NYAPRS Note: Fear is even more contagious than the virus. I hope you all find these helpful. Be safe and know that you are not alone and that we will get through this, with care, caution and compassion for ourselves and others.
Manage Anxiety & Stress
Coronavirus Disease 2019 (COVID-19)
Center for Disease Control and Prevention
STRESS AND COPING
The outbreak of coronavirus disease 2019 (COVID-19) may be stressful for people. Fear and anxiety about a disease can be overwhelming and cause strong emotions in adults and children. Coping with stress will make you, the people you care about, and your community stronger.
Everyone reacts differently to stressful situations. How you respond to the outbreak can depend on your background, the things that make you different from other people, and the community you live in.
People who may respond more strongly to the stress of a crisis include
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Older people and people with chronic diseases who are at higher risk for COVID-19
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Children and teens
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People who are helping with the response to COVID-19, like doctors and other health care providers, or first responders
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People who have mental health conditions including problems with substance use
If you, or someone you care about, are feeling overwhelmed with emotions like sadness, depression, or anxiety, or feel like you want to harm yourself or others call
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911
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Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746. (TTY 1-800-846-8517)
Stress during an infectious disease outbreak can include
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Fear and worry about your own health and the health of your loved ones
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Changes in sleep or eating patterns
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Difficulty sleeping or concentrating
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Worsening of chronic health problems
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Increased use of alcohol, tobacco, or other drugs
People with preexisting mental health conditions should continue with their treatment and be aware of new or worsening symptoms. Additional information can be found at the Substance Abuse and Mental Health Services Administration (SAMHSAexternal icon) website.
Taking care of yourself, your friends, and your family can help you cope with stress. Helping others cope with their stress can also make your community stronger.
Things you can do to support yourself
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Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting.
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Take care of your body. Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs.
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Make time to unwind. Try to do some other activities you enjoy.
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Connect with others. Talk with people you trust about your concerns and how you are feeling.
Call your healthcare provider if stress gets in the way of your daily activities for several days in a row.
REDUCE STRESS IN YOURSELF AND OTHERS
Sharing the facts about COVID-19 and understanding the actual risk to yourself and people you care about can make an outbreak less stressful..
When you share accurate information about COVID-19 you can help make people feel less stressed and allow you to connect with them.
Learn more about taking care of your emotional health.
FOR PARENTS
Children and teens react, in part, on what they see from the adults around them. When parents and caregivers deal with the COVID-19 calmly and confidently, they can provide the best support for their children. Parents can be more reassuring to others around them, especially children, if they are better prepared.
Not all children and teens respond to stress in the same way. Some common changes to watch for include
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Excessive crying or irritation in younger children
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Returning to behaviors they have outgrown (for example, toileting accidents or bedwetting)
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Excessive worry or sadness
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Unhealthy eating or sleeping habits
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Irritability and “acting out” behaviors in teens
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Poor school performance or avoiding school
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Difficulty with attention and concentration
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Avoidance of activities enjoyed in the past
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Unexplained headaches or body pain
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Use of alcohol, tobacco, or other drugs
There are many things you can do to support your child
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Take time to talk with your child or teen about the COVID-19 outbreak. Answer questions and share facts about COVID-19 in a way that your child or teen can understand.
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Reassure your child or teen that they are safe. Let them know it is ok if they feel upset. Share with them how you deal with your own stress so that they can learn how to cope from you.
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Limit your family’s exposure to news coverage of the event, including social media. Children may misinterpret what they hear and can be frightened about something they do not understand.
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Try to keep up with regular routines. If schools are closed, create a schedule for learning activities and relaxing or fun activities.
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Be a role model. Take breaks, get plenty of sleep, exercise, and eat well. Connect with your friends and family members.
Learn more about helping children cope.
FOR RESPONDERS
Responding to COVID-19 can take an emotional toll on you. There are things you can do to reduce secondary traumatic stress (STS) reactions:
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Acknowledge that STS can impact anyone helping families after a traumatic event.
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Learn the symptoms including physical (fatigue, illness) and mental (fear, withdrawal, guilt).
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Allow time for you and your family to recover from responding to the pandemic.
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Create a menu of personal self-care activities that you enjoy, such as spending time with friends and family, exercising, or reading a book.
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Take a break from media coverage of COVID-19.
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Ask for help if you feel overwhelmed or concerned that COVID-19 is affecting your ability to care for your family and patients as you did before the outbreak.
Learn more tips for taking care of yourself during emergency response.
FOR PEOPLE WHO HAVE BEEN RELEASED FROM QUARANTINE
Being separated from others if a healthcare provider thinks you may have been exposed to COVID-19 can be stressful, even if you do not get sick. Everyone feels differently after coming out of quarantine. Some feelings include :
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Mixed emotions, including relief after quarantine
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Fear and worry about your own health and the health of your loved ones
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Stress from the experience of monitoring yourself or being monitored by others for signs and symptoms of COVID-19
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Sadness, anger, or frustration because friends or loved ones have unfounded fears of contracting the disease from contact with you, even though you have been determined not to be contagious
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Guilt about not being able to perform normal work or parenting duties during quarantine
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Other emotional or mental health changes
Children may also feel upset or have other strong emotions if they, or someone they know, has been released from quarantine. You can help your child cope.
RESOURCES
For Everyone
For Communities
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Coping with stress during an infectious disease outbreakpdf iconexternal icon
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Taking Care of Your Behavioral Health during an Infectious Disease Outbreakexternal icon
For Families and Children
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Coping After a Disasterpdf icon – A Ready Wrigley activity book for children age 3-10
For First Responders
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Quarantine Has Serious Impact On Mental Health. Here’s How To Support Yourself And Others
By Olivia Goldhill Quart March 15, 2020
Earlier this week, I went through a process that will soon become commonplace: I quarantined myself. After going to a large journalism conference where someone later tested positive for coronavirus, it seemed like the prudent thing to do. The process is increasingly normal and medically endorsed; it’s already clear that limiting social contact is absolutely the best way to reduce the spread of coronavirus. But that doesn’t make it easy.
Before shaming others for going to the park or labeling staying indoors as a “minor inconvenience,” as has happened on Twitter, know that medical quarantine, and isolation in general, is associated with serious mental health effects. A recent review of research, published in The Lancet, found that quarantine is linked with post-traumatic stress disorder (PTSD) symptoms, confusion, and anger, with some research suggesting these effects are long-lasting. Given that the coronavirus crisis is likely to be with us for some time, the mental health implications can’t be dismissed.
Confusion and stigma
Whether in quarantine or not, anxieties are only worsened by confusion and social judgment as people try to figure out the appropriate response. A friend living in Venice recently described the dynamic playing out around her, as Italy enforces strict social-distancing measures. In an email, in she writes:
There is an eerie silence throughout this city now, a drawn look on the face of anyone who is scurrying around the streets (as I still am), an accusatory dynamic between friends and family as each person tries to insist either that they are right in NEVER leaving the house or alternatively that they are right in STILL leaving the house… No-one seems to be able to accept the free decisions of others at the moment, from the government right on down, and I find that worrisome.
Clear information from government sources is a helpful piece of the process.
Psychiatry professor Rima Styra and her University of Toronto colleague Laura Hawryluck, a professor of critical care medicine, researched quarantines during the SARS outbreak and found that 29% of those quarantined showed signs of PTSD, and 31% had symptoms of depression following isolation. “Our study really pointed to the importance of reliable, consistent information and updates so that people can understand what we know, what we don’t know and how we are trying to close this gap,” the professors wrote to us via email.
Public health and government services should provide detailed information about the symptoms of coronavirus, its typical course, how many are being cared for at hospitals, and for how long, Styra and Hawryluck advised. “The ways people in quarantine will be monitored and what to do if they start developing symptoms also need to be crystal clear and be flexible enough to meet the needs of people with different levels of access to and skills in technology,” they added.
Public guidance is currently vague, with various health officials offering different instructions. Among colleagues and acquaintances who were potentially exposed to coronavirus at the journalism conference I attended, some were told to isolate themselves entirely, others were told to simply avoid large crowds, and some were told it’s ok to get groceries as long as they keep their distance from others.
There’s no clear right answer given these contradictory messages, but it’s better to find a doctor or public health official you trust over amateur epidemiologists. The one I consulted for my own situation advised taking strict precautions if you come into contact with someone with coronavirus (of course, what constitutes “contact” depends on which health official you speak with). She also recommended stringent isolation for anyone with symptoms of coronavirus.
What To Do When You’re Alone
Despite the confusion over exactly how and when to quarantine, millions of people around the world will inevitably have to drastically reduce social contact and spend time in isolation to combat coronavirus. Frank McAndrew, an evolutionary psychologist at Knox College in Illinois, notes that enforced quarantine is particularly distressing. “Being quarantined gives one a sense of being at the mercy of other people and other uncontrollable forces such as an epidemic. This leads to a feeling of helplessness and uncertainty about the future that can be very unsettling,” he tells us via email.
Prolonged periods in situations where nothing changes can push people to turn inward, McAndrew notes. “For those unaccustomed to such introspection and rumination, the experience can lead to negative emotions, and in extreme cases, a blurring of the boundaries between what is going on in one’s own mind and what is actually happening around you,” he writes.
Activities that create a sense of change and purpose, such as rearranging the furniture or cleaning the house, can help create stimulation.
Sue Firth, a chartered occupational psychologist in the UK, says that humans need the ability to make decisions and be in control, a sense of community and connection with others, and purpose or effectiveness. She suggests trying to create all of this while in isolation, whether by Skyping friends, assigning yourself structured work, or exercising indoors with yoga or dance videos. Creative projects such as drawing, compiling photographs, or sudoku can help keep the mind active.
For those who aren’t in strict isolation, offering to help others can help create a sense of community. Loneliness is a serious health risk to older people who are vulnerable to coronavirus and are compelled to avoid social contact. Online groups offering to run errands and collect groceries can help those who are suffering the worst of isolation.
Ultimately, though self-care is important, professional treatment is crucial for a wide range of mental health problems. China’s National Health Commission released guidelines for psychological care during coronavirus and relocated mental health professionals to Wuhan, where the outbreak started, as reported Bloomberg. Several provinces in China also created 24-hour mental health hotlines to support those suffering from coronavirus and isolation.
The mental health implications of isolation do not mean we shouldn’t quarantine. It’s essential to follow medical professionals’ guidance on combating coronavirus, just as it’s important to recognize the difficulties. In times of isolation, we can support each other by recognizing mental health struggles and providing comfort even from afar.
https://qz.com/1818798/coronavirus-quarantine-has-serious-mental-health-implications/
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The Mental Health Cost of Containing the Coronavirus Outbreak
A Pandemic Takes a Unique Toll On People with Mental Illnesses.
By Anagha Srikanth The Hill March 16, 2020
When Dawn Brown picked up the phone, the director of the National Alliance on Mental Illness (NAMI) HelpLine was trying to figure out how to set up the hotline remotely. Building management had just informed NAMI that they were considering locking up the building next week over concerns of the novel coronavirus outbreak.
“We have seen an uptick [in calls to the NAMI hotline] and we’re beginning to track the calls related to COVID-19,” Brown said. “Right now, the bigger concerns are around anxieties about the unknowns, you don’t know what you don’t know, and the people we serve tend to be a little more vulnerable to anxiety and panic.”
One caller was grieving a loved one who died of the disease in Japan, while another reported thoughts of suicide over concerns they would lose their job.
Some callers have unstable housing or are homeless, while others are smokers, a group that is at a high risk for COVID-19.
To some extent, the reaction to the outbreak is expected, said Krystal Lewis, clinical psychologist at the National Institute of Mental Health.
“I do think it’s important to just normalize people’s experience of what’s happening,” said Lewis. “Everyone is going to feel some level of discomfort and anxiety right now, and it’s normal.”
But for some, the anxiety can rise to a clinical level during an outbreak.
Lewis said people should be aware of symptoms including difficulty sleeping, changes in eating patterns, rapid changes in mood, inability to carry out required or necessary tasks, self-medication using alcohol and drugs and prolonged self-isolation.
“For those who may already struggle with feelings of isolation due to depression, anxiety or other mental health conditions, social distancing could increase those feelings of loneliness and isolation,” Lewis said in an email.
Preventative measures such as social distancing and quarantines can also inhibit access to vital health care for people with serious mental illnesses.
NAMI is developing a list of resources to direct people to possible technology solutions, such as virtual therapy sessions. But some don’t have access to the internet at home and even those who do might not be able to afford it. Health care providers that cover in-person therapy sessions don’t always cover online versions. Prescriptions of controlled substances can also be difficult to stock up on, as some require lab tests or in-person visits to a health care provider.
“Ultimately, it is important to seek help from a professional to help manage ongoing, persistent anxiety and other difficulties,” Lewis said in an email.
But there are some measures mental health professionals suggest for both people with preexisting mental health issues and those without. One of the biggest ones is to watch your media consumption.
“Mass media coverage of a topic can have long standing and far-reaching effects. It is common for children and adults with health anxiety and generalized anxiety to be triggered by world events and news,” said Lewis in an email.
She and Brown both recommended setting limits for how often and how long you tune into media coverage of the coronavirus outbreak, as well as the sources you consult. Brown said she checks the news once in the morning and then once in the evening, and even recommends turning off push notifications on your phone.
And while it’s important to stay informed, they both advised being mindful of where you’re getting your news. If more information makes you feel in control, Lewis said to keep the Centers for Disease Control and Prevention website up for the most up-to-date and accurate information.
Other suggestions for self-care include:
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maintaining a routine
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journaling and writing down your worries
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talking to loved ones (by phone, text, social media or video) in a way that works for you
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meditative practices (such as using guided meditations and listening to calming music)
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taking walks (while avoiding large crowds)
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talking through your fears by challenging anxious, irrational thoughts
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disrupting the anxiety spiral by using techniques to bring you back into the present moment
NAMI also offers online support groups and a “warmline,” a confidential, noncrisis emotional support telephone hotline staffed by peer volunteers who are in recovery.
It’s also important to check in on those you love, especially those who are most vulnerable to mental health illnesses. Brown said to look for signs that they have been taking care of themselves and the environment around them and to ask whether they’ve eaten recently.
“Don’t be afraid to ask people pointed questions, even about suicide,” she said.
Even once measures such as social distancing and quarantine are lifted, there are still risks of lingering mental health effects, so it’s important to know the signs of distress and build up your support network.
“We’ll weather this,” Brown said. “Strength and resilience is what will get us through.”
If you or someone you know is struggling with thoughts of suicide, you can call the National Suicide Prevention Lifeline at 800-273-8255 or chat with a counselor here. To reach the NAMI helpline, call 800-950-NAMI, email info@nami.org or text “NAMI” to 741741.
You can also find more information and resources about managing anxiety and stress at:
Published on Mar 13, 2020