Category Archives: Covid-19 Crisis

Ten strategies to cope with anxiety about COVID-19

In my upcoming book, Fight/Flight/Flow, I discuss the importance of anxiety. Anxiety is a natural human reaction that involves mind and body. It serves an important basic survival function: Anxiety is an alarm system that is activated whenever a person perceives danger or threat. Anxiety is both in the mind, or cognitive; and in the body, in the form of physical symptoms.

When the body and mind react to danger or threat, a person feels physical sensations of anxiety — things like a faster heartbeat and breathing, insomnia, tense muscles, sweaty palms, a queasy stomach, and trembling hands or legs. These sensations are part of the body’s fight-flight response. The fight response can make us angry and irritable. The flight response can make us avoidant and isolated. These are caused by a rush of adrenaline, cortisol, and other chemicals that prepare the body to make a quick getaway from danger. They can be mild or extreme.

My psychotherapy for anxiety involves what I call the flow response. It’s hunkering in place, but not in a passive way. It’s observing, holding, and waiting. It’s like floating in water. You’re still in it, but you’re not thrashing about.

The fight-flight response happens instantly when a person senses a threat. It takes a few seconds longer for the thinking part of the brain (the prefrontal cortex) to process the situation and evaluate whether the threat is real, and if so, how to handle it. If the cortex sends the all-clear signal, the fight-flight response is deactivated and the nervous system can start to relax. If the mind reasons that a threat might last, feelings of anxiety might linger, keeping the person alert. Physical sensations such as rapid, shallow breathing; a pounding heart; tense muscles; insomnia; gastrointestinal problems; choking sensation; trembling; and sweaty palms might continue, too. Lastly, anxiety is curvilinear. A little bit of it can motivate us to problem solve and take action. A lot can immobilize and sicken us.

Tips to manage anxiety during these challenging times:

1. Sense of community.
Being there for and with others lessens our solitary load. From virtual exercise classes, virtual classrooms, volunteering, and zoom cocktail hours, feeling connected decreases anxiety. We are social creatures, and separating has been very difficult for many.

2. The spiritual life.
From meditation and yoga, to a peaceful walk in nature, a personal home altar, or faith based activities, these pastimes help reduce our panic and sense of fear.

3. The foundations of self-care.
Keeping to good sleep hygiene habits, nutritious meals, and daily exercise. All three of these are potent medicine.

4. Reflect don’t react.
There are many choices within our control even when we feel out of control. Dr. Victor Frankl, who was incarcerated in a concentration camp and wrote “Man’s Search for Meaning,” stated everything can be taken from a man but one thing, the last of the human freedoms, to choose one’s attitude in any given set of circumstances, to choose one’s own way of being.

5. Place stones across the river.
This is my method that I teach to patients, that consists of piecing together the small moments that make each day meaningful and significant. Speaking with a great friend, playing or cuddling with your companion animal, enjoying the beauty of the spring time, having the perfect cup of coffee, taking a moment to connect with others online, listening to your favorite music. These seemingly insignificant things become a powerful gestalt when they are pieced together, and help make our brains create hopeful pathways.

6. You are not your day.
If you have a day where nothing feels hopeful, or an even an hour of despair, it does not define you. It will pass. Remind yourself of the times that you persevered through catastrophic times. Reboot. You can even make self statement index cards and read them to yourself. Remind yourself that this too shall pass.

7. Disconnect.
Sleep, rest your body, turn off the screens, don’t read the news. We can stay in formed but we can also inundate our brain with information and misinformation.

8. Question.
Not everything you read in the news or the Internet is accurate. Similarly, when we are having anxiety or depression, our brain is a trickster that tells us misinformation. We can learn to refute it.

9. Schedule.
Keep to a routine as much as possible. This should include the aforementioned exercises, meal prep and planning, sleep, work, outdoor time, social media time, and downtime.

10. Breath-work and grounding.
Strategies that I teach individuals with anxiety disorders can be used by anyone, you can take them with you anywhere. Using the power of your breathing, close your eyes, take a deep breath in through your nose, and exhale slowly through your mouth. Repeat. And again. Similarly, you can ground your body by progressive muscle relaxation, this is a series of moments of tightening and releasing your muscles starting at your feet and working all the way up to the top of your head. For example, clench your feet hold for five seconds, and release. Continue to your legs, and so on. There are many guided strategies on the Calm App or HeadSpace, on Apple and android, that can help you practice these methods.

If you feel that anxiety is trying to take over your life, please seek professional support. Embolden offices are now offering free 30 minute sessions to first responders.

On talking to the kiddos and executive functioning

It’s hard for many people to put the coronavirus global crisis into perspective. It’s even harder to explain it to children. But understanding the big picture can often help us make sense of what’s happening around us.

Some kids—and adults—have a hard time seeing the bigger context in situations. (It’s common with kids who have trouble with executive function.) That’s not necessarily a bad thing, especially for kids who get more nervous the more they hear and know.

But for other kids, not understanding what’s going on makes it harder for them to cope. It raises their anxiety level because they don’t always recognize that people are doing things to reduce the threat. 

To help them get a broader idea of what’s happening and be less anxious, start with what they know, says Ellen Braaten, PhD, director of the Learning and Emotional Assessment Program (LEAP) and co-director of the Clay Center for Young Healthy Minds at Massachusetts General Hospital.

“Correct their misconceptions and then help them organize their thinking on the topic,” Braaten says. “Emotions tend to ‘de-organize thoughts,’ so you need to keep things real.

“You could say things like: ‘Scientists predict that this kind of virus can spread quickly. But it can’t spread as much when people stay apart for a while. That’s why you’ll be home from school for a while,’” she says.

It’s important to talk about what you’ll do during the time off. Share how you’ll continue to do things to stay healthy, like washing hands and getting enough sleep. Explain that doctors, nurses, and other health care workers are working very hard to understand how to help people, and they’re doing a good job at it. Emphasize the importance of having a routine.

“To do this, you need to be informed yourself,” says Braaten. “You also need to be able to discuss this in a fairly non-emotional way.”

(Stats from the Centers for Disease Control (CDC) and the American Academy of Pediatrics).

8 Ways to Support Others During Tough Times

Life is vulnerable; uncertainty is the only certainty. Pema Chodron has written a great book about this, the places that scare you, that I highly recommend. At one time or another, we will all go through a difficult time, whether we deal with financial hardship, health problems, death of a loved one, catastrophe, crisis, or relational breakdown. In psychology, we have a list of psychosocial stressors that include bereavement, breakups, housing problems or transitions, health problems, financial troubles, loss of work identity, and domestic or other abuse. Often people may experience more than one area of hardship simultaneously.

In those times, we need each other more than ever, but it’s not just enough to be surrounded by people. We, as supporters, need to be educated in the best way to love our friends and family through tough times.

How do we reach out to others? In tough times, circling the wagons and looking out for yourself and your immediate family becomes instinctual for many people. However, more than ever, we actually need each other. Often people don’t know what to do. They may even cause great harm by saying do not cry or just get over it.

1. Silence speaks louder than words misspoken.
Don’t ignore them. Plain and simple. If you don’t know what to say, don’t avoid them. Say something. Ninety nine percent of what you could say is better than saying nothing at all. I tell my clients to speak as close to the truth as possible. Which means sharing process. You could say, I don’t know what to say, but I really love you and I just want you to know that.

2. Don’t make them ask you for help.
Do they need help? Absolutely. Do they want to ask? Absolutely not. There is nothing more humbling than having to admit that you don’t have your life under control, and for all the people pleasers out there, asking people for something as simple as meals or free babysitting is something we’d rather avoid. We’d rather tough it out than beg.
Instead, offer your help, and offer specific ways that you would like to help.

3. Don’t rush them through their pain.
Saying things like “I know exactly how you feel” or telling me a story of your cousin’s boyfriend’s aunt’s struggle and how she made it through. While we may say things with good intentions, it can also serve to minimize their issues and urge them to stifle their pain. Yes, what they are going through has probably been faced before. Yes, people do survive. Yes, things might get better. Yes, to all the things. People need to know that the pain they feel is real and they need to move through it. They need to get a little messy and be a little more honest and feel a little more, because if they move through it too quickly or try to avoid their feelings, they might not heal just the right way.

A doctor doesn’t just give a sling with no cast to someone who has severely broken their arm. The doctor gives a cast. The doctor prescribes time for healing, because they know that if the healing is rushed, the bone may also not heal properly. In the same way, we need to give time for others to move through their pain rather than rush them. Instead, sit with them. Listen. Let them be honest when life is hard. Let them be angry. Let them be whatever they need to be, and resist the urge to fix them, heal them, or placate them. Just be with them.

4. Don’t give unsolicited advice.
Even if you have been in the situation before, support, but don’t preach. This includes all cliche and trite phrases and platitudes. You may have heard them said before, but that doesn’t mean they are helpful. Instead, listen, love, give. Give time, energy, resources… give yourself. Just don’t give advice when they haven’t asked.

5. Don’t give them magic formulas.
If they stand on their head, count to 30, twice and backwards, confess everything they have ever done, change their past mistakes, then this tough situation would no longer be happening to them. There is no magic formula. Life is hard and messy and it doesn’t negate the goodness in this world, but it does assign blame and guilt to the situation, one of the last things that someone who is suffering needs is to be shamed. Instead, let them know you are thinking of them, praying for them, loving them, and cheering them on.

6. Don’t make it about yourself.
Essentially, don’t complain about how your friend’s tough time makes you feel. If you are close, you will be affected, but if they are closer to the problem than you, then they are not the person to whom you should vent. Instead, you should offer them support. Check on them. Love them. Let someone else support you to stay on track.

7. Don’t forget the person.
With all of the above tips, don’t just follow them in a rote fashion. The beauty in each of us is that we are unique individuals with different backgrounds, personalities, experiences, and circumstances. Instead, consider the recipient. Some people want hugs. Some people aren’t touchy-feely. Some people want company. Some people prefer to sit alone. Some people want you to do things without asking, some people want you to run it past them first. Some people want someone to cry with and talk to, some people reserve that trust for a select few. Consider who they are before you act, and support them accordingly.

8. There is no timeline for grief and loss.
People may return to a place where loss feels fresh again. It’s not linear. Let people have whatever time they need. There’s no time limits or quotas.

Say a little less. Love a little more.
Life is messy, but with love, we can help each other survive even the toughest times.
#SpiralUp

Parenting and homeschooling, during COVID-19

It’s been a frequent question, how to handle the current situation with regard to kids. In Washington DC, the school systems are closed for at least a month, and I’m thinking longer. This is what I’m telling my patients and families:

1. Establish a routine. This needs to include online schoolwork, chores, exercise, scheduled not random downtime with a preferred activity, and very regular bedtimes and morning routines. You do not get to sleep till 11.

2. This is not a snow day. We can’t live on Doritos, ice cream, and junk food. I am asking all kids nine and above, to help plan and prepare a meal at least once a week for the entire family. This can actually be fun. We all need to cook.

3. Developmentally appropriate information needs to be discussed. From social media to television, we hear bits and pieces that can be very scary. No kid needs to be terrified.

4. Get some outdoor time. It’s spring, and it’s beautiful. Just because we can’t interact, touch or hug, doesn’t mean we don’t get to embrace the sun.

5. Find one cool new hobby or interest to explore. You’ve never had time like this to do that.

6. Don’t forget to check on others. Lack of social contact is one thing, but we have neighbors, relatives, elders, who need our support.

6. Last time, probably most importantly, give each other space. We are used to being at school, the office, sports, activities. Now we are stuck with each other. Annoyance happens.
Find some alone time, for each family member.

Embolden Psychology
Embolden

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

Thank you for contacting us.