Mental health in a time of COVID-19
Whether you’re on lockdown or just practicing social distancing, chances are you’re beginning to feel the strain.
We’re social creatures: We not only desire interaction with others but actually need it. Contact with others — particularly physical contact — triggers neural cascades that release oxytocin and serotonin, and going without such interaction for extended periods of time can have serious health consequences.
Indeed, according to Julianne Holt-Lunstad, PhD, professor of neuroscience at Brigham Young University, loneliness and lack of social connection can raise health risks as much as smoking 15 cigarettes a day or suffering from alcohol use disorder, and is twice as harmful to one’s health — both physically and mentally — as obesity.
“There is robust evidence that social isolation and loneliness significantly increase risk for premature mortality, and the magnitude of the risk exceeds that of many leading health indicators,” Holt-Lunstad says.
So what happens when an unprecedented health concern — such as the coronavirus pandemic — trumps our ability to socialize?
Unfortunately, just a few weeks into the widespread adoption of social distancing, we’re beginning to see the impact of isolation on people around the world. The Crisis Text Line — a hotline for free mental health support — has seen a large spike in volume, with 80% of texts relating in some way to coronavirus anxiety. On social media, users have taken to commenting on their struggle to stay positive in the midst of the crisis, while media outlets have been compulsively publishing listicles of advice on how to take care of one’s mental health during quarantine or social distancing.
So, against the backdrop of confusion and building discomfort, we thought we’d compile a list of best practices for preserving your wellbeing — mental and otherwise — during this challenging time.
Social distancing means physical distance
This may sound obvious, but still worth mentioning. Though we may be unable to head to a movie, restaurant or bar with our friends and loved ones, that doesn’t mean we have to be alone. The widespread proliferation of video telecommunications platforms like Zoom and Skype means that everything from work meetings and professional conferences to happy hours and parties can now be made virtual. And while studies have shown that in-person communication yields more benefit that virtual communications, turning on cameras for more face-to-face interaction may improve the effect.
So, start a routine of morning coffee with your family and be sure to schedule time to hang out or watch a movie with friends after work.
Exercise
This one is holds true whether we’re isolating or not. A Journal of Happiness review found that people who exercise for as little as 10 minutes just one day a week experience increases in happiness, with aerobic exercise, stretching, and yoga all found to be effective. Another pilot study found that just 30 minutes of exercise — defined as walking on a treadmill — undertaken for 10 days resulted in statistically significant reductions in depression scores among those with major depression.
Exercise stimulates the release and activity of endorphins, endogenous opioids that bind to receptor sites in the brain and both relieve pain and elevate mood; in addition, exercise has direct effects on the presence of cortisol and adrenaline in the body, the hormones responsible for the “fight or flight” response. In those with chronic anxiety — or in those exposed to stressful situations for extended periods of time (e.g., an ongoing pandemic) — levels of these chemicals may be chronically elevated.
In this time of social distancing and self isolation, options for exercise still abound in the form of fitness apps, online dance clubs, and digital classes, such as this yoga class led by mental health advocate and blogger James Downs.
Limit media consumption
In a 24-hour news cycle, it’s easy to get continually caught up in every ostensibly new development or otherwise feel unable to step away from the most recent headline. For some, particularly those with existing mental health issues, this can lead to significant symptoms. Speaking to BBC News, Nick, a father of two who struggles with anxiety, said the constant drumbeat of ominous headlines has sparked panic attacks and rumination.
“When I’m feeling anxious my thoughts can spiral out of control and I start thinking about catastrophic outcomes,” he said. “Usually when I suffer, I can walk away from a situation. This is out of my control.”
In a word, Nick felt trapped by the circumstances, which, in turn, caused him to overindulge in media consumption. To combat this, Dr Aarti Gupta of the Anxiety and Depression Association of America emphasizes the need to reframe the situation from a burden to an opportunity. You aren’t stuck at home, but rather you’re finally in a position to slow down and focus on yourself, do something you’ve always wanted to, or clear your backlog.
But what if you’re struggling to keep your worry in check? What if, like Alison from Manchester, you feel “compelled to stay informed and research the subject”?
Speaking to the Guardian, Dr. Richa Bhatia recommended setting aside a specific time in the day for worry and research. Her advice is echoed by the Association for Behavioral and Cognitive Therapies (ABCT), which has said a predefined “worry period” can help people stay in the present moment by reassuring them “that [they] will have time later to worry (…) and that there is no use upsetting [oneself]” whenever a worry arises.
Meditation
Like exercise, meditation is a staple of physical and mental wellbeing regardless of whether you’re isolating or not. For example, mindfulness meditation has been shown to reduce pain, depression, stress and anxiety, and has been studied for the treatment of drug addiction. Moreover, mindfulness meditation may even promote positive cytoarchitectural changes, with one study finding that cortical thickness was significantly increased among those who undertook an 8-week mindfulness based stress reduction program, changes that were linked to improved scores on anxiety and depression.
In general, mindfulness meditation works like this:
1. Pick something to focus on, like your breath.
2. Breath normally, and take note of the sensations associated with breathing, from the tickle of air on your nostrils to the expansion of your chest and stomach.
3. Whenever your attention wanders and you find yourself worrying about work, the latest headline, or anything else, simply redirect your focus back to your breath, doing your best not to judge yourself for letting your attention slip.
4. Repeat.
If you’re just starting a meditation practice, you’ll probably find that your attention wanders every 7 seconds or so. You may also find it difficult to quiet the chatter of your internal monologue. Either case is normal, and with practice you’ll find it progressively easier to maintain focus on your chosen object of mindfulness. But if you’re really struggling, experts suggest simply counting your breaths or following a guided meditation. You may also find the graphic below useful:
Additionally, apps like Calm, Insight Timer, and Headspace are designed to help meditation novices kickstart their practice.
If you have mental illness, stay in touch with your care provider
Speaking on BBC Debate Night earlier this week, Dr. Linda Bauld, a professor of public health at the University of Edinburge, touched on all the aforementioned points in this article, including establishing routines and habits, leveraging technology to stay connected with others, and finding ways to exercise.
Yet, she took pains to emphasize that — above all — it was “imperative” for those with long standing mental health conditions to maintain contact with their healthcare professionals.
With weeks and perhaps months of restrictions ahead, it can be easy for those with mental health disorders to become overwhelmed and lose progress — or even slip into relapse. Though this is true for all types of disorders, the widespread emphasis on hand washing has thrust the limelight on those suffering from OCD, whose obsessions may bear uncanny resemblance to many of the guidelines for limiting the spread of infection.
“It’s really difficult because I now have to do some of the behaviours that I’ve been avoiding,” says Lily Bailey, author of Because We Are Bad. “I’m sticking to the advice really rigidly but it’s hard, considering that for me, soap and sanitiser used to be something comparable to an addiction.”
Shayla Love of Vice News, who has struggled with OCD for much of her life, had this to say: “Even though I’ve made big strides in recovery, the coronavirus outbreak can bring on a little voice in my head that says things like: A ha! See, I was right that every surface is an infected cesspool that will kill you. And: I knew it wasn’t safe to touch anything, and also you should start showering in bleach.”
She adds that the CDC regularly uses words like “often” and “frequently” to describe the frequency of hand washing required to limit the spread of the virus, and this — while undoubtedly necessary from a public health perspective — can produce anxiety for those with OCD as they grapple with what exactly such terms mean in practice. Shayla cites director of the OCD and Anxiety Center of Greater Baltimore Jon Hershield’s description of this discomfort: “How do I know that I am washing my hands ‘frequently’ as opposed to every hour or after every contact with a public surface?”
Unfortunately, there are no easy solutions.
Shayla and others note that beyond limiting media intake and following — but not overdoing — the advice of authorities, patients are best served by accepting that there will always be a degree of uncertainty. Naturally, this is easier said than done, and underscores the importance of continuing to work with a mental healthcare provider throughout this crisis.
Finally, have some empathy, particularly for those who live with mental illness daily
For many of us, this period of uncertainty may represent the first real brush with thoughts and feelings that are a daily reality for people living with mental health disorders. Yet, although this crisis may have far reaching consequences both socially and economically, the fact remains that it is ultimately time limited. Life will return to normal and we will no longer have to grapple so intimately with the issues described here.
But for those with treatment resistant mental illnesses, the struggle will continue. Indeed, even the economic ramifications of the COVID-19 pandemic — which may end up costing the global economy up to $1 trillion dollars, according to Richard Kozul-Wright, Director, Division on Globalization and Development Strategies at UNCTAD — pale in comparison to the $1 trillion in lost productivity each year from depression alone (to make no mention of the billions spent on ineffective treatments). Indeed, the Lancet commission found that without meaningful changes to our mental healthcare system, the mental health epidemic may cost the global economy up to $17 trillion by 2030.
For those of us working on solutions for mental healthcare, none of this detracts from the seriousness of the current crisis. With more than 300,000 infections and more than 15,000 dead globally, there is no diminishing the urgency of our present circumstances.
Instead, for us at ATAI, the COVID-19 pandemic puts into more concrete and visible terms a comparable — but silent — emergency, and reminds us to think of those we serve and their urgent need for solutions.
So, stay safe, stay kind, and take care of yourselves in the weeks and months ahead: We will all need one another for what comes next.
Resources:
Need some more help staying upbeat? Check out Yale University’s renowned online “happiness” course: https://www.coursera.org/learn/the-science-of-well-being
Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-ncov/index.html
World Health Organization on COVID-19: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
NAMI Updates On The Coronavirus: https://www.nami.org/About-NAMI/NAMI-News/2020/NAMI-Updates-on-the-Coronavirus
Anxiety and Depression Association of America: https://www.mentalhealth.org.uk/publications/looking-after-your-mental-health-during-coronavirus-outbreak
