The healthcare response to Coronavirus is a challenge that is occupying all of our efforts right now, but there are other impacts as well. Christen Kishel, Ph.D., a licensed Psychologist who has previously commented for this blog, has offered some positive and constructive thoughts on our mental health during these challenges. If you have any lessons that you’ve learned as a leader during this evolving crisis, please submit them here anonymously.
The other pandemic: Anxiety. For emergency responders and others who have to remain in close contact with potential carriers of Covid-19, here are some thoughts from your friendly neighborhood shrink:
First of all, get the facts. Accurate information is the first thing we all need in order to manage anxiety. We may not know the long-term course of this virus, but we do know a few things, and can put our focus there:
1) As of March 18, 2020, the CDC reported:
a. 0 deaths among people under age 19
b. 9 deaths among people age 20-64 (only 9 deaths among people in the age group of most Firefighters, EMTs, etc)
c. 20 deaths across all of US among 65-84 year olds (that’s a few of you)
d. 15 deaths among 85+ year old US citizens
e. Approximately 80% of people who contract the virus have only mild symptoms.
f. Around 15% require hospitalization at present, which is a high number, but still not the majority.
2) Remember to read the above statistics with your logical mind, not your emotional brain! Your emotional brain (limbic system) will tell you that these numbers are awful and we will soon be experiencing the terrible conditions and choices citizens of Italy are currently facing. This is still an evolving crisis, and fear does not help us!
3) We have a few things going for us:
a. While social media can exponentially increase fear, social media is also helping spread the message to the citizenry to stay home and help flatten the curve. This is happening in many ways, from matchstick diagrams to probability tables that reinforce social distancing as an effective strategy for flattening the curve. Many people are posting fun sites with resources for kids and families, virtual tours of cool places, creative things they are doing to weather the storm, etc.
b. We are grownups who have the ability to get off social media if we want to stop the flood of anxiety-ridden posts. Or we can choose to stay on it to laugh at and shake our heads at all the memes about what might alternately be dubbed the Cornholio virus (since apparently we need excessive amounts of TP for our bungholes!). If you want to stay informed, call the official hotlines or visit the informational sites your departments, states, and national evidence-based entities are posting with daily updates.
c. We are smart enough to make smart choices. We know to wear N95 masks and safety glasses, to glove up, and to wash our hands and sanitize often. Those who have been in the health care industry have the most practice in using proper PPE – and IT WORKS! PPE recommendations are evolving on a daily basis, including based on availability, so use your trusted sources to stay up-to-date on today’s best practices. Consider making a checklist for your PPE practices to help you remember!
4) And now for a little good old-fashioned psychology.
a. One of the best strategies for defeating or at least mitigating anxiety is to know what is it that you cannot control (the virus) and what you can (your thoughts, focus, and actions). Let’s start with the basics.
b. The two best things we can do for ourselves to battle emotional distress, from everyday worries to fears of impending doom are exercise and sleep. Just because the gym isn’t open (it was probably gross in there long before Covid-19!) doesn’t mean you can’t exercise. In fact, it’s been shown that fresh air and sunshine are two of our greatest allies in beating any pandemic – especially the one between our ears! Take your dog for a walk, take your spouse for a walk, take yourself for a walk. Deep clean the house to get it sanitized for the form of exercise known as elbow grease (great therapy for me this week!). Try to learn some tik-tok dance videos and laugh at yourself, then film yourself doing them to make your kids laugh. Or maybe try one of the fancier YouTube dance tutorials. Hell, just walk laps around your house if you want. Remember the story of the 86-year-old African American woman who lost 120 pounds that way? (Check it out for yourself!)
c. Worry and anxiety disrupt sleep, which begets more worry and distress. Exercise earlier in the day helps with better sleep at night. Some tips to help with sleep disturbance:
1) Set up your environment. Remove TV, laptops, tablets, and non-essential communication devices from the bedroom. Limit the electronics in the bedroom to music, white noise/nature sounds, guided meditations, and clocks that are as dim as possible. The body needs to have a clear association between the bed and the 3 S’s: Sleep, sex, and snuggles!
2) Room darkening curtains or eye masks help.
3) Unless you are one of those people who have a sensory issue that means you need no sheets or covers at all, use heavier blankets and a cooler room (68 degrees is recommended by researchers).
4) When not on the job, go to bed and wake up at the same time every day.
5) Alcohol is your frenemy. The deep (delta) sleep and REM sleep are where your body clears out toxins via cerebrospinal fluid. Alcohol can make you sleepy but disrupt your ability to get to those deep sleep states.
6) Also watch out for caffeine. As a coffee addict myself, I know how hard this is. Preaching not teaching!
7) Use a “happy light” (about $35 on amazon) for 30 minutes in the morning.
8) Nap as much as you can or at least 30 minutes a day.
9) Find a meditation app like Insight Timer, Headspace, and Calm apps to find something that works for you. Those who know me know that I am a metal head when it comes to concerts with a wide palate in between, but at night, for decades, my body knows that Enya = bedtime.
10) If thoughts are getting the best of you and panic is setting in, get up and away from the bedroom and distract yourself with stupid tv, funny stuff, etc. No need to sit in bed and stew and suffer. Refer to #1 for what bed is actually for.
11) Melatonin and other sleep remedies can help during times of distress. I personally use things like Alteril or Sleep 3 that have melatonin, valerian root, and tryptophan because they work for me and don’t make me groggy. You have to decide for yourself. I would recommend staying away from Ambien. Talk to your doc to see what might help.
d. Mindfulness is powerful. And it’s not woo!
1) No need to chant OM if that is not your thing. Real mindfulness means returning to the present.
2) If you have one foot in tomorrow (anxiety) and one foot in the past (depression, resentment, regret) you are pissing all over today!
3) To stay in today, ask yourself a simple question: “Where am I now?” While snuggling between snooze alarms this morning my mind was on everything there is to worry about, including myself, my family, my friends, and the emergency responders I care about deeply. But I need take care of me if I am going to take care of you. So, I asked myself, “Where am I now?” and gave Shadow (my little granddog) another belly rub!
4) If I am doing dishes, I am doing dishes. If I need something in the background to minimize some of the 500 tabs that are always open in my brain, I make it something I can learn from or entertained by (not news!). Jeopardy, Master Chef Junior, Cash Cab, and the like are shows that I can pay some attention to if I want to while doing whatever is at hand.
5) Nutrition matters. When we are not serving people in the community, we might be spending a lot of time indoors. Take your vitamin D. Other supplements recommended by others more educated than me include Magnesium and Omega 3’s. Idiots might be buying up all the TP. But things like Swiss Chard are still readily available at most grocery stores!
6) You already know how to eat healthy. It’s up to you to make your menu what you want it to be. Involving your family in the process can be a lot of fun, and a connecting activity.
e. When you are at home, what do you think does your family more good: fretting about whether you carried something home (worry = cortisol = immune impairment = more likely to catch something), OR knowing you did the best you could to maintain high standards with PPE and cleanliness, and then focusing on relationship once you are home? I don’t think you need my PhD to know the answer! Even if you can’t let go of the worry, Take Positive Action! Remember that worry is like rocking in a rocking chair. You move a lot but get nowhere.
5) In the meantime, watch the video “Rocks, Pebbles, and Sand Story” on YouTube. What are the rocks in your life? Chances are your family is top of the list. How do you make the most of family time?
a. Kids being home from school means a golden opportunity for family team building. You might not do an escape room right now, but you can order a murder mystery online for the family to work on together! If you have siblings with kids, consider things like having all of them watch the same virtual zoo or museum tour or other educational activity and have a facetime chat about it amongst everyone.
b. Get creative! What do you wish you and your significant other, family, etc, always say they want to do but never have time for? Is it learning to change a tire, cook a meal, or watch a show? Do it!
c. Do you and your spouse dream of traveling? This pandemic won’t last forever, so plan for adventure when it passes! We are personally looking into a New Zealand trip with our friends. Our inner nerds need to do the LOTR tour at the very least!
6) If you are single, no need to despair! You can connect with friends online to play games like WordFeud or Words With Friends, read books that libraries are making available online and discussing them together, playing 20 questions, or texting/calling/face-timing to whine or collaborate!
7) Pets are indispensable. Research shows again and again that there are actual biological and neurological benefits to petting and snuggling with your pets. And some need walks that are good for you too! If you don’t have a pet but need a warm fuzzy, consider a cuddle buddy, a microwaveable stuffed animal that can warm your heart center. Pillows are good too (though not as warm). Even emergency responders need cuddles now and then!
The point is, we can let the virus win or we can win. We win by living our best lives and keeping the problem at hand in perspective. We learn the facts and take the precautions, and when we are off duty, we put our focus where it belongs. Not on the virus but on the relationships with ourselves, our families, and our friends that matter most. We give ourselves permission to indulge in connection, laughter (including dark humor), exercise, and creativity. You have no control over the presence of the virus and your exposure to it (though if you have symptoms, stay home! Let admin worry about coverage!). You DO have control over where you invest your energy, your thoughts, and your time. As long as you are alive, I recommend that you really live!!