Mental Health Toolkit for Managing the Impact of the Novel Coronavirus
Yesterday, I sent a message of support and compassion to all of the students in the 5 college classes that I teach. I assumed many of them would be struggling and wanted to send them reassurance that people in their lives care about them and are willing to help. I expected a few to reach out in response, primarily to request course-related accommodations, such as extensions for assignments.
I was surprised at the outpouring of appreciation and requests for concrete stress-management strategies to help them through their isolation, uncertainty, and fear. As I began responding to their emails, I realized that many people in my life would likely benefit from these strategies as well.
Below are the 15 strategies I’ve been recommending to my students and to the clients I work with as a psychotherapist. I hope it provides new ways of thinking about our current lifestyles and sparks ideas for maximizing the potential benefits of this period of physical distance.
I will use the term “physical distancing” throughout this article because I find that the more commonly used phrase “social distancing” sends a problematic message. Our goal is to stop the spread of the novel coronavirus, not to disconnect from our valued social connections (more on this below).
Note that I wrote this up relatively quickly because I felt that it was better to share something soon rather than something more technically perfect. Please forgive any typos along the way!
1. Address your basic needs. It’s can be challenging to accomplish the basics when we’re faced with a lack of schedule and an impaired sense of structure. We feel best when we attend to our basic needs, which is often most easily accomplished by maintaining a daily routine. Wearing grungy sweats for days on end may feel indulgent at first but it also influences us to feel even more out of whack.
Consider how you can impose structure on your basic daily activities, such as showering, eating healthy meals, drinking sufficient water, and following a typical sleep schedule (going to bed and waking up around the same time). If you’re struggling, you may benefit from creating a schedule to follow, adding these items to a daily to-do list, or setting reminder alarms on your phone.
2. Shift to a gratitude orientation. Uncertainty is scary and there’s a lot to be upset about right now. While that’s true, there are also many aspects of life that are going ok, and it’s important to acknowledge those as often as we can. Gratitude has been shown to enhance wellbeing, improve immune functioning, and improve sleep quality, amongst many other benefits.
When you notice yourself complaining or fixating on the negative aspects of your life, challenge yourself to shift your attention to something that you are grateful for. Perhaps it’s the cool breeze coming through the window, the roof over your head, or your access to food. You might consider writing down 1–3 things each day you’re grateful for and placing them in a jar to read at the end of this isolative period, when you’re feeling particularly down, or at the end of the year (this makes for a great New Year’s Eve tradition!).
3. Set informational boundaries. In times of crisis and extreme unpredictability, it’s common to seek out as much information as we can access. While it’s normal and understandable, these behaviors tend to exacerbate the stress associated with the unknown and create more fear rather than less. This is the perfect example of how too much of a good thing can become a bad thing. Information overload is real and it uses valuable cognitive resources that are better suited for valued tasks (see #4).
In general, information about the novel coronavirus does not change minute-to-minute. It’s important to take significant breaks from engagement with coronavirus-related media and other sensationalized content. It’s also important to be mindful of which sources of information you seek out. Stick to reputable sources and prioritize written material as it tends to be less anxiety-producing and less sensationalized than video-recorded media.
4. Align with your values. Values are most easily identified by asking yourself when in the past you’ve felt happiest, most proud, and/or most fulfilled. What were you doing at, or just before, these moments? It’s likely that you were living in accordance with deeply cherished values, such as being a loyal friend, a caring neighbor, a compassionate boss, an understanding partner, an adventurous explorer, or a creative innovator.
Another strategy for identifying values is to ask yourself what you want your life to stand for. Do you want to be remembered as someone who was helpful, kind, intelligent, dependable, thoughtful, patient, generous, curious, sensitive, or enthusiastic? The words that sparked a sense of joy or passion within you speak to your values.
Once you’ve identified your values, the next step is to make choices that align with those values. For example, if you identified an important value of helpfulness, you would seek out ways to be helpful, perhaps by supporting a local, small business (follow them on social media, like their posts, buy a gift card, etc.) or offering to read a story to a friend’s child over FaceTime. Grandparents and great-grandparents might consider recording themselves reading a children’s book or sharing a personal story so that generations to come may enjoy it and have the opportunity to know you.
5. De-escalate your nervous system. Stress and anxiety activate the sympathetic nervous system, which leads to increased blood pressure, muscular tension (those shoulders you’re currently wearing as earrings), digestive distress, and a host of other unpleasant changes. When faced with a short-term stressor, such as a bear that’s circling before an attack, these responses are quite adaptive, as they support our attempts at survival (run faster, fight harder). As you might imagine, these changes are much less adaptive, and actually have negative health impacts over time. Therefore, it’s important that you engage in daily exercises that help to tone down the sympathetic nervous system.
One helpful strategy for calming the nervous system is called a body scan. To start, find a relatively comfortable and quiet spot to sit or lay down. Draw your attention to the crown of your head and slowly make your way down your face, neck, shoulders, each arm down to the fingertips, chest, torso, belly, hips, and then down each leg to the toes. At each new spot, take a moment to notice if you’re holding any tension and then see if you can allow that tension to melt away. When that area feels relaxed, move to the next area until you have made it to the toes on your second leg.
Breathing exercises are also helpful for calming the nervous system. The parasympathetic nervous system has opposing functions as the sympathetic nervous system and is engaged when we’re not stressed. Diaphragmatic breathing is a powerful way of telling our nervous system that we are safe and do not need to be in survival mode. To get started, sit comfortably and place one hand on your chest and the other on your belly. As you take breaths in, notice how your belly expands (ideally, your chest would remain still); as you exhale, draw your attention to the gentle fall of your belly. Continue to take deep breaths in and out according to whatever breathing pattern feels most calming/comforting (I prefer 5 counts in and 7 counts out).
Another breathing exercise I really like involves visualizing a ring in your mind and then linking your breath to the image of the ring. As you exhale, picture the ring lighting up from the top to the bottom (12 to 6 on a clock) and as you inhale, picture the ring lighting up from the bottom to the top (6 to 12 on a clock). Continue to slowly inhale and exhale as you watch the ring light up in sync with your breath.
6. Identify what is in your control. The reality of life is that much of it is outside of our direct control. As humans, we thrive on the illusion of control and we often expend significant effort trying to control various aspects of our lives. In times like these, our lack of control can feel overwhelmingly apparent and many people shut down unnecessarily, which leads to a sense of helplessness and despair.
It is imperative that we identify what is in our control and that we take steps in those directions. While we can’t control the virus, we can control the role we play in it; that is, we can maintain physical distance, wash our hands, engage in self-care and other important health-maintaining strategies, and use our time towards important life goals and values. In essence, we must do more of what we can control and work towards accepting what is not in our control.
When I’m feeling overwhelmed, I ask what I can do at that moment (what’s in my control) and then do my best to engage in those behaviors. Ultimately, staying calm is one of the best ways that we can support our immune system. It is helpful to remind yourself that panic suppresses the immune system and makes you more vulnerable to the very thing you’re worried about. If you were to read my thoughts, you might see “I am as safe as I know how to be. I have done what’s in my control. The future is always unpredictable, but I am living in accordance with my values and I’m proud of the choices I’m making.”
7. Cultivate compassion. While self-compassion is trending, I encourage you to broaden your perspective of compassion to include not only yourself but all of humanity. These are trying times and we’re desperately in need of love, patience, and understanding for ourselves and each other. Try your best to give other people the benefit of the doubt and to offer forgiveness for past discretions and hurt feelings. I truly believe that people do their best with what their given and, while we do not necessarily agree on what their “best” might look like, it does no one any good to assume that they’re not trying.
Compassion also involves recognizing that you’re doing your best. Keep in mind that “best” is a fluid concept; what is your best today might not have been your best last week or last month, nor might it be your best next month or later this year. Anyone who’s practiced yoga knows this concept well; today you might be able to touch your toes but tomorrow you're lucky to reach your knees. The important thing isn’t how far your hands can reach, but that you showed up to practice yoga. We need to be exceptionally understanding of the impact of these abrupt changes on our lives and recognize that may struggle along the way. Try to resist the temptation to compare yourself to anyone else or to yourself in a different moment. You are perfect just the way you are right now.
8. Learn about yourself. We are afforded a great opportunity to learn about ourselves in times of change and adjustment. Now is a great time to learn about how you cope with stress and to notice what comes up for you when faced with difficult challenges. Pay attention to what soothes you and what exacerbates your stress. As these become clearer for you, make it a point to do more of what soothes you and to do your best to limit those things that are creating stress and chaos.
Everyone is different in terms of what they find helpful and harmful. You may find that a warm bubble bath, playing your favorite music, cuddling with your pet or watching the Puppy Bowl on Hulu, journaling, breathing exercises, stretching, or connecting with a friend provide you some relief. If so, do those things! Many people will likely discover that excessive fear-based media, social disconnection, poor sleep hygiene, unhealthy dietary choices, and lack of physical movement will contribute to their stress and worsen the impact of stress on the body. If this is you, limit these factors to the extent possible.
9. Connect socially. As I stated in the opening, it’s crucial that we approach this time period as one of physical distancing rather than social disconnection. As humans, we are incredibly social creatures; we thrive on social interactions and often experience despair in response to isolation. In fact, isolation is considered a form of torture because it goes against our very nature to be alone for long periods of time. Loneliness is also linked to an increased risk of depression, so be particularly mindful of the people in your life who are prone to depression and consider how you might best reach out to those people.
We are fortunate to have numerous options for connecting through technology, such as FaceTime, texts, phone calls, emails, Snapchat, Marco Polo, WhatsApp, Zoom, Google Hangouts, and the many other platforms that exist for this purpose. If we think creatively, many of our typical social engagements can be accomplished via technology. Game night? Schedule a group chat to play a game that lends itself to virtual play, such as Boggle, Scattergories, or Trivial Pursuit. Wine tasting? Set-up a time to meet with your friends in a group chat while you each dip into a bottle of wine you’ve been saving for a special occasion (or whatever alcohol you have on hand). Movie night? Start a group chat and begin the movie at the same time. Bonus points for a comedy — we all need a good laugh right now!
10. Strike a balance. It’s important to find an effective balance between productive pursuits and unstructured downtime. If you are currently working, you might feel that you have enough on your plate in terms of productivity between professional tasks, personal self-care, and household responsibilities. If not, reflect on what you’d like to accomplish with your time, a productivity bucket list, so to speak, such as learning a new skill or growing in some valued area of your life (pssst Yale’s most popular class The Science of Wellbeing is offered online for free, to anyone, right now!).
There are numerous other informative and educational resources out there, such as TedTalks (a few of my favorites: Brené Brown, Adi Jaffe, Robert Sapolsky, and Johann Hari) and books (these are my favorites from 2018 and 2019) that can offer you exciting insights into yourself and the world and provide strategies for growth and progress. And, of course, learning isn’t the only productive pursuit. You might clean out your closet, organize your garage, paint your nails, try a new recipe, clean the floorboards, or rearrange your furniture. Whatever makes you feel good at the end of the day!
As for downtime, what have you always wanted to do but “never have time for” under normal circumstances? Maybe it’s a Harry Potter marathon, writing fan fiction, or coloring in the adult coloring books you bought years ago and only opened a handful of times (just me??). If you’re like me, you might derive quite a bit of joy from music. I’ve been watching music videos (blast from the past!), at-home recordings from the likes of John Legend, Kelly Clarkson, Lin-Manuel Miranda, and Dave Matthews, and recorded concerts on YouTube.
11. Defuse from your thoughts. Our minds are very powerful, and we tend to buy into our thoughts as though they’re reliable statements of fact about reality. Logically, we know that our minds are often inaccurate and that they lead us astray, but it’s challenging to notice that in the moment. Psychological or cognitive defusion refers to a set of strategies that encourage us to distance ourselves from our thoughts. In doing so, we have an opportunity to notice our thoughts for what they are (simply thoughts) and to consciously decide whether and how we want to respond to them.
One defusion strategy I find effective is to repeat my thoughts back starting with “I’m having the thought that…” For example, if I were to think to myself “I can’t handle this” I would then repeat it again in my mind as “I’m having the thought that I can’t handle this.” This strategy helps to reinforce the fact that this was simply an anxious thought, not a statement of fact, and that I have the choice of whether I want to buy into that thought or notice it as a function of my worried mind and move on.
Another approach to defusion is similar to “I’m having the thought that…” but involves repeating the thought back in the voice of a character you choose to play your anxiety. I’ve found that this strategy is particularly effective for creative types and for children. I’ve had clients give their anxious (or angry, sad, etc.) voice the character of everything from an old female New Yorker (this also gave her a good laugh), to a proper British gentleman, to the “purple guy” from Disney’s Inside Out. The character does not matter; what matters is that the character helps to create distance between you and your thoughts so that you have the space to notice it and decide how you want to respond. Some thoughts are helpful, but many are not!
12. Stay present. Remaining present might sound easy but it’s actually pretty darn challenging! One of the major aspects of the human brain that differentiates us from the majority of the animal kingdom is our exceptional ability to revisit the past and to anticipate the future. While this is certainly a gift in many ways, it also leads us to experience stress and anxiety on a level that other animals simply do not have the capacity for. As mentioned in #5, our nervous system is designed for short-lived stressors; chronic stressors overwhelm the nervous system and suppress immune functioning.
When you find yourself reminiscing, ask yourself if it’s serving a positive function. If it is, reminisce away! If not, thank your mind for the thought and bring yourself back to the present moment (more on that in a bit). If you’re thinking about the future in a productive way, such as reflecting on how you can best prepare yourself for the future, that’s great too. However, if thinking about the future is giving you a sense of impending doom or causing significant stress, thank your mind for the thought and come back to what’s really happening right now.
One of my favorite strategies for re-engaging in the present moment is an exercise commonly referred to as 5, 4, 3, 2, 1. It’s often categorized as a “grounding exercise” because it helps people feel rooted in the present moment through accessing sensory experiences. Our senses are inherently present; it’s challenging to smell tomorrow or to taste yesterday! To practice this exercise, you will ask yourself to list 5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can smell, and 1 thing you can taste at that moment. Note: taste is the most difficult, so feel free to just pay attention to what your mouth feels like rather than trying to come up with a word for it.
Mindfulness and meditation are also helpful for promoting a sense of present-centered inner peace. Mindfulness and meditation practices encourage us to stay present and to notice our inner experiences without judgment or attempts at control. These practices also reinforce the reality that thoughts and feelings are transient, they come and go without any effort on our part and ultimately, we’re not really in control of them (see #6). If you don’t believe me, try not to think about a pink elephant right now. No really, stop. Were you successful? No, because you aren’t really in control! There are numerous mindfulness and meditation approaches out there. If you’re new to it, I encourage you to try a structured program, such as Headspace, Calm, or Insight Timer.
13. Get creative. Part of a balanced day involves setting time aside for creative pursuits. Creativity serves many beneficial purposes, including enjoyment, expression, and in some cases, productivity. It may feel challenging to identify creative endeavors that do not require special equipment or skills, but there are certainly many options available if you think outside of the box (creative in and of itself!).
Perhaps you can challenge your family member or roommate to a Chopped style cook-off by identifying a few random ingredients in the kitchen to see who can make the tastier dish. You could put that old magazine collection to good use and make a collage or vision board. Color by yourself or with your kids (this is a great free resource). Or, impress all of the kids in your life by recording your first Tik Tok video!
This might also involve thinking creatively about new approaches for financial opportunities. I’ve been inspired by stories of hairdressers who are selling DIY hair dye kits with video instructions, yoga instructors who have hopped over to FaceTime and Zoom to offer their classes, and health care professionals who have successfully transitioned to telehealth to provide continuity of care for their patients (myself included).
14. Be a role model. We’re all looking for someone who can show us how to manage this worldwide trauma. You can be a role model by expressing your feelings in productive and healthy ways, sharing effective coping skills and reliable sources of information, engaging in physical distancing, and showing support for vulnerable members of your community. As a society, we’re scared, confused, and overwhelmed. Our leaders are embroiled in conflict and many of us lack the guidance and skills to navigate this temporary reality with poise and confidence.
What can you do? Be honest about your experience; you do not need to put on a brave face and pretend that you’re fearless. Instead, express your vulnerabilities while also demonstrating your commitment to resilience and growth. Share the resources you find along the way that you believe offer a source of strength or insight. Encourage people to stay inside when possible and give thanks to those working in essential businesses who need our support. Help people understand that staying home is an act of love for yourself and for your community; not an act of fear and paranoia. Our health care professionals as well as those who are keeping our grocery stores, pharmacies, gas stations, banks, and other essential businesses running, despite the risk to themselves and their families, need our help — show them you care by doing your best to remain healthy.
15. Reach out for help. It’s important to offer support but it can be equally important to receive it as well. If you’re struggling, let those close to you know what you need. Oftentimes, people do not provide support not because they don’t care, but because they don’t know it’s needed or because they don’t know how to help. If the people in your life are already offering support, take them up on it; if not, reach out now to let them know what you need.
If you’re particularly overwhelmed or have a history of depression or other mental health conditions, consider whether therapy might be an effective source of support right now. Many therapists are offering telehealth services that can accommodate physical distancing while also providing much-needed support, encouragement, and practical strategies for managing the intense emotions you may be feeling. If you are at home with someone who is abusive, or fear you might be, please read this article that provides helpful hints for how best to address this situation.
Wow, when I set out to write this article, I never intended it to be this long. Thank you for those who made it this far! I hope that I’ve offered helpful suggestions that will aid you in navigating this challenging time of adjustment and uncertainty. My thoughts are directed towards our collective wellbeing and I’m sending out virtual hugs to each of you!
Ashleigh Louis, Ph.D., LMFT, RYT-200