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.

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