Living in the times of Covid-19

'Pandemic' was a word I had come across many years ago and I never thought that a time will come when I would be analyzing the impact this word has on our mental health. Come to think of it, I had never thought that I would look at soap or soap bubbles with so much respect.

In this modern era where media rules, the amount of information overload we have had and are still having is beyond explanation. This information overload combined with the human tendency to either over-react or under-react (go in denial) in crisis situations, is bound to increase emotional and psychosocial vulnerability. Though preparations for such events are mostly focused on stabilising the resources and health plans, focus on psychological and social aspects somehow get neglected.

A very interesting question asked by a friend during these pandemic discussions was, 'what has mental health got to do with a medical crisis like this?' And that's when i thought of writing this blog. So, If I may be allowed to get a bit technical, in terms of mental health, a major epidemic implies a psychosocial disturbance that can exceed the affected population’s capacity to handle the situation. It can even be said that the entire population experiences stress and anguish to some extent. At an individual level, many people may experience a crisis, defined as a situation caused by an external life event that exceeds a person’s emotional response capacity. In simpler terms, the person’s coping skills are insufficient, and a psychological imbalance or failure to adapt occurs. The most common expression of psychological disturbances in such situations are depression, adjustment disorders and acute transitory stress reactions. An increase in violent behaviour and excessive alcohol consumption has also occasionally been observed in emergencies. And thus, when we focus on health management in such situation, mental health has an important role in having short, middle and long term management plan in epidemic/pandemic crisis.

If we flip the coin on emotional reactions, another unique thing about human nature is its resilience, its capacity to cope with the worst. I may not be wrong when I am assuming that the most common thought in everyone's mind today is, 'what can I do in a situation like this?' and 'how do I contribute'? Maybe, as a result of this thought, these last few days we have seen a serge of well-meaning WatsApp messages with information on what to do, what to eat, how to survive isolation and so on. Though some messages were useful, some were not and some were debatable.

One major observation for me from these messages was human resilience, the will to survive this crisis and to reach out. Keeping that thread in mind, I wondered, as to how to use this human quality and use it to our advantage. Hence, decided to do my bit by compiling information on what we all can do as a community as well as individually to help others as well as ourselves in this situation. I have tried to compile information from reliable sources as well as from my work experience with the aim to convey correct message from a mental health point of view. Since we are at the beginning of the curve, I will focus on the short term management in this write-up.

So, we will first focus on handling common anxious thoughts, then we will focus on how to communicate information, how to speak to children and lastly on how to take care of our mental health.

HANDLING DIFFICULT SITUATIONS

Although these situations would be many, I'm answering a few questions which have been commonly asked.

How can I support a loved one who is very anxious?

First thing to remember is that everyone responds to a crisis situation differently. If you have a family member or friend who is worried or scared, try to listen to and empathize with them. Some people may want to vent their fears or anger at the situation, find fault in the system while others may want to problem solve.

Share the facts in a simple and straightforward way and ask how you can help (make sure you get your facts from approved sources). Stick to the facts and offer them resources if they are open to it. Its important to keep your cool and avoid confrontation if your aim is to help.

Check in with the person from time to time to make sure their stress levels and mental state are not getting worse. Always keep the lines of communication open.

At the same time, ensure you take care of yourself, and limit the amount of time you devote to supporting others. It is okay to say that you also need a break from fear and anxiety. Sometimes the support may be mutual, in which case it is important to respect each other’s ability to help.

I have a friend who can't stop talking about it and gives worst case scenario. How do I deal with it?

Sometimes sharing stresses with colleagues, friends or family members can be helpful. However, be mindful that others may be feeling very stressed or anxious themselves, and may not be coping well. Hearing about your anxieties may make them more anxious.

When others share information with you, their facts may not always be accurate — keep this in mind when you hear something about the virus that is not endorsed by the World Health Organization or the government. It's ok to distance yourself from people in whose company you feel stressed out.

How do I deal with feeling lonely in self-isolation?

Being in self-isolation can be very lonely. While in self-isolation, remember to continue to isolate from your friends and family, to ensure the virus does not spread to others. It's important to remember, that this isolation no matter how difficult it may be, is important not only for you but for your loved ones too. However, self-isolation is only for physical proximity so remember to stay connected with your family and friends through social media. Though being with self is a good time to self-introspect, it becomes a daunting and boring task when done in repetition. Its important to make a time schedule for yourself, maintain healthy diet, engage with nature by going out to the balcony or the garden, switch activities from a sedentary activity to a physically active one, stay connected with your family and friends, limit news intake, be mindful of the content of the media exposure and avoid getting into the negative 'what if, why me' thought cycle (Read coping with stress and worry for more details and refer to the WHO's and national guidelines on self-isolation).

Due to lockdown remedial sessions of my child have shut down. What do I do?

Many of us have children with special needs and situations like lockdown and closed remedial centres challenge mental as well as emotional regulation of the child as well as the caretaker. However, online home-based remedial management activities are being provided by many organisations including ours, you could contact them. In the meantime, it is advised to have a structured schedule for your child, do not change the sleep pattern, make a visual time table with each to-do activity listed (make sure you include activities related to gross motor, fine motor, activity of daily living, receptive-expressive language, cognitive, social & emotional skills), plan for indoor physical activities focusing on gross and fine motor skills, choose activities that your child likes and take out time for yourself.

I have done everything but still my anxiety and fear doesn't go. What do I do?

Sometimes, even after trying to reduce our stress and anxiety, we may continue to struggle. If you still feel significant distress around COVID-19 and feel you are not coping well, you may need extra support from someone like your family doctor or a psychologist, psychotherapist, social worker or other health professional. Many free helplines are available, you should reach out and take help.

HOW TO COMMUNICATE WITH CHILDREN

This time may be very challenging for children and adolescents especially with the annual examinations just getting over. Younger children might not understand the reasons for school closures, the cancellation of extracurricular activities and vacations. It's also likely that they are likely to be bombarded with information through social media and from their friends that can cause anxiety and alarm, thus It's important to give them correct information.

Young people may also sense the anxiety of their parents, and worry about their own health and that of other family members. For example, young children may not understand why they can no longer hug a grandparent. It's important to keep calm yourself to avoid chain reaction of stress and panic.

Children need to be reassured in a way that is age appropriate. As a first step, you may consider a family meeting to:

Acknowledge their fear.
Explain the overall risk of getting the virus and what happens if they do get sick (be mindful of giving explanation according to the child's age).
Outline the steps you are taking to keep them and yourself safe during this pandemic.
Reassure them that young children tend to get a mild form of the virus, but at the same time do not undermine the importance of taking the required precautions.
And most important, discuss any questions they may have. So read up from correct resources. Have patience as children will have a lot of questions answers to some which you might not have. It's ok to tell them that you do not know the answer but you could find out and let them know.

While in isolation, it might be a good time to do all the activities you had put-off as you were busy doing other things. It's a good time to explore and encourage the talents, qualities as well. as teaching lifeskills to children.

COPING WITH STRESS & WORRY

High levels of anxiety and stress are usually fuelled by the way we think. For example, you might be having thoughts such as “I am going to die” or “There is nothing I can do” or “I won’t be able to cope.” These thoughts can be so strong that you believe them to be true.

However, not all our thoughts are facts; many are simply beliefs that we hold. Sometimes we have held these beliefs for so long that they feel like facts. How do we know if our thoughts are true or are just beliefs we’ve grown used to?

Here are some ideas that might be helpful. Some might apply to you and some might not – or they may need to be adapted to suit you personally, your personality, where and with whom you live, or your culture. Please be creative and experiment with these ideas and strategies.

Accept that some about of stress and anxiety is normal
Seek reliable information
Find a balance- stay informed but be mindful of information overload
Set a 'no media' time in a day and indulge in creative artistic activities (you need not be a master at it)
Deal with problems in a structured way (refer to the next section)
Remember that you are resilient and have the ability to handle your stress. Avoid negative (what if) thinking
Stick to a schedule. Practice relaxation and meditation (many free resources are available).
Be kind to yourself, take adequate rest, eat healthy food, practice home exercises and stay active (many healthy diet plan resources are freely available).
Avoid any non-prescribed substance.
Take prescription medications as prescribed.
Try to reduce or avoid caffeine and alcohol.
Seek out professional help if you cannot do it alone.

However, if some anxiety arousing thoughts still trouble you, you may try few steps given below-

Start with catching your thoughts. When you are feeling anxious or stressed, stop and write down what you are thinking. There may be more than one thought going through your mind when you are feeling anxious. (Hint: Your thought might sound something like “What if ...” or “I’m worried that ... .”
Once you have identified a thoughts, challenge it. Ask yourself:- Is this thought true?

- How do I know it’s true?

- Is it 100% true and always true?

- What is the evidence for the thought?

- What is the evidence against the thought?

- Has the thing I’m worried about ever happened before?- What actually happened?

- How did I cope? What was the end result?

If you find it hard to let go of worrying, ask yourself, “What does worrying do for me? Is worrying actually helping me solve a problem or is it keeping me stuck and feeling anxious?”
Ask yourself how helpful it is to keep thinking this way?
After working through these approaches, see if you can come up with a more balanced thought. For example, “I am elderly, and so many older people are getting extremely ill. I could die from this” could be replaced with “I am elderly, but I am also taking all of the recommended precautions, I have a good support network, and I am taking steps to stay healthy. I am extremely likely to get through this and be fine.

If you feel that you are still not able to handle your stress, then it is recommended that you reach out for professional help.

HANDLING PROBLEMS

All the issues you might need to address during this pandemic situation may feel overwhelming. It can be useful to identify which things are actually problems that need to be solved or addressed, and which are just worries that are not necessarily grounded in reality. Here are some steps you can take to resolve issues that come up for you.

Take some time to identify what you feel are problems. As we deal with the COVID-19 pandemic, planning for self-isolation or quarantine might be something you identify. What concerns are causing you stress or anxiety?
Break each problem down into smaller parts, so you don’t feel so overwhelmed. Think about what parts of the issue are most immediate and urgent: what needs to be done now, what can be tackled tomorrow, and what can be delayed or even dropped completely because it doesn’t really matter in the long run.
Brainstorm some options that can help address the problem. List all possible options.
Identify the pros and cons of each option.
Narrow down to the best option you have.
Put the solution into practice and see how it goes. Did it solve the problem? Did it help a bit? Do you need to adjust the solution or consider another solution from your list?
Ask others how they see your “problem”? If they agree that it is a real problem, ask for feedback on your solution.
Consider writing things down—putting this process down on paper. You can cross off tasks as you do them. This can help you feel you are getting things resolved and can combat feelings of helplessness.
If you may need to plan for self-isolation or quarantine, do so ahead of time.

REDUCING STIGMA

Public health emergencies are stressful times for people and communities. Fear and anxiety about a disease can lead to social stigma towards people, places, or things. For example, stigma and discrimination can occur when people associate a disease, such as COVID-19, with a population or nationality, even though not everyone in that population or from that region is specifically at risk for the disease. Stigma can also occur after a person has returned from a foreign location or has been released from quarantine even though they are not considered a risk for spreading the virus to others.

Some groups of people who may be experiencing stigma because of COVID-19 include:

Persons based on physical appearance
People who have traveled
Emergency responders or healthcare professionals
Other essential service providers

Stigma hurts everyone and by creating fear or anger towards other people, stigmatized groups may be subjected to:

Social avoidance or rejection
Denial of healthcare, education, housing or employment
Physical violence.

Stigma affects the emotional or mental health of stigmatized groups and the communities they live in. Stopping stigma is important to making communities and community members resilient .

Everyone can help stop this stigma by knowing the facts and sharing them with others in your community.

Knowing and sharing Facts can help stop stigma (from reliable resources)
Speak out against negative behaviours, including negative statements on social media about groups of people, or exclusion of people who pose no risk from regular activities.
Be cautious about the images that are shared. Make sure they do not reinforce stereotypes.
Resist the temptation to repost every message you get on social media without verifying it.

I know that there are many other questions that need to be answered, many topics which need to be touched. You could write it in the comments and I will try to address them as they come.

I would like to pen off with a Buddhist quote "No one saves us but ourselves. No one can and no one may. We ourselves must walk the path".

The author is a Consultant Psychologist with experience in Child and Rehabilitation Psychology

Resources:

https://www.mygov.in/covid-19

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

https://www.camh.ca/en/health-info/mental-health-and-covid-19

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/share-facts.html

https://www.alz.org/help-support/caregiving/coronavirus-(covid-19)-tips-for-dementia-care

https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf?sfvrsn=6d3578af_8