(Managing) Anxiety & Fear in The Time of COVID 19

Earlier this week, I got an email from an Iraqi doctor I trained a few months ago, asking for my help in responding to her patients worried about the virus. I gladly sent her a few words of advice without giving it very much thought. Here in Thailand, we’ve been living under the shadow of COVID 19 (CV 19) since January when the usually plentiful Chinese visitors vanished from Bangkok. We’ve all been wearing masks. I hear from clients about their concerns. My wife, Jen, and I talked about it a few weeks ago and we made what we feel are prudent preparations.

Then, on Wednesday, I got an email from a client asking if she should include therapy in her self-quarantine. She just got back from vacation in another Asian country. Her school has asked her, and all staff who visited other Asian countries during the vacation, to self-quarantine for 14 days. I never got an email like that one before and I wasn’t sure how to respond. I’ve occasionally gotten emails from sick clients worried they are contagious and asking how I feel about it since they would like to have their session (most clients of course, cancel when they’re sick). My general rule has always been to say, if you feel okay coming in, please come in. At first, I was inclined to respond to this recent message the same way. But I decided to ask Jen before replying. Jen is a public-health nurse and consultant. I think that her reaction can correctly be described as stronger than mine. I had been thinking only of myself. She was concerned about the client using public transportation to come to the appointment and other clients who would be in the same room with me afterward.  Until that moment, the full scope of the situation had not landed with me emotionally.

I found myself not able to sleep that night. As I did my usual sleep routine of following my breathing and feeling my body melting into the mattress, I noticed that stimulating, anxious thoughts kept floating up. What if this is the last week of my life? I could feel my body getting tenser. I started to review what I would be doing if this were the last week of my life. I also recognized it as anxiety and a distraction from sleep. Then a really anxiety-stimulating thought came up. What if Jen gets sick? What if Jen dies? My body went from tense to panicked — I could feel my heart rate accelerate. I saw the anxiety mushrooming into fear and panic. I started to feel overwhelmed and like I needed to get up and do something. At that point, I intentionally deepened my breathing, gently directed my attention to my body, and used some self-soothing skills I know from my work as a teacher of Mindful Self Compassion. I smiled at my human mind, put both hands over my heart and soothed myself until I eventually fell asleep.

That was a few nights ago, before the stock market crashed and emergence of CV 19 in the USA. Yesterday, an upset client emailed me saying their spouse is breaking down from the strain of fear. As I’m writing this, Kuwait announced the evacuation of their citizens from Thailand, where I live. People, including me, are anxious and getting afraid. In fact, something like CV 19 will trigger the most intense forms of anxiety for most people. The anxiety arising from coronavirus comes from normal human fear of real risks combined with the equally normal emotional reactions to uncertainty, unpredictability, and uncontrollability. These three elements — unpredictability, uncontrollability and uncertainty, are the “perfect storm” when it comes to anxiety and fear. They can stimulate strong anxiety reactions in anyone, especially in people who are more vulnerable to feeling unsafe or threatened (for example, those with a history of trauma or other mental health challenges).  This situation involves a very high degree of uncertainty and unpredictability/uncontrollability about something that poses real risks for some of us (bearing in the mind the overwhelming majority of CV 19 cases appear to be mild).

You can add to this the emotional impact of misinformation, rumors and outright hysteria, which unfortunately abound at the moment. Plus, we feel more anxious when many (or all) of the people around us are anxious or when we are constantly consuming anxiety-provoking information. Taken together — real risks, normal reactions to uncertainty, unpredictability and uncontrollability, plus misinformation/rumors, group panic — these are ideal conditions to stimulate anxiety, and easily feed anxiety to develop into fear and panic. Fear and panic are problems that make life unlivable and contribute to poor decisions.

So, on the one hand, we need to take steps to prepare ourselves and to act prudently. On the other hand, simply taking those steps will not eliminate anxiety. In everyday life, using our good problem-solving skills usually reduces anxiety significantly since we feel we have managed the problem. CV 19 is a situation where we will have to tolerate a higher degree of anxiety-provoking uncertainty, unpredictability and uncontrollability that prudent action will not soothe.

How can we handle the challenge and the anxiety? I have eight ideas to offer:

1. Educate yourself with reliable scientific information. If you are not sure where to find such information, try hereor here or here or here or here or here.
   1. Recognize that prudent action will not eliminate all risks. Even isolating yourself in a bunker would not eliminate all risk (eventually you have to come out of the bunker…) and trying to do so in the context of living your life might create dysfunction.
   2. Make this experience more bearable by avoiding misinformation (see # 5).
2. Take all the steps you feel are reasonable and prudent to protect you and those you love.
   1. What’s right for you and your family may be different than what feels right to others.
   2. If you and your spouse/partner disagree about steps to take, see if you can agree about what to use as a source of authoritative information first.
3. Once you have taken the reasonable and prudent steps, take a moment to pause and recognize and appreciate that. Beyond this point, it becomes really important (and perhaps the next big challenge) to recognize and manage anxiety to prevent it from blooming into panic and panicked behavior. It may also help to recognize that anxiety comes in the form of self-doubt and worry.
   1. Consider asking yourself: Once I have taken the steps I am able to take today, what can I do to relax and recharge so that worry and tension do not take energy I need for other things or make me act like a person I do not want to be?
4. Connect with the people around you.This is such an important tip that it deserves its own point!!
5. If you find yourself constantly seeking information and reading or watching clips about it, just stop.  Please stop seeking information constantly. This is like trying to drink from a firehose. Social media does not exist to inform you; these services exist to stimulate you and capture your attention. Constantly seeking and consuming negative stories about this situation may be a sign of anxiety and it will definitely stimulateanxiety and panic, not reduce it.
   1. Recognize that looking for information is part of trying to feel in control (psychologists call it informational control and it is sometimes helpful). It’s normal to do this. But after a certain point, you will not get more useful information.
   2. You will do yourself a big favor if you avoid sources of misinformation and mass hysteria. For example, if you live in Thailand, that means avoiding Pantip (for those fluent in Thai) and Thaivisa.
6. Rely on timeless and enduring wisdomthat is beautifully expressed in the first lines of Reinhold Niebur’s Serenity Prayer:

God, grant me the serenity to accept the things I cannot change,

Courage to change the things I can,

And wisdom to know the difference.

In this situation, we do need to take action and hopefully our actions are prudent and reasonable. At the same time, there is a limit to what we can do. There are elements of this that we are all going to have to live with for a while. In general, this is one of the biggest challenges of human life and can also help us through painful passages like now and the coming months.

7. Recognize that your emotional reactions are normal human reactions. Please do not rub salt in the wound of anxiety and stress by blaming and criticizing yourself for feeling anxious and upset by what is happening. Consider trying to be kind to yourself, perhaps by giving yourself permission to feel worried and anxious because you are a normal, caring human being.
8. Use your regular coping skills and find additional ways to soothe and distract yourself when you notice that anxiety is coming up and pushing you.
   1. There are so many wonderful ways to take good care of yourself and deal with anxiety. For example, what do you think is motivating me to write this? This is one way I’m managing my own anxiety, by using some of my usual coping strategies: trying to help others, and organizing my thoughts into a list. What do youusually do?  Exercise? Do that. Talk to friends? Do that. Gardening? Walking? Cooking? Do what what you usually do to help you relax. Or try something new… If you need some ideas about self care, coping or how to sooth anxiety, please check out this. Or this. Or this. Or this. Or this.
   2. You might try asking yourself, “what do I need today?” This can be a very hepful question. Start from accepting that this is going to be stressful period, with a high level of tension and anxiety. In order to take good care of yourself and take care of others, you might ask yourself “When I’m living through a more difficult period, what do I need to cope with the tensions and bring out my best?” ANDthen give yourself permission to have/get/give yourself some of what you need!

Thanks for your time in reading this. I want to offer good wishes, wellbeing and prayers for those who are already suffering or have lost those they love. I want to wish all of us a safe passage through stormy waters. Most of all, wishing all of us courage and wisdom.