Coping with this new coronavirus has taken on many forms since mid March of 2020, six months feels like a long time and many transitions ago. From a stay at home order, to safe social distancing, to small group gatherings to hybrid learning environments, for many people the novelty of COVID-19 has worn off. The politics associated with it and the many opposing views and realities are exhausting. Not to mention anxiety provoking. Below is an excellent, well written article that may help all of us focus on how we can help ourselves and our loved ones cope during such an exhausting and trying time.
During this unprecedented time know NorthStar Counseling Group is here for you. Currently sessions are being offered via telehealth.
For further information or to set up an appointment please call 847-400-0223 or send a request for services through northstarcounselinggroup.com
Dr. Caroline Adelman of Chicago Psychotherapy LLC has generously given me permission to post her work below:
Coping In the Time of COVID: 20 Evidence-Based Strategies for Self-Care in 2020
If scientists ever wanted to design “ideal conditions” for observing the human stress response at its peak, their experiment would likely include the following four elements:
1. Novelty (i.e., we haven’t been here before and aren’t sure what to expect)
2. Actual or perceived threat to safety or wellbeing
3. Uncertainty about outcomes and risk level
4. Lack of control/perceived inability to prevent the threat from occurring
You know what meets all four of these anxiety-generating criteria? A global pandemic. So if 2020 feels like a wave that won’t stop crashing on your life, that’s because the current circumstances truly are a perfect storm for kicking the brain’s stress response into high gear. If you are physically and emotionally drained, and feel like it’s more difficult than ever to focus or sustain attention, there’s a good chance that it’s because your brain has been working in overdrive for months now, all in an effort at self-preservation.
There is a term in the fields of Medicine and Psychology, allostatic load, which refers to the toll of prolonged stress exposure on the brain and body. Prolonged stress can impact everything from mood to memory to cardiovascular health. The human brain is built for pattern detection and prediction, and our survival as a species has largely depended upon being able to make fairly accurate predictions about how best to respond in the face of potential threat. When we face situations in which we believe our safety and wellbeing rely upon making accurate predictions AND we don’t have sufficient information to confidently predict the best course of action (or worse, are facing an overload of conflicting information), our brains are left constantly reassessing risk and trying to calculate the best course of action. The result is a state of prolonged, chronic stress and diversion of energy from other elements of cognitive and physiological functioning.
Because the human threat response system is optimized for responding to acute threats (such as escaping a tiger in the wild), we have evolved to respond to perceived threats with a cascade of cognitive and physiological changes, including increased blood pressure and heart rate, muscle tension, hyper-vigilance for threat, heightened reactivity, and a surge of various stress-related hormones coursing through the body. Thus, the very same cognitive and physiological processes that help us to survive in the face of acute stress can undermine our physical health, mental health and cognitive functioning in the face of more sustained stressors.
Bottom line, 2020 has been an extremely challenging and exhausting year for most of us. For folks who were already living with the chronic stress of racism and other forms of marginalization before the pandemic started, chronically heightened allostatic loads have been exacerbated during the pandemic, amplifying existing health disparities (much more on this piece in our next blog post). In other words, it’s not you… our brains and bodies are built such that chronic stress comes at a high cost to our physical, cognitive and psychological functioning, and we are all feeling that toll at points.
The good news is that what doesn’t kill you really can make you stronger, but there are some important caveats. Resilience research has shown that the most resilient individuals are those who have experienced moderate levels of adversity across a number of domains, with opportunities to recuperate between adverse experiences. Social support during times of adversity also appears to be an important predictor of the long-term impact of these experiences, particularly for children and teens facing traumatic stress.
So, how do we use this knowledge to move forward? This pandemic and other chronic stressors in our lives are unlikely to disappear tomorrow, but many of us need some relief now, so what do we do? While we can’t offer you the holy grail of safety, familiarity, predictability, and control, we hope that we can offer some valuable perspective from the field of Psychology on how best to navigate, tolerate, and even “grow through” particularly challenging times. You may not be able to stop the waves from crashing, but you can create small islands of respite for yourself, even as the storm rages on. Below are 20 for ‘20 evidence-based strategies for managing uncertainty and prolonged stress, and for reducing the negative impact of prolonged stress on your physical and mental health:
1. Practice self-validation and self-compassion. Being kind to yourself in the face of challenging emotions requires first recognizing those feelings as valid responses to your current situation. Sadness is driven by perceived loss. Anger is a natural response to perceived injustice. Anxiety is a hard-wired emotional response to uncertainty and perceived threat. All of these are very understandable emotions, particularly under the current circumstances. Once you recognize your emotions as valid and understandable, you can practice treating yourself the way you might treat a friend who is going through a difficult time. Self-compassion is about noticing and allowing for these emotions (“I get why I feel this way. It makes sense.”), combined with showing yourself kindness in the face of these emotions (“This is a lot to carry… maybe talking to a friend or going for a walk would help lighten the load for a bit.”).
2. Practice “emotional hygiene.” If you are more cognizant of recharging your phone at night than you are of recharging yourself each day, emotional hygiene may be a very useful concept to introduce into your life. Emotional hygiene, as described by Dr. Guy Winch, is the concept of engaging in small but meaningful daily actions that pay large dividends over time for our mental health. Just as we brush our teeth and shower daily (most of the time, anyway), we can engage in small but meaningful self-care habits that are non-negotiable parts of our mental health care routines.
3. Keep standards for yourself and others realistic. There is a fine balance between setting standards that help us to feel confident in our abilities (i.e., setting achievable goals that generate pride and satisfaction), and setting standards that create unnecessary pressure and judgment under challenging circumstances. If you are maintaining the same expectations you had of yourself and others prior to a global pandemic, you may benefit from recalibrating your short-term expectations to account for most people operating on very limited cognitive and emotional bandwidths at the moment.
4. Engage in activities that help you to contribute to the greater good and focus on something outside of yourself. Whether sewing masks, helping out an elderly neighbor, being there for a friend, or walking shelter puppies is your thing, engaging in altruistic behavior is good for your mental health. Not only does it help us to focus on something other than our own worries, but it serves as the sort of values-driven action that can remind us that we are all in this together, and that we all still have very valuable, active roles to play.
5. Practice actively looking for the good and expressing gratitude. When you practice noticing the good in your life and expressing gratitude for what you have, you get a boost on multiple levels. Studies of gratitude show that the simple daily practice of expressing gratitude (through journaling, to others, or through prayer) releases the neurotransmitters responsible for boosting mood, strengthens interpersonal relationships, counteracts the body’s stress response, and even improves sleep. By mindfully looking for the good in our lives, we also gain greater awareness of what we are living for, not just what we are living through, and we incorporate these positive elements of our lives into our larger narratives of ourselves.
6. Embrace joy and humor wherever you find them. You’ve probably heard the expression “laughter is the best medicine.” But did you know that there is actually scientific data supporting regular laughter as an evidence-based strategy for decreasing stress and anxiety, increasing social bonding, decreasing blood pressure, and increasing quality of life and resilience? Pretty great news, right? So go watch that show that makes you laugh, talk to your funniest friend, or get silly with your kids. And if you have a little guilty voice inside your head saying “this is no time for laughter,” you can remind yourself that laughter is just what the doctor ordered.
7. Practice giving the “grace of context.” In circumstances in which there are only difficult choices (e.g., whether to return to school during a pandemic, whether to lose your job or ignore your children, whether to socially isolate or assume health risks, etc.), it is easy to mistake making the best available choices for “making bad choices.” When we give others and ourselves the grace of seeing these choices in context, it decreases guilt and judgment, and helps to maintain more functional relationships with those making different decisions than our own.
8. Maintain an active stance towards the elements of the situation still within your control. There is a very real drive to be “in control” when you are feeling anxious, largely because you can predict what you can control, and your brain has a strong preference for predictability over uncertainty. The problem is that, when we are feeling anxious, we often fail to differentiate what is within our control and what is not. When we try to exert control over things outside of our control, such as the behavior of others or whether schools will reopen, we often waste energy, damage relationships, and generate frustration and resentment on top of our anxiety. By focusing on the elements of a situation within our control, such as caring for our own bodies and minds, communicating our needs effectively, achieving small daily tasks, and making values-driven plans in the face of uncertainty, we gain both self-efficacy and some level of near-term predictability over important elements of our lives.
9. Engage in creative activities and projects with tangible outcomes. Most of us know how good it feels to get lost in a project or creative task, whether playing an instrument, gardening, building something, or painting. When we engage in creative tasks, we can get so immersed that we enter a very mindful and calming state of “flow.” We also often see short-term outcomes that offer evidence that our efforts mattered, that our energy was well-spent, and that we can still move from point A to point B with intention. As our skills improve and we see tangible outcomes of our efforts, we can experience a combination of self-efficacy and mastery, both of which buffer against the negative impacts of stress. Research has shown measurable benefits of engaging in creative pursuits in terms of our stress and anxiety responses. According to research, simply engaging in creative tasks lowers our cortisol (stress hormone) levels and leads to decreased feelings of anxiety. Time to dust off that old keyboard, pull out your sewing machine, or start that project you’ve been meaning to do for years.
10. In the face of uncertainty, take actions that align with your values. In the absence of a clear road map, your values can serve as an internal compass, helping to ensure that you don’t lose track of yourself as the path becomes uncertain. Think of this as a way of saying, “I don’t know exactly what is going to happen, but I know what I care about and I am committed to spending my time and energy in service of those values.” You cannot choose how long the pandemic will last, but you can choose to treat those you love with kindness and respect throughout this challenging time. You cannot determine whether schools will open their doors, but you can show compassion for the many people who will be negatively impacted by either outcome. You don’t know when you will next be able to safely see your loved ones, but you can make a point of telling those you love how much they mean to you. By focusing on taking values-driven actions within your control, you maintain an internal locus of control over core aspects of your life, decrease symptoms of anxiety and depression, and increase your sense of personal resilience in the face of uncertainty. Next time you find yourself facing a stressful situation, consider what it looks like to respond according to your values instead of just reacting.
11. Breathe with intention. You’ve probably heard this one before, and that’s because it really does work. The simple act of engaging in controlled diaphragmatic breathing (i.e., the kind of breathing that expands your belly, rather than your chest), while slowing down your breathing to a rate of 6-10 breaths per minute, provides rapid feedback to your brain that a “threat has passed.” This type of breathing can lower your heart rate and blood pressure, and counteract multiple elements of the body’s “fight or flight” response. Think of it as your body’s equivalent of manually turning off an alarm system.
12. Reflect upon the stories of resilience that have been passed down to you by previous generations of your family, or by others you admire and respect. Stories serve as powerful reminders of what is possible. What have you learned from others in your life about surviving difficult times? As recently described by Esther Perel, stories shared with us by previous generations can serve as “reservoirs of resilience” during difficult times. Also allow yourself to reflect on how this time in your life may end up being a story of resilience that you pass along to future generations. What would it take to make this a time of resilience in your own life?
13. Exercise regularly. Because many of the physical processes associated with the fight or flight response are intended to mobilize our bodies for action, exercise is one of the most effective ways to “complete the cycle” of the body’s stress response, helping the brain and body return to baseline following a stressor. Regular exercise boosts your mood, decreases stress, and can also reduce the risk of many of the longer-term physical and mental health consequences of heightened allostatic load.
14. Seek social support and connection with others. As social animals, we have human connection as one of our basic needs. Neglecting this need generates additional stress, and meeting this need helps to buffer against the negative impacts of other stressors in our lives. Everything you go through in life is made easier by the presence of people “in your corner,” so to speak. Social support is consistently shown to be a powerful protective factor for the mental health of individuals facing traumatic stress and a number of other stressful life events. Just as we are currently facing the challenge of redesigning work, school, boundaries, and many other elements of our lives, we may need to be creative and flexible in designing strategies for connecting with others during the pandemic. As others have noted, we need to practice “physical distancing,” rather than “social distancing.”
15. Practice setting healthy boundaries, both for yourself and in your relationships. Boundaries are fundamentally the ways in which we intentionally protect what matters most to us. Just as the physical boundary of a door is intended to protect privacy (or safety), personal and interpersonal boundaries are intended to protect other aspects of our lives that we value – for example, our sleep, energy, leisure time, and social relationships. In the absence of clear boundaries, stress abounds, relationships often struggle, and resentment often builds. Prior to the pandemic, many of our boundaries were baked into our routines. Clearer delineations existed between work and home life, between family time and non-family time, and between social vs. “alone” time. As many of these naturally occurring boundaries have temporarily evaporated, you may find yourself wondering how to get back to some semblance of balance, and how to set boundaries in this “new normal.” Begin by considering what it is that you value and feel is at risk, and then consider what boundaries would help to better protect those aspects of your life. For example, if you value leisure time and feel it giving way to the constant pressure of work emails, consider setting a boundary around the times of day you check your work email. If you value your friendships but now spend all of your time alone or with your family, consider setting a boundary in your calendar of dedicated time for catching up with friends each week, even if it doesn’t look the same as it used to look.
16. Engage in activities that offer a sense of “mobilization,” especially outdoors. A core feature of traumatic experiences is a sense of immobilization (i.e., being stuck, unable to escape) in the face of threat. Activities that get us out of the house, and out of our heads, can be very helpful in countering this sense of immobilization under the current circumstances. Time in nature, particularly time spent moving our bodies freely (walking, running, hiking, etc.) in nature, can be a very powerful reminder to our stress systems that we are not, in fact, trapped.
17. Engage in planning that does not rely upon accurate predictions of things outside of your control, and trust yourself to adapt in the face of changing circumstances. It is easy to get caught up in a belief that certainty about the future is a prerequisite to planning the future. In our brains’ efforts to make accurate predictions in the face of uncertainty, many people engage in behaviors that only serve to exacerbate anxiety in the long run: anxiously checking the news multiple times, social reassurance-seeking, and making black-and-white (often catastrophic) predictions about what will come to pass, for example. To move forward in the face of uncertainty, we in fact need to learn to tolerate uncertainty, to trust ourselves to pivot, and to plan in the face of uncertainty, focusing on the elements of the situation within our control. This is the difference between believing “I need to know how things will work out in order to move forward,” versus believing “I don’t know exactly how things will work out, but I trust myself to adapt to changing information, and for now I’m going to focus on my short-term plan.” Keep in mind that “future you” knows everything that “today you” knows, PLUS everything you learn between now and then, so our money is on “future you” being in the best position to figure out how best to respond to what may come.
18. Practice mindfulness. Broadly defined, mindfulness refers to non-judgmental awareness of the present moment, including awareness of and acceptance of our thoughts, feelings and sensations in any given moment. When we are under stress, our minds have a tendency to “time travel” – ruminating about past events, worrying about future events, and often missing the present moment in the process. Mindfulness is about intentionally bringing a gentle, non-judgmental awareness to the present moment. The non-secular practice of Mindfulness Based Stress Reduction has been pioneered by Jon Kabat-Zinn, and impacts of this intervention have been examined for decades. These studies have shown that regularly practicing mindfulness can reduce stress, improve our health, aid in recovery from illness or medical procedures, decrease symptoms of depression and anxiety, boost resilience, and improve our relationships.
19. Embrace a “both/and” mentality. One of the ways our brains can work to regain a sense of certainty in the face of uncertainty is by engaging in a form of overly rigid thinking known as black and white thinking. For example, “I am right, so those people are wrong,” or “either I can predict everything, or I can’t decide anything.” Balance is often found in the gray, however. One very helpful strategy for thinking in the gray is remembering that two seemingly incompatible things can actually both be true at once. For example, “this school plan is going to put a lot of families in a tough position” AND “this was the best available option under the circumstances” are statements that can both be true at the very same time. Similarly, it may be helpful to follow the thought “this is so hard…” with “AND I can do hard things.” When we practice replacing either/or thinking with both/and thinking, often called dialectical thinking in the field of Psychology, our thinking becomes more nuanced and our reactions more balanced.
20. Use your senses to ground yourself when stress becomes overwhelming. There is a set of emotion regulation strategies often used in the treatment of Post-Traumatic Stress Disorder and Anxiety Disorders, known as grounding techniques. Broadly defined, grounding techniques are strategies that employ any of the five senses in order to bring you out of feelings of panic (or flashbacks, in the case of PTSD) and back into the present moment when you become flooded with emotions. These strategies can be useful in regulating particularly intense emotions in the moment. Next time you are flooded with strong feelings of anxiety or overwhelm, try engaging your senses to ground you back in the present moment. Can you name five blue things in the room? What scents can you pick up on in your favorite candle or lotion? Can you listen to a favorite song and try to follow one particular instrument throughout the song?