E5: Coping with Covid Stress and Anxiety
In this episode we check in with ourselves to evaluate how we’re feeling about of these changes that are rapidly occurring as we deal with Covid-19. We discuss several ways to cope with the stress of this pandemic including Dialectic Behavioral Therapy distress tolerance skills, which I have personally found incredibly helpful and effective.
Are you feeling stressed?
It’s important to check in on yourself, though it can be hard to tell exactly what we’re feeling. We may be feeling scared, panicked, angry, confused, concerned, or we may be feeling nothing at all, a way our bodies try to protect ourselves from overwhelming emotions. No matter what you’re feeling, or not feeling, I want to remind you it’s okay. It makes sense and it’s valid. Stress can create some of the following symptoms:
Cognitive signs: forgetting things more often; feeling confused; having trouble concentrating; difficulty making decisions
Emotional signs: anxiousness; anger; guilt; sadness/depression
Physical signs: stomachaches; very tight muscles; headaches
Behavioral signs: irritability; trouble sleeping or sleeping more than normal; crying easily; worrying excessively; wanting to isolate
What steps can we take to reduce anxiety in these unsettling times?
It’s important to pay attention to our physiological experience. Sometimes we have feelings even before we can think about them. In the morning, we might be waking up with a sense of anxiety or disequilibrium, or simply not feel as grounded as we’re used to feeling. Then, it might quickly come to us: Oh, I’m not going to the office. My kids aren’t going to school. My kids are coming home from college. Around the world, everything is in an uproar.
At that moment, it’s important to remember that you’re OK, that you’re lying in your bed and that nothing dangerous is happening to you at that moment. It’s a good time to do a breathing exercise. Breathe in for a count of three, then breathe out for a count of six. Taking just three or so breaths like this can really help lower our physiological response. The idea is to double the number of exhales you’re taking. Any time you are aware of feeling anxious during the day, you can take a few breaths like this to calm your nervous system.
If you’re feeling overwhelmed or panicked about the coronavirus, per the CDC’s advice, these are some steps you can take to help keep your anxiety controlled.
Limit news
Keep your news consumption to two to three credible sources for 30 minutes or less per day: Too much news consumption can make your anxiety worse. So if you’re feeling overwhelmed by the media coverage of COVID-19, then make an effort to keep it to a minimum. If you notice that you’re anxious at night, avoid the news a few hours before bed.
Check the facts
Challenge your irrational thoughts and replace them with facts: Irrational thoughts and beliefs are untrue or exaggerated thoughts about a situation. In contrast, rational thoughts are accurate and based on facts. An example of a rational thought would be: “There is a risk that I could catch the virus. But if I take the recommended precautions, then I will significantly decrease my risk.” Irrational thoughts foster anxiety, while rational thoughts help you view a situation more accurately and calmly.
Relax
Practice at least 5 minutes of relaxation each day: Counteract your stress with time spent in relaxation. For some people this may mean taking a hot bath, reading a book, or meditating. If you’re unsure what to do, you can try deep breathing, which stimulates the parasympathetic nervous system and helps induce calm. Start by setting a timer for 5 minutes and sitting in a comfortable space. Breathe in through your nose for 4 seconds, hold it briefly, and then exhale through your nose for 6 seconds. Continue this practice for the remainder of the time.
Connect
Stay in contact with your support system through phone, internet, and social media: This is very important. Humans are social creatures, and if you have to limit contact with loved ones, it can lead to feelings of isolation and depression. Whether you’re quarantined, social distancing, or just being careful, maintain contact with friends and family in whatever way you can.
Focus on what you can control
Paying attention to what we have control over is important. There are many things we cannot control about this situation and not knowing how long it will last can feel unnerving – but we can control some pieces of the day and it’s important that we focus on these things and not the things we can’t control.
If you’re unable to cope with your anxiety on your own, seek professional help: If you’re concerned about seeing a provider in person, you may be able to meet with a mental health professional through phone or video chat. The Coronavirus Preparedness and Response Supplemental Appropriations Act is a new law that allows healthcare providers to bill Medicare for services that are carried out through telehealth. You can call your health insurance company, speak with your physician, or conduct an online search for local mental health professionals.
DBT skills
Radical Acceptance
Acceptance means being willing to experience a situation as it is, rather than how we want it to be. To be repeatedly 'turning the mind'.
Be in the actual situation you are in, rather than the situation you think you're in, or think you should be in.
Each time your mind wanders and you notice these other thoughts and images, simply bring your attention back to this moment, right now, and being effective in this situation.
Don't judge the situation to be good, or bad. Judgement increase our emotional response.
You may need to 'turn your mind' many many times in a short space of time.
What Radical Acceptance is NOT:
Not judging the situation to be good
Not giving permission for the situation to go on forever
Not giving up your options
It can help to use memory aids to remind us of how we can help ourselves during distressing times
Distress tolerance
In DBT, Distress Tolerance skills are used when it is difficult or impossible to change a situation. These skills are used to help us cope and survive during a crisis, and helps us tolerate short term or long term pain (physical or emotional).
Tolerating distress includes a mindfulness of breath and mindful awareness of situations and ourselves.
Distracting
Self-soothing
Improving the moment wise mind
Focusing on pros and cons
Skill No. 1: Distracting
The first skill, distracting, helps clients change their focus from upsetting thoughts and emotions to more enjoyable or neutral activities. This skill is taught with the acronym ACCEPTS:
Wise Mind ACCEPTS
A - Activities (see distraction ideas below)
C - Contributing – helping others
C - Comparisons – comparing self with (better) self
E - Emotions – generate different emotions by watching movie/tv, listening to music etc.
P - Pushing away – thinking about or putting our attention onto something else
T - Thoughts - new thoughts. E.g. counting, playing 10 (10 colours in room, 10 fruits, 10 Bond films etc), or 54321 (5 things I can see, 4 things I can hear, 3 things I can touch, 2 things I can smell or like the smell of, 1 slow deep breath)
S - Sensations – use seeing, hearing, smelling, tasting and touching senses
Activities
Self-Soothing
The second skill in distress tolerance is self-soothing; clients can use the five senses to nurture themselves in a variety of ways: Vision: Look at beautiful things such as flowers, art, a landscape, or an artistic performance.
Vision: Look at beautiful things such as flowers, art, a landscape, or an artistic performance.
Hearing: Listen to music, lively or soft, or enjoy the sounds of nature such as birds chirping and waves crashing. Savor the voice of a relative or friend.
Smell: Use a favorite lotion or perfume, light a scented candle, notice the scents of nature, or bake an aromatic recipe.
Taste: Enjoy a hearty meal or indulge in decadent dessert. Experiment with a new flavor or texture, and focus on the food’s flavors.
Touch: Pet an animal or give someone a hug. Have a massage, rub on lotion, or snuggle up in a soft blanket.
Skill No. 3: Improving the Moment
In the third distress tolerance skill, the goal is to use positive mental imagery to improve one’s current situation. The acronym for this skill is IMPROVE:
IMPROVE the moment
I - Imagery – e.g. safe place visualisation
M - find Meaning in the situation
P - Prayer – meditation, spirituality, affirmations
R - Relaxation
O - One thing at a time
V - Vacation – take some time out of the situation, 'me' time, or imagining yourself on an idyllic beautiful holiday
E - Encouragement – positive and calming self talk
Skill No. 4: Focusing on Pros and Cons
In focusing on pros and cons, the individual is asked to list the pros and cons of tolerating the distress and of not tolerating the stress (i.e., coping through self-destructive behaviors). It can be helpful to remember the past consequences of not tolerating distress, and to imagine how it will feel to successfully tolerate the current distress and avoid negative behaviors. Through evaluating the short-term and long-term pros and cons, clients can understand the benefits of tolerating pain and distress, and thereby reduce impulsive reactions.
TIPP
You’re at your emotional breaking point. Maybe the worst has happened, or maybe it was just the “last straw”. The DBT distress tolerance skill you need is TIPP. This skill is designed to bring you down from the metaphorical (hopefully not literal) ledge. The distress tolerance skills in TIPP will bring you a step closer to wise mind, where you will be able to make a constructive choice and cope productively. TIPP stands for Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation.
TEMPERATURE
When we’re upset, our bodies often feel hot. To counter this, splash your face with cold water, hold an ice cube, or let the car’s AC blow on your face. Changing your body temperature will help you cool down—both physically and emotionally.
INTENSE EXERCISE
Do intense exercise to match your intense emotion. You’re not a marathon runner? That’s okay, you don’t need to be. Sprint down to the end of the street, jump in the pool for a few laps, or do jumping jacks until you’ve tired yourself out. Increasing oxygen flow helps decrease stress levels. Plus, it’s hard to stay dangerously upset when you’re exhausted.
PACED BREATHING
Even something as simple as controlling your breath can have a profound impact on reducing emotional pain. There are many different types of breathing exercises. If you have a favorite, breathe it out. If you don’t, try a technique called “box breathing”. Each breath interval will be four seconds long. Take in air four seconds, hold it in four seconds, breathe out four, and hold four. And then start again. Continue to focus on this breathing pattern until you feel more calm. Steady breathing reduces your body’s fight or flight response.
PAIRED MUSCLE RELAXATION
The science of paired muscle relaxation is fascinating. When you tighten a voluntary muscle, relax it, and allow it to rest, the muscle will become more relaxed than it was before it was tightened. Relaxed muscles require less oxygen, so your breathing and heart rate will slow down.1
Try this technique by focusing on a group of muscles, such as the muscles in your arms. Tighten the muscles as much as you can for five seconds. Then let go of the tension. Let the muscles relax, and you’ll begin to relax, as well.