Protect Your Mental Health During the Pandemic

The pandemic is making mental illness worse

COVID-19 has created a mental health crisis. Uncertainty, stress, isolation, and financial strain have led to more people becoming depressed or anxious. It’s also worsened the symptoms of those who were already struggling with mental illness.

A recent study found that over 40% of people said they experienced a mental health issue during the pandemic.

It’s important to understand that what you may be feeling is not a personal failure. It is a normal response to an abnormal event. But it does not mean you should or need to suffer.

Call your doctor or get a referral to a mental health provider. Connect with your insurance provider to get a list of mental health providers or check www.psychologytoday.com. The sooner you address it, the better your prognosis.

There are so many ways that the emotional burden of the pandemic can affect us. But, fortunately, there are also many ways to protect your mental health.

Substance-related and addictive disorders

There are many jokes on social media about alcohol use during the pandemic. And alcohol sales have indeed risen. But it’s no laughing matter.

The anxiety, stress, job loss, and isolation associated with the pandemic can increase the use of drugs and alcohol. People often use substances to cope with difficult circumstances. When substances are used in excess, they activate a reward pathway in the brain, which can lead to addiction.

Watch for these symptoms

Substance abuse can sneak up on you. Normal use (such as social drinking) can quickly change to abuse. Pay attention to your behaviors and address them early.

Ask yourself if your behaviors have changed during COVID-19 (i.e., are you drinking alcohol more regularly?). If so, ask yourself why and notice what you are feeling when you reach for a substance (like wine).

• You are using substances more now than before the pandemic.
• Using substances “works” in the short-term, relieving you from uncomfortable emotions.
• You lie to yourself or others about your use or minimize how much you are using.
• You feel guilty or worry about your substance use.

What to do

• Assess your emotional well-being. COVID-19 has stressed everyone. In some ways we have adjusted to this stress, which has become a chronic state of being. Notice any feelings of stress, worry, anxiety, sadness, or frustration. If you are feeling any of these, you are more likely to use substances.
• Increased emotional distress is a normal response to an abnormal event (COVID-19). You are not alone. Accept the feelings—do not beat yourself up for having them.
• Try to change your thoughts (replace your negative thoughts with more helpful ones) and your behaviors (focus on replacing unhealthy behaviors with healthy ones). You cannot just will the emotions away. You have to change the way you think, and that helps change emotions and behaviors.
• Notice what you are feeling and thinking when you reach for a substance. Write it down. Validate the emotion and pick an alternate, positive coping behavior (such as a 5-minute meditation or a walk around the neighborhood).
• Make a commitment to cut back on substances. Focus on reducing the behavior, rather than complete abstinence.
• Find a friend or community that will support you in cutting back or stopping substance use. Find people to talk with about the emotions that drive the use/abuse.
• Seek help. There are many resources including groups (like AA), mental health providers, and medications that can help manage these urges. Resources are available at the National Institute on Alcohol Abuse and Alcoholism and the Substance Abuse and Mental Health Services Administration.

Depression

People often talk about the cloud of heaviness COVID-19 has put on everyone. This sadness can morph into depression.

Depression is a persistently low mood that does not lift. It causes a loss of interest in things you care about (activities, relationships, and even self-care). It can affect how you sleep, how you eat, and your energy level.

Depression causes people to have low energy, feel more irritable or apathetic, and might make people cry more frequently. Children with depression may complain of physical symptoms (like headaches and belly aches) and mood change like sadness and irritability.

Watch for these symptoms

• Notice any change in behavior. Has your sleeping, eating, or physical activity changed? Do you have a hard time pulling yourself out to exercise or do activities that you generally enjoy? These may be signs of depression.
• Notice your mood. How would you describe it? If you find yourself saying that you are sad, irritable, or tired more often than not, it could be depression.

What to do

• It is normal to feel sad about the pandemic and its impact. Many people are experiencing isolation, financial strain, uncertainty, and loss. Sadness is not a personal flaw. It is a normal human response to a sad event.
• Focus on incorporating positive behaviors that can lighten your mood. For many, this means connecting with people in a safe way. That may be socially distanced walks, online meetups, spending quality time with the people in your family, or creating a pod (a small group of people you see who have committed to social distancing).
• Seek support from a mental health professional if your mood is persistently low and you think you might be depressed. Check with www.psychologytoday.com to find a provider who accepts your insurance. You can also call your insurance provider and ask for a list of behavioral health resources.

Anxiety

People rely on a sense of predictability, consistency, and certainty to create comfort and safety. Anxiety is on the rise right now because these basic needs are not being met. We do not know when our communities will open, when we will get employed, or when we will see people we love. This creates anxiety.

Anxiety is a clinical word for persistent worry. It creates a physical discomfort that can cause increased heart rate, sweating, muscle tension, shortness of breath, and a feeling of antsy-ness.

Watch for these symptoms

• Any changes in sleep, eating, or exercise. Anxiety may cause you to have difficulty sleeping, eat more or less than usual, and exercise more or less.
• Notice your thoughts. Often people with anxiety have a hard time getting certain thoughts out of their head. Certain worries are on repeat in their mind.
• Notice physical symptoms like racing heart (sometimes people feel like they are having a heart attack), sweating, and shortness of breath.

What to do

• Do physical exercise. Get outside and move. This helps manage the physical discomfort of anxiety and triggers the release of brain chemicals that promote relaxation.
• Pay attention to sleep. Lack of sleep makes anxiety worse. If you are having a difficult time falling asleep or staying asleep, practice good sleep hygiene—don’t lie in bed awake for more than 15 to 30 minutes. And only use your bed for sleeping and sex.
• Limit screen time at least 2 hours before bed. The light from our screens as well as online activity can activate your brain and make both anxiety and sleep issues worse.
• Cut the alcohol. People use alcohol to relax, but it actually creates more anxiety when the alcohol wears off.
• Cut the caffeine or limit to very little caffeine—and drink only in the morning or midday.
• Practice meditation. Use an app (such as the Calm app) for short exercises. Practice when you are not particularly anxious, even for 5 minutes a day.
• If the anxiety becomes overwhelming, seek support from a mental health professional.

Post-traumatic stress disorder (PTSD)

The COVID-19 pandemic has created conditions that can lead to post-traumatic stress disorder (PTSD) in some individuals. PTSD is a mental health condition triggered by experiencing or witnessing a terrifying event. During the pandemic, potential traumatic experiences include severe illness, hospitalization, loss of loved ones, or prolonged exposure to stressful working conditions for frontline workers.

Studies have shown varying rates of PTSD related to COVID-19, with some research indicating prevalence as high as 22.9% to 36.0% in certain populations. Risk factors for developing PTSD during the pandemic include direct exposure to COVID-19 (such as personal illness or caring for infected patients), pre-existing mental health conditions, and inadequate social support.

Symptoms of COVID-19-related PTSD may include intrusive thoughts about the pandemic, nightmares, avoidance of reminders of COVID-19, heightened anxiety, and emotional numbness. These symptoms can persist long after the immediate threat has passed, potentially impacting an individual's quality of life and ability to function normally.

If you're experiencing symptoms of PTSD, it's crucial to seek professional help. Mental health providers can offer effective treatments, including cognitive-behavioral therapy and medication when necessary. Additionally, maintaining social connections, practicing self-care, and engaging in stress-reduction techniques like meditation can help manage symptoms and promote recovery.

Eating disorders

An eating disorder is when a person has disordered (or unhealthy) eating habits. There are different types, but the two main ones are bulimia (binge and purge) and anorexia (calorie restriction).

A person with bulimia might binge on a large quantity of high calorie food and then vomit in an attempt to get rid of the calories. A person with anorexia might significantly restrict their food intake with the goal of being thin.

The pandemic has created a great deal of uncertainty and loss of control. When people with eating disorders feel out of control in other parts of their life, they are more likely to attempt to control their eating, often in unhealthy ways.

Aside from worsening symptoms in people with eating disorders, the pandemic could also push susceptible people to unhealthy eating habits.

Watch for these symptoms

• Notice any change in eating habits (more or less).
• Notice your feelings and your self-talk about your body.
• Notice if you find yourself lying to friends and family about your eating habits.

What to do

• Try to maintain connections with your community and support system. Community support is often really helpful so the social isolation of COVID-19 can make symptoms worse.
• Create a structure and schedule for your meals and eat with other people.
• Seek help sooner than later. Eating disorders are serious and can snowball fast, causing serious medical conditions. Check www.psychologytoday.com to find mental health specialists.

Obsessive-compulsive disorder

Obsessive-Compulsive Disorder (OCD) is a serious type of anxiety disorder where people obsess over certain thoughts and can only relieve those thoughts by completing a specific behavior. For example, a person might feel like they have to disinfect the counter 100 times before they can eat off of it, because they fear contamination of germs.

Before the pandemic, this behavior would generally be viewed as irrational. During the pandemic, the over-focus on germs and contamination makes these fears very real and based in reality, at least in part. In addition, times of high stress can worsen symptoms so people with OCD may be struggling more now.

It is important to compare your behavior to the recommendations of authorities like the Centers for Disease Control and Prevention (CDC). Is it more extreme than the recommendations?

It is also important to notice how you are thinking about this fear (does it consume you completely?) and how you respond to it (are you avoiding things more than other people?). Although all feelings are valid, all behaviors (what you do with the feelings) are not healthy.

It is normal to worry about the impact of COVID-19, but it is not healthy to completely shut yourself off from the world.

Watch for these symptoms

OCD is a serious medical condition that can get worse if left untreated. It is important to pay attention to any symptoms.

• How often are thoughts repeating themselves and consuming you? Do you have a worry that you can effectively address and let go, or does it feel impossible to move on (with or without doing a certain behavior)?
• Notice your feelings and your self-talk about your body.
• Do you feel particularly anxious?
• Do you find yourself continuing to watch the news and seek COVID-19 information more than others?
• Do people tell you that you keep talking about the same thing or notice that you are doing repetitive behaviors?

What to do

• Know that this is an incredibly anxiety-provoking time. All your feelings are valid, but what you say to yourself and how you respond to them can create more anxiety. Challenge yourself to notice thoughts that might be irrational and notice your behavioral responses to those thoughts. Try other options like saying something different and responding differently.
• Focus on challenging your thoughts. What is reality-based and what is fear-based? Ask yourself, “What evidence do I have that (this thought) is true?” Check the CDC for guidelines for preventing COVID-19.
• Build in alternate behaviors. When you feel compelled to do a repetitive behavior in response to a thought, try replacing it with an alternate behavior.
• Manage anxiety and try to keep it low through regular meditation.
• Limit your exposure to the news.
• Exercise regularly. Physical activity helps.
• Stay connected to people—online or safely in person.
• Medication helps, as does therapy. Seek help sooner than later.

Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) can occur after being exposed to a traumatic event (like a car crash, war, death, sexual abuse, etc.). People with PTSD often suffer from intrusive thoughts, nightmares, intense fear, physical symptoms (like sweating), intense rage, and sometimes dissociation. PTSD is incredibly difficult to live with and greatly impacts a person’s quality of life.

The intense stress and anxiety as well as the death, loss, uncertainty, isolation, and cultural sadness around COVID-19 can worsen symptoms in people with PTSD.

COVID-19 can also cause PTSD. We are essentially experiencing a cultural trauma. There is death, fear, and anxiety all around us. Many people have lost loved ones and were not able to say goodbye or grieve with others. With job loss, isolation, and fear as part of the everyday, PTSD is on the rise.

Watch for these symptoms

• Avoidance of traumatic event or reminders of it
• Intrusive worry
• Flashbacks of traumatic event
• Irritability, anger, sadness, numbness, and/or agitation
• Sleep disruption
• Hypervigilance
• Social isolation
• Severe anxiety and mistrust

What to do

• If you know you already have PTSD, stay connected or reconnect with your mental health provider, knowing that COVID-19 can make you more vulnerable to an increase in these symptoms.
• If you feel you are experiencing PTSD for the first time, you should see a mental health professional. The sooner you get help, the fewer symptoms you will experience.
• Remain connected to other people.
• Practice lots of good self-care with proper exercise, sleeping, and eating.
• Manage underlying stress and anxiety as best as possible. Regular meditation can help.