Coping During Coronavirus: Tips from Cognitive-Behavioral Therapy
In recent weeks, many of my patients have asked me about how to manage stress and take care of their mental health during the coronavirus pandemic. Between social distancing, working from home, and school or daycare closures, many people’s routines have been upended.
As a clinical psychologist and researcher who studies how stress impacts mental health, I’ve come up with a few suggestions that I shared with my patients on how to manage stress in this time. Most of these are from a cognitive-behavioral therapy (CBT) perspective. I’ve also included some suggestions from colleagues — one specializes in family and couples relationships, and one is a psychologist experiencing the pandemic from one of the earliest hit countries.
Daily Routines — If you are suddenly working from home, caring for kids who are no longer in school, or have reduced work hours, your daily routine may have gone out the window. Routines are predictable and give structure to our days: alarm rings, start the coffee, hop in the shower, breakfast, get ready for the commute, and so on. Once that’s gone, it can be easy to feel unanchored. So, try to create a new daily routine for yourself.
Perhaps you’re not commuting anymore, shuttling kids to the school bus stop, or managing after-work social or school activities. Are there other ways you can structure your day? Maybe without the commute, you have time for a little exercise or a leisurely breakfast in the morning. Maybe at lunchtime you have time to take a walk. Try to plan out your day or week with a similar daily structure.
In CBT, this is consistent with behavioral activation, the idea that our activities or behaviors have a big impact on our moods. When we do something we enjoy, are good at, or that feels meaningful, we usually have a lift in mood. If we avoid activities or isolate ourselves, it tends to worsen our mood.
To make use of this, in CBT we use “activity scheduling” to map out specific activities that we know will bring us enjoyment or a sense of mastery, slotting those activities into our days at specific times. Maybe I know that I always get a good laugh when I talk on the phone with my brother, so I set aside 20 minutes at lunchtime to call him. Maybe I am really great at organizing things and know that I’ll feel accomplished afterwards, so I set aside an hour in the evening to work on organizing my closet. Maybe exercise gives me a boost in energy, so I schedule in time for a jog or a yoga video online.
Jot down a list of things that you know make you feel good, have meaning to you, or you’re good at. Then see if you can block off little chunks of time throughout your week to do those things.
2. Social Distancing and Social Connection — Connecting with other people is important for mental health. It gives us emotional support, helps us feel part of something larger than ourselves, and gives us a space to decompress and share our experiences and feelings.
Maybe you’re used to chatting with coworkers, meeting up with friends for a drink after work, or seeing your neighbour at the gym. With people working from home, and restaurants, bars, movie theatres and gyms shutting their doors, many of our social connections are being cut off. This can mean less emotional support and a loss of belongingness and connectedness. If you are feeling cut off from others, see if you can maintain those ties even from six feet apart! Try calling or texting a friend, or emailing a coworker to see how they’re doing.
Having virtual hangouts, group chats or Skype happy hours with friends is another way to stay connected. See if a few friends want to Facetime over afternoon coffee or a beer after work from their living rooms, instead of the local café or pub. Also, keep in touch with friends or relatives who are older, immunocompromised, or live alone — they will feel supported knowing that someone is keeping an eye out for them, and it will help them to feel less isolated too.
3. Managing Relationships — In addition to changes in daily routines and social connections, the pandemic may have caused changes in our relationships at home. For those who live with a partner, children, or roommates, you are suddenly seeing a lot more of each other. This is an adjustment and can put strain on relationships.
Heather Pederson, Ph.D., a board-certified couple and family psychologist, says that one approach is to see the relationship with your loved one as a means of self-care, using that connection for comfort. This can include doing things together as a team (even simple things, like planning grocery lists), and looking at your partner or family member as a resource. Some couples or families might need to work on negotiating responsibilities, e.g., for new cleaning, childcare, or cooking routines due to social distancing. Dr. Pederson emphasizes that this doesn’t always happen naturally, and family members might need to check in with each other to keep the balance of responsibility, which she likens to an always-shifting teeter-totter.
What about those moments when we’re worn thin and anger starts to bubble up? Pederson says that “anger is a protective emotion.” It’s telling you that somewhere, you have a need that’s not being met. She encourages people to get curious, to try to figure out what’s underneath the anger and what needs aren’t being met? Then communicate that to your family member. If conflict gets too heated to work out alone, Dr. Pederson suggests looking for a therapist trained in Emotionally Focused Couple Therapy (EFCT).
4. Dealing With Uncertainty — Uncertainty can be scary. Most of us have not dealt with a pandemic of this scale before, nor had our lives so directly affected. It’s hard to know what to expect. And it is totally normal to feel anxious or stressed in the face of these changes. However, there is a line between a normal level of pandemic-related anxiety, and anxiety at a level that’s interfering with your functioning.
If you are having blips of anxiety related to the pandemic that are relatively minor, try using some acceptance-based coping skills. Remind yourself of what’s in your control, and what isn’t. Then be ready to release what’s not in your control — things like how public health officials are responding to the pandemic, or schools and businesses closing.
Instead, focus instead on what you are able to control — practicing handwashing and social distancing, setting your daily routine, checking on loved ones.
Another technique is practicing mindfulness. This is a skill that focuses on shifting your awareness away from anxiety-producing thoughts, and into a more neutral space, focusing on your breath, movements, or an object. Moving away from the tangle of thoughts that can bring anxiety and fear.
There are some free mindfulness meditation audio tracks online, including a 20-minute breathing exercise from mindfulness meditation leader Dr. Jon Kabat-Zinn at the UMass School of Medicine. If you are having more severe anxiety that’s affecting your functioning, it’s best to contact a mental health professional for help.
5. Adapting — Sooyeon Suh, Ph.D. is a clinical psychologist at Sungshin Women’s University in South Korea, one of the countries first affected by the pandemic. Living through the pandemic over the past weeks, she has seen a few patterns play out. For instance, she mentions that some people might be too ambitious at the start — making elaborate meals every night, starting a difficult new exercise routine, setting out to write a novel, etc. She says it’s important to manage expectations so that you don’t burn out. If you try to do too much, you may just end up exhausting yourself. She says that a doable routine is key if you are going to maintain it long-term.
Similarly, she says that expectations may need to change for those who are trying to work from home and parent or home-school at the same time (for instance, your kids might get more screentime than usual). She said there is also a tendency for people’s sleep schedules to shift, or to engage in snacking or boredom eating. She emphasizes that it’s important to keep a regular routine for meals, bedtime, and waking up at the same time in the morning.
Overall, she says that a key step in coping with these changes over the course of weeks to months is to acknowledge that change is difficult, to adjust expectations of yourself and others, and to give yourself credit for doing what you can in this difficult time.
I hope that these suggestions were useful. Stay safe and take care of yourself and others, physically and emotionally!
A version of this article was originally posted on Dr. Hantsoo’s website.
NOTE FROM THE EDITORS: We would like to say a big thank you to Dr Liisa Hantsoo for allowing us to share this wonderful blog with our readers on InSPIre the Mind. Liisa works at the Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine. She has previously written another great blog for us on stress early in life and the effect it can have on our gut. Thank you, Liisa!
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