Even if you are not prone to worrying about every ache or pain, scouring the web for worst-case scenarios, it is easy to obsess about your health during a worldwide pandemic. To many of us, in fact, that seems like a much more realistic reaction to COVID-19 than standing shoulder-to-shoulder in crowded bars and party venues, seemingly without a care in the world.
And from a public health standpoint, of course, most experts want you to land closer to the more cautious end of the spectrum. “Some anxiety is good,” says Angela Drake, Ph.D., a professor of psychiatry and behavioral science at UC Davis. “You don’t want to be the guy stumbling around Safeway without a mask and with very low anxiety, because he is being exposed more and could get sick. You want to modulate and use anxiety as motivation (to keep yourself safe).” But, she adds, you also want to avoid going so far into a COVID panic that you are “driving yourself and everyone around you crazy.”
Sounds practical, but if you are prone to health worries, how do you strike the right balance? Is it possible to maintain physical distance, gracefully accept mask-wearing, drench yourself in hand sanitizer, dance around a shared bathroom or break room at the office, monitor potential exposure, evaluate possible symptoms—but not assume you have coronavirus every time you cough or feel hot?
Several local mental health professionals offer some timely—and very warmhearted—advice.
Normalizing the Situation
First of all, it’s important to realize the emotions you are feeling about this unprecedented worldwide public health emergency are a rational response.
“There’s a lot of stress and anxiety all around,” says David Hsu, M.D., an adult and geriatric psychiatrist with Dignity Health Mercy Medical Group. “The pandemic context is important. I empathize with patients because I struggle with it, too. There have been a lot of changes, and it’s good to have some concern and be serious about this.”
The fact we are all going through this experience at the same time means it is easy to find others who share your fears and can provide some camaraderie, but also help set a brake on unrealistic panic.
“We must physically distance . . . but we don’t have to be socially distanced,” says Christina Bilyeu, M.D., chief of mental health services for Kaiser Permanente Sacramento and Roseville. “If you’re checking in with yourself and friends and family, it’s easier to see this is normal.”
As an example, Bilyeu cites a personal experience she had a couple of months ago. She arrived at work on a summer day, parked her car, then got caught up for a few minutes after turning off the ignition—and the air conditioning. When she arrived at the hospital entrance for her required temperature check, the reading was 99 degrees. “Oh, no!” she instantly thought. But her co-worker said, “Weren’t you just sitting in your car?” She calmed down, realizing that, yes, she had gotten physically warm in a hot automobile and did not have COVID. “(It’s important to) have someone to reflect that back to you,” Bilyeu says.
The length of time we have been forced to alter our behavior also takes an emotional toll. “For students and parents, at first it was going to be two weeks, then three weeks, then six weeks, then the rest of the school year,” says Tam Nguyen, Ph.D., director of ambulatory mental health and addiction care for Sutter Health, who also has two young children. “It’s really dramatically changed the way we live, work and play.”
She, too, has felt the challenge, balancing her job as a clinical psychologist with managing education and activities for her 4- and 7-year-old children: for example, slathering them with sunscreen and sending them to the park with a socially distanced tutor minutes before a phone or Zoom meeting. “At first it was kind of cool, working at home,” she says. “But now it’s not so cool and becomes a question of how do I adjust?”
Stay in the Now
A big component of anxiety is anticipating the very worst possible outcome and reacting emotionally as though this scenario has already come to pass. It is times like this, in fact, when our big human brain with its ability to envision the future is not always helpful. But mental health professionals have a variety of tricks to combat this type of catastrophic thinking.
“It’s important to take an inventory, monitoring where you’re at on a scale of one to 10,” says Drake, who specializes in people with health anxiety—even pre-COVID. “If your anxiety is getting high, go wash your hands, do some deep breathing, go for a walk. Activity helps.”
She describes one of her own coping methods when she walks her dog in the mornings: Rather than worrying if someone is too close to her or is not wearing a mask, she focuses on how she is placing her foot, how it is rolling on the ground. She also recommends yoga, knitting and crocheting, folding laundry, doing little household tasks. “Moving in a rhythmic pattern, and doing something that’s not hard—so no sudoku,” she says with a laugh. “Think about how do you calm a baby: in a rocking chair. It’s rhythmic and soothing.”
It’s also helpful to focus on things you can make decisions and choices about, as opposed to things that are out of your hands (like how long this pandemic will last). “You have control over your behavior—how you spend your day,” says Hsu. “One extreme is probably not good: the idea of being in a crowd, shoulder-to-shoulder, no mask. But the other extreme is also not a good idea: to stay at home all day, neglecting the essential activities of life.”
He suggests these include going to work and paying attention to your finances (which can alleviate economic anxiety), taking care of your children or other family members (which includes grocery shopping and cooking meals) and getting some exercise. “You’re not going to sit on the couch all day,” he says.
Bilyeu encourages people to be aware of COVID symptoms and to be mindful of self-care, but to also stick to a routine and keep moving forward with their lives. “Even working remotely, get up on time, shower, put on your makeup,” she says. “A daily routine helps relieve anxiety, even if you’re just going from your bedroom to your kitchen table.”
In general, it is best to stay in the moment with a cautious appreciation for the international emergency you find yourself in. “We should be adequately prepared—just as we are for earthquakes in California,” says Nguyen. “But you’re not sitting by the earthquake kit every night.”
There is also at least some suggestion you shouldn’t be sitting by a screen all night—and certainly not all day. Instead, find a balance in terms of how much information you need to navigate COVID-19. But there is a subtle spectrum there, too.
“If you’re watching too much TV, reading every article, searching the internet, you can become more anxious,” says Drake. “But others do well with information; it’s comforting. Their anxiety levels feel better after watching CNN or reading The New York Times.”
Experts suggest, however, that your news sources should be reliable and objective. It’s best to pick a couple that you trust.
“Staying informed is in the category of being prepared,” says Nguyen. “But you don’t want to be inundated because it can be conflicting, and that also raises anxiety. Stick to the same news sources.”
It might also lessen your anxiety to read a newspaper, where you can pick and choose what stories you take in, as opposed to watching TV news, where you can’t control what you see, says Bilyeu. She also recommends about one hour of news in the morning, so you have the information you need for your day, and a half hour in the evening to catch any changes. “And social media is not the most objective source, so limit the amount of time (you consume) news through social media,” she advises.
If you’ve been working upstairs on a warm afternoon and you feel a flush of heat, an outbreak of sweat, it’s easy to run for the thermometer. And for some people, there is even a big temptation to rush out and get a COVID test. But if your risk exposure hasn’t changed (you haven’t been around someone who has the virus; you haven’t been eschewing public health guidelines; you haven’t been in a crowd with unmasked strangers), leaping to these medical steps may not be the best decision. For one thing, tests are still not readily available for people who are not actively showing symptoms. For another, your anxiety can become “hooked” on this type of relief. “If you test negative, your anxiety will be reduced immediately, but then you’re dependent on that,” says Drake, adding the next time you feel anxious, you’ll be running for the thermometer again or wanting another test. If you’re away from home, or denied a test, your anxiety can conversely ramp up.
On the other hand, people should not avoid medical treatment for real issues. “Especially for older people, if you wait, a condition can get worse,” Hsu says. “And you should still be seen for checkups. Kids still need their vaccines.” He also recommends a flu shot, which is generally a good idea every year but might be especially crucial as health officials worry about the intersection of influenza and COVID this winter.
Seeking treatment for mental health issues is also encouraged—and totally understandable, given the situation. “For anybody who is not coping well or is stressed, there are mental health professionals, wellness coaches, doctors, therapists and social workers who can offer—through telehealth or in-person visits—some extra support,” Hsu says. “We will welcome you, because we recognize there’s a lot going on. Hang in there, Sacramento. We are resilient and all in this together. And we’ll get through this.”