.theguardian.com/world/2020/mar/22/think-about-the-best-case-scenario-how-to-manage-coronavirus-anxiety?CMP=Share_iOSApp_Other

https://newpaltz.edu/media/idmh/covid-19/IDMH%20COVID19%20Community%20Stress%20Management%20Tip%20Sheet%202020%20Final.pdf

HOW TO MANAGE THE PSYCHOLOGICAL EFFECTS OF SOCIAL DISTANCING AND QUARANTINE

https://www.nytimes.com/2020/03/21/opinion/scott-kelly-coronavirus-isolation.html

https://www.smithsonianmag.com/innovation/ten-tips-scientists-who-have-spent-months-isolation-180974547/?utm_source=smithsoniantopic&utm_medium=email&utm_campaign=20200405-Weekender&spMailingID=42188561&spUserID=NzQwNDU2NTU3NzkS1&spJobID=1740515199&spReportId=MTc0MDUxNTE5OQS2

https://www.nytimes.com/2020/03/23/well/family/coronavirus-loneliness-isolation-social-distancing-elderly.html

HOW TO DEAL WITH GRIEF: MISSING THE WAY THINGS WERE

https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief?fbclid=IwAR0kOOWk-kKECz_5R8THiKwbjU1h6OIZ8MHfKIDmDkrQgYKkr706E2N4ook

https://www.theatlantic.com/health/archive/2020/04/nostalgia-before-coronavirus-missing-the-recent-past/609196/?utm_source=newsletter&utm_medium=email&utm_campaign=atlantic-daily-newsletter&utm_content=20200401&silverid-ref=NDM4MDY5OTI2NTg3S0

PARENTING ADVICE TO HELP YOU

AND YOUR CHILDREN COPE

SELF-CARE FOR PARENTS

https://www.facebook.com/ChildMindInstitute/videos/591058088157058/

A PARENTS’ GUIDE FOR MEETING THE CHALLENGE

https://mailchi.mp/nyumc/csc-parental-guide-covid-19-1049030?e=6314558468

SUPPORTING KIDS DURING THE CORONAVIRUS CRISIS

Young Kids: childmind.org/article/supporting-kids-during-the-covid-19-crisis/

Teenagers & Young Adults: childmind.org/article/supporting-teenagers-and-young-adults-during-the-coronavirus-crisis/

HOW TO SPEAK TO YOUR KIDS ABOUT CORONAVIRUS

https://childmind.org/article/talking-to-kids-about-the-coronavirus/

ADVICE TO MANAGE RELATIONSHIPS

HOW TO KEEP QUARANTINE FROM RUINING YOUR MARRIAGE

https://ideas.ted.com/how-to-keep-quarantine-from-ruining-your-marriage/?utm_source=recommendation&utm_medium=email&utm_campaign=explore&utm_term=ideas-blog-1

WHAT TO DO IF YOUR FAMILY OR FRIENDS AREN'T TAKING CORONAVIRUS SERIOUSLY

https://www.huffpost.com/entry/family-friends-not-taking-coronavirus-seriously_l_5e710940c5b6eab7793d91f0

ADVICE TO MANAGE BEREAVEMENT DURING COVID
 (loss of a loved one)

https://complicatedgrief.columbia.edu/wp-content/uploads/2020/04/Managing-Bereavement-Around-COVID-19-HSPH.pdf

VERY PRACTICAL HOW TO ADVICE

HOW TO OPEN AND HANDLE PACKAGES SAFELY

https://thewirecutter.com/blog/coronavirus-packages/

HOW TO GET FOOD

https://www.theatlantic.com/health/archive/2020/03/coronavirus-how-get-food-safely/608008/?utm_source=newsletter&utm_medium=email&utm_campaign=atlantic-daily-newsletter&utm_content=20200318&silverid-ref=MzEwMTkwMTM3ODg3S0

HOW TO STOP TOUCHING YOUR FACE

https://theconversation.com/how-to-stop-touching-your-face-to-minimize-spread-of-coronavirus-and-other-germs-133683

HOW TO MAKE YOUR OWN CLOTH MASK

https://www.nytimes.com/article/how-to-make-face-mask-coronavirus.html

https://www.youtube.com/watch?v=XfyTDy_VIek

VIRTUAL PLEASURABLE ACTIVITIES

VISIT MUSEUMS: https://www.smithsonianmag.com/smart-news/ten-museums-you-can-virtually-visit-180974443/?utm_source=smithsoniantopic&utm_medium=email&utm_campaign=20200329-Weekender&spMailingID=42134346&spUserID=NzQwNDU2NTU3NzkS1&spJobID=1722812780&spReportId=MTcyMjgxMjc4MAS2

WATCH ANIMALS: 

https://www.insider.com/live-animal-cams-zoos-aquariums-watch-from-home-2020-3

GO TO DISNEY:

https://www.travelandleisure.com/trip-ideas/disney-vacations/watch-disney-rides-on-youtube

RIDE A ROLLER COASTER: https://www.canadaswonderland.com/blog/2020/march-2020/heres-how-to-take-a-virtual-ride-on-all-the-rides-at-canadas-wonderland-in-your-own-home

PRACTICE YOGA, MEDITATION, SOCIAL DISTANT DANCING, ETC., THROUGH LIVE STREAMS:

https://www.today.com/health/miss-gym-yoga-hiit-social-distance-dancing-stream-these-workout-t176820

EXPLORE 32 NATIONAL PARKS:

https://www.insider.com/national-parks-america-virtual-tours-3d-visit-2020-3

TAKE A FREE ONLINE COURSE FROM IVY LEAGUES (YALE, PRINCETON, HARVARD):

https://www.businessinsider.com/free-online-courses-from-best-colleges

TOUR NASA’S SPACE CENTER HOUSTON:

https://spacecenter.org/app/

WATCH BROADWAY SHOWS:

https://www.broadwayhd.com/

https://broadwaydirect.com/andrew-lloyd-webber-offers-free-musicals-to-stream-on-youtube-during-covid-19/

TAKE FREE GUITAR LESSONS:

https://try.fender.com/play/playthrough/?clickref=1011l82zEvD2&aff_id=305950

WATCH CONCERTS:

https://tidal.com/AtHome 

TAKE FREE COOKING CLASSES:

https://www.huffpost.com/entry/cooking-classes-online_l_5e83a194c5b65dd0c5d582f9

AMAZON PRIME IS OFFERING FREE TV SHOWS FOR KIDS:

https://www.businessinsider.com/amazon-kids-shows-movies-free-prime-video-coronavirus-2020-3

SELF-CARE ADVICE FOR MENTAL HEALTH PROFESSIONALS

https://www.apa.org/news/apa/2020/03/psychologists-self-care

IF YOU NEED PROFESSIONAL HELP

If in reading this you realize that a self-help guide is not going to help you enough because your symptoms are severe you should find a therapist to work with directly.If you do not know of one, you can use the following national organizations referral services.Most therapists are using telepsychology (remote therapy by video) and thus it should be much easier to find someone who is licensed in the state you live in (which is typically a requirement for remote therapy).

 www.abct.org

 www.academyofct.org

 www.adaa.org

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