Ask the experts: Mental health and wellness during the COVID-19 pandemic

Advice provided by:

Susan Mercer MSW, RSW
Clinical Social Worker RSW at Onward Choices Consulting Inc

Keith S. Dobson, PhD
Professor of Clinical Psychology, University of Calgary
Past- President, Canadian Association of Cognitive and Behavioural Therapies (2019- 2020)
Consultant, Opening Minds Program, Mental Health Commission of Canada

Frequently asked questions
 

How do pandemics in general affect our mental health?

Dobson: Right now, being worried and anxious is perfectly understandable. We can break down what’s happening by looking at the psychology of anxiety. There are three big predictors of how stressful something is going to be: (1) how predictable it is, (2) how much we can control it, and (3) how important it is to us.

With COVID-19, we’ve got a situation that checks all three boxes. There’s a lot we don’t know, we have relatively weak controls (e.g., hand washing, physical distancing), and it’s really important ꟷ even lethal in the worst case. So we shouldn’t be surprised at our heightened reaction.

Mercer: While any change to our regular day or routine can affect our mental health, this situation is doubly challenging because news of the pandemic is virtually inescapable, and there’s no clear end date. It’s all over the television and social media.

If we’re used to feeling pretty good, the fear of “What if I get sick?” can shake up our confidence. On the other hand, if we already experience less than optimal health, the current climate can ratchet up pre-existing anxiety or stress.

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How can I monitor my mental health? What’s healthy in this situation, and what’s concerning?

Dobson: The Mental Health Commission of Canada has a great resource inside The Working Mind COVID‑19 Self-Care and Resilience Guide, called the mental health continuum model. It’s a simple tool that presents a series of emotional, cognitive, behavioural, physical, and substance use indicators. These indicators can be used to measure positive-through-deteriorating-to-poor mental health, and changes in personal functioning. Colour-coded as green (healthy), yellow (reacting), orange (injured) and red (ill), the indicators are paired with their corresponding colours to help you understand when it might be time to ask for help.

Mercer: Everyone is different, and everyone will react differently. So, what you need to understand isn’t what’s “normal” but rather what’s healthy for you. As we’re being asked to constantly monitor our physical health (are we coughing? is that a sore throat? do we have a fever?) it’s easy to overlook our mental health. But in fact, it’s more important now than ever. Keep an eye on how you’re feeling or what might trigger negative responses. If news and social media are causing you to believe that everyone else is juggling competing demands better than you are, shut down the computer. If the news cycle is causing your stomach to clench, turn it off. If your kids are resisting a rigid routine, focus on manners and kindness, and forget the mess.

Don’t try to fix everything right now. Pick one thing that isn’t sitting well with you and focus on that.

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How I can cope with the stress and anxiety I’m experiencing because of the pandemic?

Dobson: Negative thoughts, such as predictions, worries, or even catastrophic thinking, are normal when we feel anxious. The key is addressing them properly, and there are three basic strategies.

First, ask yourself if your negative thought is realistic. To bring your thinking more in line with the facts, seek out information from a reliable source. Of course, if the situation is unknown, searching for answers isn’t a good use of your energy. Sometimes, recognizing that “only time will tell” is the hardest but most effective strategy.

Second, see if you can challenge your negative thought with a healthier alternative. For example, instead of saying “This is awful,” try “This is a challenge, but I’ve overcome lots of challenges in my life before.” Just make sure you don’t replace negative thoughts with unrealistically positive ones.

Third, try to use gentle, more compassionate language with yourself. In other words, talk to yourself like you’d talk to a friend. Be aware of your negative thinking, but don’t beat yourself up if you don’t conquer it every time. Consider saying to yourself, “There’s that horrible thought again. Oh well, it’s reminding me to be concerned. I’m still going for my walk to take care of myself.”

Sometimes, turning our thoughts to others is the best remedy. Humans are social animals, and we all need contact and support. Send a few “Hi, I was thinking about you” texts or emails. You might just find yourself feeling better as a result.

Mercer: Some anxiety is healthy. If it motivates us to be diligent about washing our hands, for example, then it’s doing its job. But if your anxiety is so intense that it prevents you from getting out of bed because you’re worried you won’t be able to wash your hands enough, the balance has obviously tilted toward unhealthy.

Right now, there‘s no shortage of information telling us what to do. Often it includes things like, make a routine, go to bed and get up at a regular time, get dressed as if you were going to work, keep your kids on a schedule, cook healthy foods, eat well, and get exercise. If you’re trying to do all these things to allay your anxiety, it might have the opposite effect. Quite frankly, the thought of doing all those things makes me want to go back to bed.

So we’ve circled back to knowing ourselves and being forgiving of our imperfect efforts. If two hours of social media leaves you feeling depleted and afraid, consume less. Too much of anything is unhealthy. Take what you need to know and leave the rest.

Exercise helps anxiety. But gyms are closed, and some of us aren’t supposed to go outside. Our regular energy level may be lower just from adapting to a drastically new routine. Exercise doesn’t have to be running for an hour or a robust workout. Turn up the music and dance around the room. Go for a walk with your kids if you can. A gentle online stretching course can do a world of good. This is going to be a mental marathon, so we have to be kind to both our bodies and our minds.

As for healthy eating, here’s another place to try and do your best. But your best right now may not be a veggie tray. And that’s OK. If that bag of chips is calling your name, and you want to stress‑eat the whole thing, try for half. This wisdom isn’t conventional, perhaps, but it’s honest. Do what you can. Take the small wins. And remember, if you’re generally doing less, you also need to eat less to match your activity level.

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I feel anxious about catching the virus or transmitting it to a loved one. What can I do?

Mercer: Take comfort that you aren’t alone. Everyone is feeling anxious about this. Our best tool is to employ the facts from a reliable source. What we can control are very basic but very important things. We should avoid touching our faces and wash our hands often and well ꟷ as though those things are now part of our job. If you’re in the fortunate position of being able to stay home, do that. Get groceries for the week, keeping essential outings to a minimum.

If you must go to work, educate yourself about your rights. Federal and provincial-territorial governments have clear guidelines for employers, so make sure your employer is following those. If you feel you’re in a job where you might bring the virus home to your loved ones, talk about the steps you can all take to feel safe. Wash your hands and face, and change your clothes as you walk in the door. Work toward effective solutions that make everyone in the home feel more comfortable.

Dobson: If you must leave home for work but live with someone who’s vulnerable ꟷ ill, older, with an immune condition ꟷ consider whether you have the means to change your living situation for a time. Can you move in with a co-worker, for example? If not, you may have to rely on very diligent at-home hygiene.

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How do I balance washing my hands enough and not becoming obsessive about it?  

Mercer: There’s no easy answer because we’re being told by experts to be excessive with hand washing. Again, it comes down to knowing yourself. If your hands are becoming raw and blistered, or you can’t leave the sink without wanting to rush back, these are signs of obsessive behaviour. We know the ideal amount of time to hand wash is 20 seconds. Sing a short song. Watch the videos. It all comes back to educating yourself and following those guidelines.

Dobson: In addition to hand washing, try to think of ways to keep surfaces clean so you can be less focused on constantly washing your hands. Again, be mindful that you’re not obsessively cleaning surfaces. You can put up a schedule, for example, so you can track how often you’re doing each activity. It is not possible to contaminate yourself.

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What if I’m already living with an anxiety disorder? Media coverage can be especially triggering. How can I cope best?

Mercer: First, since routine is good, try to limit your news consumption to the essentials: maybe watch a reliable daily press conference or read a public health bulletin. It can feel like we might miss out on an important announcement, but if we’re isolating in our home with our families, it’s likely sufficient to check for updates once or twice a day.

In terms of managing existing anxiety, the most important thing is to maintain the social supports you usually rely on, while respecting the constraints of physical distance. Call, video chat, email, text. If you are in counselling, keep it up. Virtual therapy is becoming more readily available by the day. Skip social media and check for online supports and programs from reputable sites. If you’re starting to feel really overwhelmed, or concerned for your own safety, call your local crisis line.

Dobson: Remember, the actual amount of “news” ꟷ in that it’s new, relevant, and important ꟷ is limited on any given day. Consider watching at around noon, when most of the information from the last 24 hours will be gathered in one place. Avoid listening to the news in the evening, and put your phone away if you’re scrolling incessantly for updates before bedtime. It will set your mind abuzz and may cause you to lose sleep ꟷ and we all cope less well when we’re exhausted.

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How do I offer emotional support to friends, family members, or co-workers who have been quarantined?

Dobson: There are some innovative ways to use technology. Try a virtual dance party or games with someone who is in another location.

Mercer: Practical support for friends and neighbours is likely best: if you can drop off food, check their mail, pop some reading material on their porch. When checking on others don’t forget to check in with yourself. The responsibility of caring for others can become draining. Try to share it if you can. If you can’t provide on-site support, consider email, texts, cards, calls, and movie suggestions. All these small gestures can add up to big-time connection.

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Which is making people more anxious: the virus or the hysteria in the media? 

Mercer: The anxiety is driven by both. This is something we’ve not experienced before, so we have the fear fuelled by our imagination, the fear we hear expressed by family, friends, and on social media. It’s important to stick to the facts, not reach too far into the future, and look at the concrete supports the government is providing. Get clear direction from schools and employers so you understand your obligations. If you can, talk to people in your home about your anxiety, in lieu of turning to websites and the media to seek answers. If you feel compelled to turn to the media, limit yourself to reliable sources.

Dobson: It’s really both factors. The risk of illness is anxiety provoking, but the media coverage doesn’t help. If you feel your anxiety ramping up after binge watching news on television or your smartphone, consider getting your information from more static sources ꟷ like the Public Health Agency of Canada or the World Health Organization. These sites are free of the added sights and sounds that can produce heightened anxiety.

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How do I talk to my children about the coronavirus without making them anxious?

Mercer: Children are perceptive, and they’re sensitive to anxiety. Don’t make things up, and don’t pretend the situation outside their four walls isn’t real. There are some excellent resources on how to frame conversations in an age-appropriate manner. Consider telling your kids that they are helpers and that their role is important for keeping themselves and everyone safe. Again, don’t make things up. Stick to simple, relatable language.

Take your cues from them, and talk about it as much, or as little, as they want to. Be sure to balance weightier conversations with levity: watch a happy movie or take a short walk after a difficult conversation. Kids often have short attention spans, and sometimes distraction is the best medicine. If they can’t see their grandparents, help them write letters, make cards, or use FaceTime.

Most of all, let them know that you’re OK and that your number one job is to keep them safe. It’s OK to acknowledge that even parents don’t have all the answers but that you’re taking advice from people who know the most (like health-care experts).

Dobson: Talk to them at a level they can understand. If they aren’t old enough or can’t or won’t verbally express their anxiety, watch for signs of distress: being overly clingy, being oppositional, crying unpredictably, or even pulling away, avoiding, or becoming quiet. In short, look for changes in their healthy behaviour. Again, the mental health continuum inside The Working Mind COVID‑19 Self-Care and Resilience Guide can help identify the signs and signals that your child may be having mental health problems. So consider using it with children, too.