Firs published in thejournal.ie May 2020
Distress around Covid-19 is not a mental illness. It’s an understandable reaction.
SUDDEN AND UNEXPECTED events can elicit intense emotions, uncertainty and catastrophic thinking. During a pandemic, it is reasonable to feel worried, anxious, confused and to experience low mood. Now is the time to take responsibility and to learn to manage your mental health.
I am a trained psychotherapist and Cognitive Behavioural Therapist with specialisations in working with anxiety, depression and trauma. Some of my clients will reengage with therapy when the crisis is over, whereas others are opting for online counselling.
My concern is for the people who are feeling vulnerable, lonely or helpless right now who are not seeking support because of embarrassment, anxiety or uncertainty about the value or availability of counselling.
On Friday 1 May 2020, Taoiseach Leo Varadkar addressed the nation. He spoke about “the frustration of having our lives restricted, the uncertainty about when things will get back to normal, and the fear of the virus itself”.
Varadkar reflected on the impact of the crisis on the economy, unemployment and the erosion of our mental health. The good news is the Covid-19 coronavirus graph is beginning to flatten and plateau.
However, during a pandemic crisis, while the curve increases, so do our instincts for survival and fear. Mental health professionals are concerned for the people who will continue feeling anxious during the plateau and will be unable to return to a baseline of psychological functioning of feeling good and staying well.
The phones are not ringing
Counsellors and mental health services are available. Most counsellors have adapted to online therapy and telephone counselling. The problem is our telephones are not ringing. In an online survey of 100 therapists conducted by The Mindfulness Clinic at four different locations in Dublin recently, 87% of therapists reported that they are less busy since the country went on lockdown in March.
Comparable findings are reported throughout North America, the United Kingdom and Europe. Online analysis of internet search activity in Ireland over a recent weekly period portrays a similar picture.
People were searching for counselling resources late at night, or early morning, with over 47% searching around “anxiety”, 27% around “depression”. This compared to Google searches for counselling at 10% and online therapy at 4%.
According to the Central Statistics Office survey of 4,033 people in Ireland during April 2020 on the impact of Covid-19 on health and wellbeing 59.6% of the respondents were “somewhat” concerned about household stress and confinement with 17% reporting that they were very concerned. Overall life satisfaction was rated as “high” by 12.2% compared to 44.3% in 2018.
Pornography is overwhelmingly on the increase not only in Ireland but worldwide. Recently, Pornhub.com reported internet traffic increases of up to 38.2% in France on 17 March and 61.3% in Spain.
The increases in pornography are not surprising as this is the first pandemic to occur in the digital age as people try to make sense of social isolation, loneliness, anxiety and boredom. Some psychologists are linking the increase in pornography to our survival instincts and our fear of mortality and isolation.
Before the emergence of Covid-19, anxiety disorders already ranked as one of the most common mental health problems globally. According to University of Oxford research, anxiety disorders, the most widespread of mental health disorders, impacted an estimated 284 million people in 2017 worldwide.
The outbreak of Covid-19 will impact mental health by elevating anxiety due to challenges with uncertainty, health, financial concerns and the psychological impact of self-quarantine.
US psychologists report that prescriptions for anti-anxiety medications increased by 40% over a four-week period between March and April 2020. Prescriptions for anti-depressants and sleep disorders have also increased (18.6% and 14.8% respectively).
Why do people come to therapy?
According to Irvin Yalom, an American psychiatrist people attend therapy for one of four concerns: freedom, isolation, death or meaninglessness. These concerns are more pronounced during a pandemic. Client presentations include anxiety, grieving, insomnia, anger, confusion, exhaustion, and low mood.
Some clients attending counselling have taken a break now because they are coping well and are consolidating the learning from therapy. As mental health professionals, we cannot lose sight of an equally alarming issue and the long-term impact that the pandemic will leave on society.
Do not be anxious or embarrassed about seeking professional help from a counsellor or mental health professional. Most people are waiting for our country to return to our normal. Taking responsible action for mental health is one area that you can learn to manage during these uncertain days.
We’re in survival mode
As our country adjusts to the new realities of a global pandemic and the threat of coronavirus through social distancing, our intolerance for uncertainty will be activated, and we will often find ourselves reacting with survival instincts for protection and self-preservation. This can present with such behaviours as over-shopping, hoarding and excessive cleaning.
Our human brain has evolved to protect ourselves and our loved ones. Anxiety and panic are normal stress reactions during a crisis. The rapid spread of the pandemic gave us little chance to prepare or to process all that has happened in recent weeks.
Our reactions to social isolation mirror a grieving cycle including shock, denial, anger, sadness, fear, frustration and a fear of losing control. Sometimes it is difficult to find the words to understand what is going on.
Emotional distress around Covid-19 is not a mental illness but an understandable stress reaction.
During the 2003 SARs outbreak, researcher Rima Styra reported increased presentations of PTSD and depression for patients in quarantine. This is on a global scale now because SARs affected just 8,000 people. We are in this together but remember we also have different circumstances, reactions, processing styles, and coping skills.
Threat reactions activate the survival brain to fight, flight or freeze while uncertainty about the timeline of the virus unlocks a need to control through overthinking, fixating and ruminating. Uncertainty drives anxiety. Below are some tips to help you battle any negative thoughts:
Pay attention to “what if” thinking which fuels anxiety and panic. The mind wanders 46.9% of the time into the past (ruminations) and into the future (projections). Keep things in perspective and train your brain to return to the present moment.
Remember the impermanence of change – nothing is fixed, enduring or stable, this too will pass. Distinguish between unhelpful and helpful worry, which is a coping strategy and find practical ways that you can use these thinking styles to stay safe and connected. The way you view a situation affects how you feel. Notice the difference in language between social distancing and social isolation.
One of the most significant challenges during a crisis is the deliberate practice of upholding structure and routine. Discipline is beneficial to mental health for maintaining structure, physical exercise, healthy diet, boundaries around work and home, relaxation and social connection.
Connection & gratitude
Connection is a basic human need. Communicate with family and friends as you adapt to social distancing. Write a letter, text, email or WhatsApp message of appreciation to family members you cannot meet.
Science suggests that expressing gratitude boosts your health and spreads happiness.
Gratitude may help in recovery from depression and anxiety (Wong et al., 2015) and may help healthcare professionals to manage perceived stress and depression (Cheng et al., 2015). Connect in with mind and body by establishing a simple checkpoint. What am I thinking? How am I feeling? Ground yourself by connecting with the five senses and nature.
Mastery and accomplishment
Take time to develop accomplishment, personal satisfaction and achievement to enhance mood positively. Aligning your mind to accomplishment, achievement, and savouring pleasant events is one of the most helpful ways to interrupt low mood and dissatisfaction. If you are feeling unmotivated, remember Now is a good time to Just Do It. Action precedes motivation.
Limit social media and news reports
Get the facts and gather the information that will help you accurately determine your risk so that you can take reasonable precaution. Most of the newsfeeds are anxiety-provoking and at times are predicting future outcomes, uncertainty, and are contradictory to other news reports. Limiting your access to just one or two news checks with trusted sources per day will help enormously.
Sleep and exhaustion
Clients we meet are reporting exhaustion and disrupted sleep. Exhaustion is linked to working from home with the intensity of online meetings and the disruption of everyday activities such as commuting and connecting with work colleagues.
Create boundaries between work and home by trying as much as possible to work in a separate room to where you eat or sleep. This is not always possible, but it can help if you can do it. Insomnia can be treated through Cognitive Behavioural Therapy, CBT-I. Sleep is important for concentration, focus and wellbeing.
Healthcare frontline staff
It’s clear that frontline staff in our health service are under incredible pressure through this. Free online psychological support is available from therapists who have volunteered to support frontline workers from IAHIP.IE or IACP.IE.
Explore different forms of self-care including mindfulness, self-compassion and techniques to self-regulate and to avoid vicarious trauma, burnout and empathy fatigue. More can be found on this at mindthefrontline.com.
The World Health Organization (WHO) guidance advises: Managing your mental health and psychosocial wellbeing during this time is as important as managing your physical health.
A study published by the Canadian Medical Association Journal reviewed all studies of Cognitive Behavioural Therapy (CBT) conducted between 2000 and 2010 and found that CBT can effectively reduce symptoms of depression and other mental health presentations. In some cases, the online CBT intervention was even more beneficial than meeting a therapist in person. Counsellors and therapists are available; we are here to listen, to help and to support.
Gerry Cunningham, MIAHIP is a psychotherapist and CBT therapist. PG Dip CBT, M. St. MBCT, University of Oxford and M. Ed. Child and Adolescent Psychotherapeutic Counselling, University of Cambridge.