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Coronavirus – Managing Your Anxiety

Coronavirus-manage-your-anxiety

Introduction

In this unprecedented period of global uncertainty, we felt it was necessary to put together this workbook to provide our community with much-needed support.

The first thing to note right now is that it’s completely normal to be experiencing a wide range of emotions. Accepting your feelings is an important first step to building resilience. The simple act of naming your emotions has been found to benefit wellbeing. So, take a moment now to tune into your body and notice how you’re feeling. Circle the emotions that you identify with:

  • Anxious
  • Stressed
  • Worried
  • Fearful
  • Low
  • Lonely
  • Overwhelmed
  • Helpless
  • Frustrated
  • Guilty
  • Angry

Remember: It’s okay to feel discomfort. Accepting distress is often the quickest way to feel immediately calmer.

What Are Stress and Anxiety?

The terms stress and anxiety are often used interchangeably. To develop a deeper understanding of mental wellbeing, it’s helpful to understand how they differ.

Stress

Kelly McGonigal, an expert in the new science of stress, offers us this definition: “Stress is what arises when something we care about is at stake”. Many of us are now in positions where things that matter to us feel more uncertain, which understandably gives rise to our stress response.

Stress is best understood as manifesting in the body. It’s the racing heart, sweaty palms and funny tummy we’re all familiar with. Central to the experience of stress is the amygdala, the area of your brain responsible for generating your body’s stress response.

Experts agree that a core component of stress is the perception of threat and danger. You’ve probably heard of the ‘fight-or-flight’ stress response as a reaction to perceived danger. In fact, we have various stress responses. For example, there is one response that encourages us to reach out for social support, named the ‘tend and befriend’ response.

Dr. John Arden, an author of several books integrating neuroscience and psychotherapy, recently put forward the term auto stress for describing what happens when our body’s stress response goes on for a long time. He explains:

“Like autoimmune disorders that hijack the immune system, attacking the body instead of protecting it, auto stress [transforms] the stress response system into something that attacks the self rather than protecting it.”

If your body is in auto stress mode, you’ll experience a wide range of physical stress symptoms on an ongoing basis, regardless of your situation. That’s why people often reporting feeling anxious for no apparent reason. If you’re suffering from high levels of distress triggered by the pandemic, you might continue to feel this way after the virus has passed.

Signs of auto stress include:

  • Chest tightness and feeling like you can’t breathe
  • Muscle tension, aches and pains
  • Headaches
  • Difficulty sleeping
  • Restlessness and an inability to relax
  • Heart palpitations
  • Digestive issues

Anxiety

Anxiety is commonly described as having both mental and physical symptoms. The distinction between mental and physical anxiety is important because different tools are required for addressing physical symptoms (what we label auto stress) and mental symptoms (what we label anxiety). Anxiety is best described as the unhelpful thinking patterns we experience when our mind fixates on threat, uncertainty and negativity.

Anxiety can occur on its own, as a response to stress, or it can trigger stress. When it occurs as a response to stress, it can intensify the stress, and, in worst cases, lead to panic attacks. It’s important to understand that you cannot control anxiety from occurring – this is your brain’s automatic survival mechanism. What matters is learning how to respond to anxiety helpfully, so that you don’t get carried away by it.

Here are five examples of what to look out for:

Threat Scanning:

When your mind searches the environment for what you fear (consciously or subconsciously). Threat scanning is often associated with your mind assigning meaning to harmless events.

Examples

  • Frequently checking your body for coronavirus symptoms
  • Obsessively checking the news for coronavirus updates

Catastrophising:

When your mind jumps to worst-case scenarios, i.e., ‘making a mountain out of a molehill’.

Examples

  • You feel chest tightness and your mind tells you that you have coronavirus and that your life is in danger
  • Your mind gives you the mental image of losing all the people you love

Hypothetical Worry

It’s important to note that worry is completely normal. It only becomes unhelpful when you focus excessively on hypothetical worries instead of practical worries. Hypothetical worries include ‘what if’ thoughts and are typically about things you don’t have much control over.

Practical worries concern things you do have control over, and they can help you be more proactive. If you’re very uncomfortable with uncertainty, you’re likely prone to hypothetical worry and spend a lot of time focused on the future instead of the present.

Examples

  • “I know I’m following all the guidelines, but what if I spread the virus?”
  • “What if someone gets too close to me at the supermarket and I catch it?”

Emotional Reasoning

When your mind tells you that your emotions reflect reality. While emotions can act as helpful messengers, they often aren’t reliable.

Examples

  • “I feel scared, so I must be in danger.”
  • “I feel guilty, so I must’ve done something wrong.”

Fortune Telling

When your mind interprets predictions as facts.

Examples

  • “I’m going to be stuck inside for months on end.”
  • “My mental health will keep deteriorating and I’ll have to go back on meds.”

Part 1 - Tool To Manage Your Anxiety

Planning Your Information Diet

The media is fully aware that our brains are built to fixate on threat, uncertainty and negativity – and they capitalize on it. Most news sources are negatively biased, sensationalist and speculative in order to win your attention. Anxiety is easily fuelled by consuming this kind of information. To reduce anxiety, it’s important to be aware of and take control over your information diet.

My Current Information Diet

Which information sources are you feeding your mind and how often? Take some time to write your answer on a piece of paper

Key Coronavirus Facts

If you’re prone to catastrophizing, you may find it helpful to redirect your attention to the facts:

  • The vast majority of people only experience relatively mild symptoms.
  • Coronavirus is fatal in about two to three percent of cases.
  • Health advice for the public is to wash your hands with warm water and soap for at least 20 seconds:
  • After coughing or sneezing

    Before, during and after you prepare food

    Before eating

    After toilet use

    When you get in from the outdoors

    When hands are visibly dirty

    When caring for the elderly or sick

    After handling animals or animal waste

  • Use alcohol-based hand sanitizers as a substitute for washing your hands, but do so sparingly.
  • Maintain a distance of at least 2 metres (6ft) between yourself and anyone who is coughing or sneezing.
  • Cover your coughs and sneezes and throw your tissue into a closed bin immediately after use.
  • Avoid touching your eyes, nose and mouth.
  • Frequently disinfect surfaces, like your desk, phone, tablet, smartphone, and countertops.

Trusted News Sources

We recommend finding and sticking to a credible source you can trust, such as:

Uplifting News Sources

Good News Newsletters

Planning My Information Diet

To reduce anxiety, we recommend checking your trusted news source once per day. We also recommend balancing out your information diet with uplifting news sources (as listed above). Which news sources will you use and when will you read them? How else can you limit your exposure to anxiety-provoking news (e.g., by doing one digital detox day per week and limiting time on social media)?

Take some time to write down your trusted source and add them to your favourites.

My Spheres of Influence Worksheet

If you’re prone to hypothetical worry (i.e., the ‘what if?’ thoughts), you may find it helpful to practice noticing these thoughts and then redirecting your attention to things within your control. Research shows that when we shift our focus to what we can control, we see meaningful and lasting differences in our wellbeing, health, and performance. So, write down what you have control over inside the circle below. Then, note the things you cannot control outside of the circle, using the table below as inspiration.

Remember: You cannot stop hypothetical worries from occurring, but you can control your response to them.

Within My Control

  • Building resilience
  • Following the latest information and advice
  • Focusing on what’s important to me
  • My information diet
  • My routine
  • Relaxation
  • Cultivating connection
  • Eating well
  • Exercising
  • Seeking and offering support
  • Voting and activism
  • Outside My Control

  • Other people’s decisions
  • Other people’s health
  • The news
  • The government’s actions
  • Schools opening or closing
  • The state of the healthcare system
  • Flights and holidays being cancelled
  • Traffic
  • Public transport
  • Aging
  • The weather
  • Practical Wisdom for Tolerating Uncertainty

    People who experience anxiety have been shown to have a low tolerance for uncertainty. It’s worth reminding ourselves that uncertainty is an inescapable part of life, and the sooner we become more comfortable with it, the sooner we can reduce mental suffering.

    Stoic and Buddhist philosophy both emphasize embracing uncertainty and change as the essence of life. Many people find reading about these topics helpful, stating that practical wisdom helped them shift their mindset and reduce anxiety.

    Practical Wisdom Resources

    Videos

    Books and Audiobooks

    Reducing Anxiety With Thought Challenging

    Thought challenging is a simple yet powerful cognitive behavioural therapy (CBT) technique for reducing anxiety. As mentioned, anxiety is best described as the unhelpful thinking patterns you experience when your mind fixates on threat, uncertainty and negativity. Thought challenging helps by broadening your focus to include the bigger picture.

    Below are two thought challenging techniques you can experiment with. Keep practicing and discover what works best for you.

    The ABCDE Technique

    Attention – When you feel distressed, stop what you’re doing and pay attention to your innerdialogue. What is your mind telling you?

    Believe – Do not automatically believe your thoughts!

    Challenge – Defuse anxiety by broadening your focus. What’s the bigger picture? Is the thought

    Fact or Opinion - What might you think if you were feeling calmer?

    Discount – Acknowledge that anxiety has been is dominating your thinking and let the unhelpful thoughts go.

    Explore options – What would be helpful to focus on right now? What options do I have available?

    The THINK Technique

    True – Is this thought 100% true? If not, what are the facts, and what is opinion?

    Helpful – Is paying attention to the thought useful to me or others?

    Inspiring – Does the thought inspire me or does it have the opposite effect?

    Necessary – Is it important for me to focus on the thought? Is it necessary to act on it?

    Kind – Is the thought kind? If not, what would be a kinder thought?

    Thought Challenging Tips

    • Writing or typing your thought challenging process is more powerful than trying to do it in your head. We recommend trying out the free CBT Thought Diary app.
    • If you’re not used to paying this much attention to your inner dialogue, thought challenging might feel unnatural at first. That’s okay. Over time, it’ll start to feel easier.
    • This isn’t the most appropriate tool if you’re feeling very distressed, as it can be hard to think rationally when your emotional brain has taken over. Try defusing your emotions with a distraction activity (see the following page) and returning to thought challenging once you’re feeling calmer.

    Reducing Anxiety Through Distraction Activities

    If your mind continues to spiral with unhelpful thoughts, distraction can be an effective tool for nipping it in the bud. It’s important to note that a distraction activity must be very attention absorbing to effectively reduce anxiety. When an activity isn’t working well, spend some time reflecting on why this could be and how you could make it more attention-grabbing in the future.

    Distraction activities have the added benefit of helping you feel happier, more motivated and more energized, as well as combatting feelings of boredom. Low activity and social disconnection are the two most fundamental maintaining factors of low mood, motivation and energy.

    To feel better through building up your drive system (see page 8 of our Understanding Your Mental Wellbeing Guide), you need to increase your activity levels and ensure you’re meeting your social connection needs (which we’ll address later).

    Motivation Follows Action

    “What assistance can we find in the fight against habit? Try the opposite!” - Epictetus

    If you’ve been inactive and feeling low for a while, you’ll likely be experiencing low motivation and energy levels. You can build up your motivation and energy by increasing your activity.

    Don’t think – just do it. Motivation will follow! Check out this video on the opposite action technique for more guidance.

    Part 2 - Creating Your Stress Resilience Action Plan

    Starting a Planning Practice

    Maintaining structure can work wonders for your mental wellbeing. Routines help you increase your sense of control and defuse feelings of overwhelming.

    Planning Tips

    • Schedule regular breaks. Take time to mindfully drink your tea or focus on your breathing – here’s a great website you can bookmark from Calm.
    • Write a weekly goals list. Identify what you need to do to achieve your weekly goals. Break tasks down into smaller steps and cross them off as you go to maintain a sense of progress throughout the day.
    • Identify 1-3 “Most Important Tasks”. Creating a daily MIT list helps you prioritize your most important and urgent tasks.
    • Review your crossed off items at the end of the day. Taking stock of your achievements can help boost mental wellbeing.
    • Try a to-do list app. You may prefer a digital format such as Google Keep.
    • Experiment with productivity techniques such as The Pomodoro Technique and Eat The Frog.
    • Write your daily to-do list the night before. You might find that being able to start work straight away helps increase your productivity. Also, this practice can help you clear your mind and switch off in the evening.
    • Tidy your workspace at the end of the day. Research finds that cluttered environments interfere with your ability to focus.
    • Decide on a regular sleep schedule. When it comes to improving sleep, research suggests that maintaining a regular sleep schedule is of high importance.
    • Create an end of the workday ritual. To enforce work-life boundaries, you might find it helpful to create an end of day ritual such as changing into comfier clothes, switching off work email notifications and putting on some music.
    • Create weekly family traditions. Strengthen family routines through traditions such as “Board Game Fridays” and “Movie Night Mondays”. Find more advice and resources for setting up a family routine here, here and here.
    • Be kind to yourself. You might suddenly have a lot more on your plate. Be mindful of your inner critic, and remind yourself that you can only do the best you can.

    Starting a Daily Gratitude Practice

    “Enjoy the little things. For one day you may look back and realize they were the big things.”Robert Brault

    Research shows that cultivating gratitude has a plethora of benefits, including:

    • Reducing stress and anxiety
    • Boosting mood
    • Strengthening your immune system
    • Improving sleep

    A simple way to cultivate gratitude is to keep a gratitude log. Each day at a set time in your daily routine, write down one thing you’re grateful for on a sheet of paper.

    Starting a Daily Breathing Practice

    Breathing difficulties are associated with auto stress. When you have problems with your breathing, you lower the amount of carbon dioxide that’s normally in your blood. This leads to a wide range of symptoms, including:

    • Shortness of breath
    • Chest tightness
    • Tingling or numbness in the arms, fingers, toes, or around the mouth
    • Feeling dizzy and light-headed
    • Weakness
    • Heart pounding and racing
    • Heart palpitations
    • Sweating or hot flushes
    • Headaches
    • Feeling sick
    • Fatigue

    These symptoms can appear out of the blue and can also lead to panic attacks. Your breathing difficulties may be related to:

    • Shallow breathing (breathing in too quickly)
    • Over-breathing (breathing in more air as you feel like you’re not getting enough, for example through yawning or sighing frequently) Some people experience both.

    So, let’s take a moment to test your breathing:

    1. Put one hand on your chest, and one on your belly

    2. Breathe for a few seconds. Which hand rises?

    3. If it’s your chest, you might have developed a habit of shallow breathing

    Although the effects of shallow breathing can be very unpleasant, it won’t harm you, and you can reverse the habit with a daily breathing practice. The next time you feel anxious, take a moment to notice your breathing. Focus on breathing through your stomach so that your belly rises when you inhale and drops when you exhale.

    Here’s a belly breathing exercise you can practice for 5-10 minutes a day:

    • Inhale gently, lightly and slowly count to four, expanding your belly as you do so,
    • Hold that breath for a count of two,
    • Slowly exhale through your mouth for a count of six.

    This is referred to as ‘belly breathing’. Research shows that practicing regular belly breathing can help people feel calmer within a matter of weeks.

    Improving the Quality of Your Social Connections

    How to cultivate connections in a period of isolation? Here are some ideas. Tick the ones you’re interested in adding to your Stress Resilience Action Plan:

     1. Use this time as an opportunity to complete the Relationship Inventory Exercise (see page 27).

     2. Schedule video chat catch-ups with friends you haven’t spoken to in a while.

     3. Use the video chat app Houseparty to play popular games like trivia and Heads Up! with friends.

     4. Have a virtual happy hour over video chat.

     5. Browse Meetup.com for events that have been transferred to online.

     6. Organize a weekly lunch date with a friend over video chat.

     7. Use the Netflix Party extension to watch Netflix with your friends online.

     8. Send letters to your loved ones using a service like Postable.

     9. Play Scrabble and chat with friends using the Words with Friends app.

    Developing a Regular Exercise Routine

    “Walking is man’s best medicine.” - Hippocrates

    Exercise reduces the overall activation of your amygdala and sympathetic nervous system – the parts of your brain and body that generate your stress response. Research suggests that aerobic exercise (such as walking, cycling, and jogging) provides the same benefits as non-aerobic exercise (such as yoga and pilates).

    Studies also suggest you need around 21 minutes three times a week to experience the benefits. So, you don’t have to spend hours doing it – it’s something most of us can fit into our lives when it becomes a priority.

    It’s important to find something that you enjoy when it comes to building an exercise habit. Now more people than ever are interested in fitness, you have endless options. These include ‘bedroom fitness’ resources and tools that make it easy to keep moving indoors.

    Here are some ideas. Tick the ones you may be interested in adding to your Stress Resilience

    Action Plan:

     1. Schedule a daily walk.

     2. Complete YouTube video workouts.

     3. Do a free trial of Les Mills at-home workouts.

     4. Do online yoga with Aura.

     5. Do the 5-week strength and flexibility plan from the NHS.

     6. Set yourself a challenge to run 5k with the support of the Couch to 5k running plan for beginners.

     7. Invest in some indoor exercise equipment.

     8. Do this 10 minute home cardio workout from the NHS.

     9. Find an outdoor gym to visit.

     10. Browse Pinterest for indoor workouts.

     11. Do an affordable at-home cardio workout with a jump rope.

     12. Invest in a Fitbit to track your progress.

    Don’t forget: Motivation follows action!

    #staystrong #stayhealthy #stayhome #healthylifestyle #eatwell #pillarsofwellness #onestophealthsolution
    Laurent Pinci
    Laurent Pinci
    Pillars of Wellness is a truly Integrated Healthcare Centre providing a high degree of collaboration and communication among health providers.
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