THE COVID-19 Pandemic: How can we keep coping?

In a guest blog post, Dr Charlie Vivian, Consultant Occupational Physician at Icarus Health Solutions gives some really useful tips on how we can all cope with the challenges of the coronavirus pandemic

Covid-19 is setting up to be the defining event of our lifetimes. Wars, disasters and tragedy
happen with distressing frequency across the world, but for most of us, it is others who
experience these. Our lives continue, perhaps with gentle monotony, perhaps with routine
busyness, or even with stress of all the things we’ve GOT to do, but they continue.

But Covid-19 seems likely to be about to change everything. Suddenly, we ALL face an
existential threat. The accustomed pace and rhythm of our lives suddenly feels threatened.
We fear for our jobs, finances, our families, our health, our lives.

This provokes an emotional response that is entirely predictable. We will feel anxious, and
we may feel depressed. We can also feel guilty. Let’s explore these.

Anxiety

Fear is a natural and healthy response to a threat. In evolutionary terms, if we come across
a bear, we become anxious. This provokes a ‘fight or flight’ response, which triggers a range
of bodily responses, which increase the chances of our survival.

This fight or flight response is great for an immediate threat, but is hellish when the threat
becomes extended, such as we face now. Therefore, we need to adopt techniques that help
to switch off the response.

One of the simplest, and yet most effective, is to change our breathing. When faced with a
threat, our breathing rate increases, because we need more oxygen. Except, in a long-term
stressful situation, we don’t. So we have to slow down our breathing. The following is
recommended:

  • Breathe in through your nose, and out through your mouth. Do this SLOWLY.
  • Breathe out for longer than you breathe in. Imagine there’s a candle in front of you which you mustn’t blow out.
  • Breathe using your stomach not your chest: feel your tummy going in and out as you breathe.
  • Do this for two minutes: set up the timer on your phone.

This technique is used by everyone from top athletes to the US military to help stay in
control while under stress. There are all sorts of versions – from yogic breathing to box
breathing to 4-7-8. Google them, figure out what works for you. But use this, ideally several
times per day. And especially before you try to sleep.

Other things that will help include:

  • A problem shared is a problem halved. Speak to a family member, a friend, someone who’ll listen. Choose someone who will let you be you, who won’t judge you. And be willing to be there for others.
  • Laughter. It releases chemicals that are hugely beneficial. Silly memes, silly jokes, stand-up, rolling around with your kids – videos on YouTube. The sillier the better.  Also very good for bonding with friends, which will also help you feel less alone.
  • If you’re used to doing mindfulness or meditation, continue to do it now. If not, it may be difficult to derive any benefit, because it will take a while to develop the skills. But there are loads of apps which can help you develop this skill. It can be particularly useful after an emotionally draining day to quieten your mind before you try to sleep.
  • If you’re spiritual, engage with this. Prayers and rituals can help to calm the mind.
  • Do something! Do some exercise, do some activities, such as hobbies or DIY, and treat yourself! Eat some food you love, treat your body.
  • Reduce your consumption of news and social media. Watch news at set times, for set times, rather than endlessly accessing it. The same applies to social media, particularly the digital Wild West that is Twitter.
  • Avoid actions that will reduce your ability to cope. Be careful with alcohol, which makes it more difficult for you to remain in control. Same for drugs, and look to optimise your sleep, rather than staying up late.
  • Be kind to yourself. The golden rule of ‘love your neighbour as yourself’ applies.  Many people in caring professions are brilliant at loving their neighbour, but neglect themselves. The reality is that we have to care and nurture ourselves, to be able to continue to care and nurture others.
  • Be kind to others. Remember that, when faced with a huge threat like this, others may act very differently to how they would normally behave. If you assume that another person’s strange or unacceptable behaviour is being prompted by fear, you’re probably right.

Depression

Depression is part of a bereavement-type reaction. People assume that bereavement is
caused by death, but it’s actually caused by loss. Loss of a loved one, loss of job, income,
health, hope. And the greater the sense of loss, the greater the sense of bereavement.
The bereavement process goes through a number of phases, but it’s normal for you to move
back and forth between these.

Lost

Phase 1 is shock or denial. We cannot believe what is happening, or may simply deny that it
is. We carry on as though nothing has changed.

Phase 2 is a phase of anger, where we try and recapture what’s been lost. We might be
angry at God, the government, our employers, other people, even ourselves. But the anger
is all aimed at getting back what we no longer have. And if we don’t express this anger, it
flips over to become depression or low mood.

Phase 3 is the phase of despair. We realise that what we had has been lost. It’s as though
we sit in the wreckage of our lives, not knowing how to proceed.

Phase 4 is the phase of recovery. This breaks down into 2 very different situations. Firstly,
we may feel resigned to what has happened. In practice, this is little different to phase 3
(despair). Alternatively, we may become reconciled to what has happened. Normally, this
includes us identifying some good that has come out of our loss. Somewhat paradoxically,
we may even feel grateful for what has happened.

But we also may simply feel angry and frustrated. A formula can help us understand this:

Frustration = expectation – reality

We become frustrated if our expectations exceed what’s actually happening. To use a
simple example, we may expect our computer to work normally, with no glitches. (Ha!) If it
stops working normally, we might feel really frustrated. But if we realise that our
expectations are unrealistic, this can help us adjust our expectations, so that they match
reality.

In the context of Covid-19, it’s obvious that we may feel frustrated about lack of support,
information, communication, equipment, and so on. It’s useful to reflect for a moment, to
determine whether our expectations are realistic.

Cognitive behavioural therapy and/or medication

If, despite the above, you find you are struggling to bring your symptoms under control,
then it may be appropriate to seek further help and support. Your doctor will be able to
assess whether you might benefit from a course of medication. You may be able to access
counselling through your GP, through work, or privately.
One very good online programme is available here

Guilt

Many will feel incredibly guilty at times like this. It’s worth reflecting on the fact that ‘guilt is
caused by unreachable goals.’ What may normally be possible may be impossible, given the
new reality. If you are feeling guilty, stop and reflect on the goals you’re trying to meet. It
may help you realise that you’re being unkind to yourself, expecting what simply can’t be
delivered currently.

Other things we can expect

There are other aspects of this for us to bear in mind:

  • The calm before the storm is often one of the worst bits. We all realise the severity of what we face, rather like being at the top of the rollercoaster. But this doesn’t last long, and quickly a new ‘normal’ will be established, with new rhythms, and various aspects of life re-emerging. Humans are incredibly adaptable, and we will witness extraordinary events.
  • There will be amazing bits. When humans are faced with a crisis, we can be extraordinary in our care for each other. You’ll witness acts of kindness you’ll never forget, and you’ll do the same for others.
  • Small gestures can be immensely powerful. Doing a simple act of kindness for another person can reap huge rewards.
  • It will be over one day. One day we will gather, socialise, hug, relax again. We’ll reminisce, and return to the trivia of our former lives. And each day, that day is one day closer.
Conclusion

The Covid-19 pandemic confronts us with a threat to our existence. This provokes
predictable responses, which cause us a great deal of distress. But if we understand what is
happening, and take some steps, we can greatly reduce this distress, leaving us better
placed to cope.

Good luck!

Dr Charlie Vivian ([email protected])
Consultant Occupational Physician
Icarus Health Solutions

With acknowledgement of Imogen Wall, for her postings on FaceBook. Imogen is a former
BBC journalist and UN spokesperson, specialising in crisis response, particularly mental
health and peer support.

(Published 03/04/20)

For more information on any of the topics covered, please contact Dr Charlie Vivian ([email protected]) directly, or contact your usual Howden Consultant.

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