COVID-19

Mental Health Resources

SURVIVING AND THRIVING THROUGH THE COVID 19 CRISIS

By Penny Hobson-Underwood, Ph.D.


As a recently retired clinical psychologist, I have spent much of my working life helping people to deal with the challenges and stresses in their lives (as well as those in my own life).  Not surprisingly, many of us are currently feeling confused, uncertain, and fearful about the unfolding COVID 19 pandemic, and I was asked recently if I had any suggestions that people might find helpful to alleviate the increased anxiety and stress they may be feeling.  So, I have put together some suggestions here, ranging from coping with new challenges in the moment, to reducing unnecessary fear and anxiety about what might happen.

 


CRISIS = OPPORTUNITY


Amongst all of the angst, it is good to remember that most every problem situation has something of value to give you, and this one is no different. People often find that they are capable of much more than they realized, and during a crisis, we are often more receptive to learning new strategies that replace some of our habitual ways of reacting.  We can work towards staying healthy and calm, by learning new ways to co-exist with whatever disturbing emotions and thoughts come and go, and choosing sources of information and activities that allow us to maintain a balanced view of ongoing events.  In this way we are better prepared to take action as and where necessary, day by day, while continuing to appreciate all that is positive, in these ever-changing circumstances.

 


WORKING WITH ATTENTION  


A key point is that what we put our attention on each moment hugely affects how we experience life and the actions we subsequently take.  Therefore, changes in what we choose to attend to, or ignore, in any situation, can have powerful effects on our well-being and efficacy.  For example, many normal negative habits of the mind amplify fear and other dark emotions, rather than help in any way.  Some of these include spending lots of time following  the endless stories of illness, tragedy, and contention elsewhere in the world;  scrolling through social media; engaging in “what’s not right” conversations with ourselves or others, or focussing on our own negative thoughts and fantasies of what “could” happen to us or our loved ones in the future, etc. These habits don’t increase control, nor help anyone:  they just increase anxiety.
On the other hand, we can choose to stick with facts from reputable sources that we check  regularly but not overly frequently (references at the end of this), to help maintain our perspective, continue to   broaden our vision to include all the beauty and goodness around us,  and focus on finding activities that help us and others  become and stay healthy and balanced.  In this way we are best prepared to cope with whatever is called for.


Short habit interruption strategies.


We can start to practice interrupting our automatic reactive patterns when we become aware of feelings of stress or negativity, to create a little space, in which me might choose a more life-affirming response, which benefits ourselves as well as those we live with.  The simplest way to do this is to put our attention on the sensations of our breath, which is always with us.  Here are several short strategies for training our attention, using the breath, and words, to easily insert into your day.   
Start bringing your mind home to your body.  Whenever you can today, whatever you are doing, pause long enough to take one breath in, and one breath out, and feel the sensation as it happens.  That’s all.  This pause with the breath is a life-changing habit to develop.

When you’re ready, build up to doing this for a minute, then 3, then 5.   Just put your attention on the sensations of your breath as it breathes the body, without trying to change it or improve it.  You’re breathing anyway.  All you have to do is notice it; feel it.  When your attention wanders, which it will, bring it back home to the breath in the body, wherever you feel it at this moment.  Practise riding the wave of your breath and returning your attention again and again and again, whenever you notice your focus has strayed from the sensations of the breath.  

When feeling stressed all of a sudden, exhale all the air out of your lungs, and then just observe and wait for the body to decide when to breathe in again.  It knows what to do.  Keep doing this until you experience a settling in your body.

Think of a word that is comforting to you (e.g. Calm. Love. Peace). Take a deep breath and hold it for 7 to 10 seconds.  Exhale completely while silently repeating your focus word.  Feel how the muscles in your shoulders and chest continue to release.  This will only take about 10 seconds.  Continue to breathe regularly, and carry on with your day.  Use as needed.

 


MEDITATION  


 Exercise makes our body stronger and more resilient (as well as being a well-known stress reducer).  We now know that training our minds is just as beneficial to health and well being.   We learn that thoughts and feelings (including negative ones) come and they go as part of being human, and ultimately, we have a choice about whether to believe them and act on them or not.   Decades of research in many different areas show the indisputable benefits of meditation.  Regular meditative practice leads to less stress, less anxiety, less depression, less fatigue and pain associated with physical conditions. It leads to improved health, enjoyment and appreciation of life, mental stability, and increased ability to cope in all circumstances.


There are 2 main types of meditation.  In concentration meditation we choose a particular focus to keep coming back to – like the breath, above, or sounds, repetitive movement, a word or phrase, etc – every time our mind wanders away from where we are here in our body.  In mindfulness meditation, rather than one focus, we become aware of everything in our field of awareness; all thoughts, feelings, perceptions or sensations as they arise in each moment.  There are many good resources to choose from, and over time you will find the meditative activity that is best suited to you.


Below I have listed some good free websites with guided meditations of all lengths and types to listen to and practice with.  See which appeal to you, including the yoga, which is an excellent movement meditation, and start practicing daily.   What better time to start exploring meditation practices??!
Keep the bar low and start by choosing one that you know you can easily do every day.   Have reasonable expectations.  It could be just starting with the little breath exercises above.  Doing ANY meditative activity daily for any length of time is highly beneficial.   


http://www.freemindfulness.org/download
https://palousemindfulness.com/index.html
https://www.uclahealth.org/marc/mindful-meditations
https://mindfulnessexercises.com/free-guided-meditation-scripts/
https://www.mindful.org/audio-resources-for-mindfulness-meditation/
http://franticworld.com/free-meditations-from-mindfulness/


Yoga with Adriene   https://www.youtube.com/watch?v=Ba0fweKUwIc
(obviously there are many free online yoga resources online – this is a popular one though).

 


TWO of the many BENEFITS OF ALL MINDFULNESS AND MEDITATIVE PRACTICES:


We become better able to “ride out” any difficult situation.   These practices help us get through challenging times that occur throughout our lives.  Sometimes circumstances are such that there is nothing we can do but accept what is happening, because it is;  we can’t do anything to change it or leave it at this point; we know it will change as everything comes and goes, and so we have to live through it as best we can.  Examples might include feeling unwell mentally or physically, or facing an immediate situation that is difficult (like many situations during the current pandemic).  When no other action seems possible in the moment, we can use the sensations of the breath as an anchor to the present moment, to prevent negative thoughts making us feel even worse.   We just come back to sensations of the breath again and again, letting thoughts go by like clouds in the sky of our mind, and knowing that we can ride out any storm by centering ourselves using the breath. With practice, this becomes a beneficial habit.

Meditative practices, when done for at least 12 to 15 minutes, lead to a triggering of our body’s “relaxation response” which increases comfort and calm and decreases stress.


The following is a more detailed description of one well-known technique used to elicit and use the relaxation response in combination with positive visualization.

 


THE RELAXATION RESPONSE (Dr. H. Benson)


The “relaxation response”  is the opposite of the “stress response” in our body.   This relaxed state is characterized by the following physical and mental changes.

 

  • Decreased heart rate, blood pressure, rate of breathing, metabolism

  • Decrease or “calming” in brain activity  

  • Increase in attention and decision-making functions of the brain  

  • Changes in gene activity (epigenetics) that are opposite to those associated with stress.


Given that an important healing principle discovered centuries ago by meditators and more recently by psychologists and others is that you can’t be relaxed and fearful at the same time, it is clear that regularly engaging in activities and practices that turn the relaxation response on (other than alcohol and drugs)  is another life changer.   


There are additional ways to trigger the relaxation response, such as any of the activities listed below or others of your choosing  

 

  • Breathing exercises (examples in this handout)

  • Meditation, as mentioned, yoga, repetitive prayer,

  • Progressive muscle relaxation, hypnosis, tai chi, qigong, etc.

  • Playing a musical instrument, singing, listening to soothing music,

  • Tasks that require automatic repetitive movements like knitting, some gardening, drawing

  • Sitting outside contemplating nature: watching the trees, sky, clouds, rain birds, ocean etc,

       Long baths, showers.  


Make sure to incorporate 3 guidelines:

 

  1. Choose and stick to one mental focusing device (examples of activities given above) to help break the pattern of everyday thoughts and concerns

  2. Maintain a passive “Oh well” attitude towards distracting thoughts, then return to chosen focus.

  3. Time – you need at least 12 to 15 consecutive minutes to allow physical changes to happen.

 


VISUALIZING POSITIVE OUTCOMES (8 to 10 minutes)

Once your brain is calmer and more open to POSITIVE suggestions now that you are relaxed, you can use your imagination to visualize what you want to happen.

Sit quietly with your eyes closed, and go backwards in time to remember a time when you experienced the state your want to feel again (a remembered time of wellness and/or serenity) – or go forward in time and imagine the positive outcome you want to experience; play with this in your mind for 8 to 10 minutes.   Make a mental movie with you as the healthy, calm, stable central character.  The more you practice the easier and more effective it becomes.  

 


DAILY WAKING POSITIVE SELF-HYPNOSIS

Thoughts are estimated to go through our minds, mostly below conscious awareness, at about 200 words a minute.  If these are negative, which they usually are, they obviously make us feel anxious, depressed, unable to cope, etc. and we are unwittingly going around giving ourselves negative suggestions which we then follow – negative self-hypnosis.

 We can learn to counteract this in two ways.  First, we can become increasingly vigilant to start “catching” thoughts that we can become aware of that are going through our minds when we are feeling stressed, anxious, or depressed, and then rather than assuming they reflect reality, question them.  The worse we feel the more likely these thoughts are just inaccurate.  It’s usually a loop of the same old useless thoughts as well.  We can ask ourselves, “what makes me think this negative thought is true?  On the other hand, what else might be going on?  What evidence is there that it’s not true?  What is a more balanced thought to replace this with?

We can also develop the habit of positive self- talk and visualizations, as above, throughout the day, not just when we’re relaxed.  Repeat to yourself, and imagine what you want to happen in the immediate and distant future, not what you don’t want to happen.  This directs our attention and our resources, and can be another excellent tool to counteract some of the brain’s less useful tendencies.  

“Life is so much easier these days now that I _________”

“What a relief to realize I can stay calm and clear”

“I did it!  That was actually enjoyable”

 

Etc.
 


ANXIETY AND PANIC


Anxiety is one of the most distressing emotions that we feel.  Sensations of anxiety are a normal part of the “fight or flight response”, which is activated when we perceive that we are in danger in some way.     It can be adaptive to a point, and mobilize us to take protective action (like handwashing and vigilant social distancing right now). High anxiety, however, as well as being very unpleasant, does not help you or anyone, and is a reaction you can learn to control.   

When we are worried or overwhelmed, the fight-or-flight response (triggered by the sympathetic nervous system) is turned on.  Our breathing tends to become irregular, thereby upsetting the balance of oxygen and carbon dioxide in the blood.  This imbalance leads to the familiar physical symptoms of anxiety (sweaty palms, muscle tension, racing heart, light-headedness, dizziness, nausea, feelings of losing control, etc).  It also affects mood, and we become more nervous, irritable, and anxious.  Finally, anxious thoughts are generated, which are FUTURE ORIENTED and often predict catastrophe (What if…?).   In this state we assume that our terrifying thoughts are an accurate reflection of reality, when this is rarely the case.  The more anxious we are, the worse we feel, and the more likely it is that our thoughts are not accurate.  We are more likely to be OVERESTIMATING the actual danger, UNDERESTIMATING our and loved ones’ abilities to cope, as well as UNDERESTIMATING help and support that is available.  

If we are actually on the ground dealing with a threat in front of us, we are more likely to use adrenalin to  work with the unit of time to focus on most productively, which is now, and whatever  is right in front of us,  to engage directly and constructively with opportunities and challenges.  

A
PANIC ATTACK is a sudden (typically within ten minutes) rush of intense fear with at least 4 strong body sensations of anxiety.  Research shows that approximately 1 in 10 but as many as 1 in 3 people you know may experience a panic attack each year.  It is a normal experience and more common than you might have thought, particularly at the present time.  For most a panic attack is usually a sign that the person is very upset or feeling high levels of stress – a sense of danger or threat in their lives.

 


WHAT CAN BE DONE TO RELIEVE SYMPTOMS OF ANXIETY?


For quick results, we learn to regulate the balance of oxygen and carbon dioxide in our blood, and switch the natural relaxation response of our body ON (the parasympathetic nervous system,) using breathwork and self talk.  This in turn switches OFF the fight or flight response (the sympathetic nervous system).    These two systems compete, and people feel more or less anxious depending on which one is dominant at any given time.   When you learn to switch the relaxation response ON, it will start to close down the fight or flight response, as they cannot both be on at the same time.

 


SPECIFIC BREATHING EXERCISES FOR QUICK RESULTS


 In addition to mindfulness meditation practices, and lifestyle habits of exercise, etc. (outlined in next section), to turn down our body’s reactivity and make future episodes of anxiety and/or panic less likely, it’s important to have some tools to bring relief in the short term. Controlled belly breathing work to reduce symptoms noticeably within approximately four minutes. Practice these techniques regularly, so that they become familiar, and therefore easily available when you need them.


1. 4-4-8 BREATHING  
Look at a watch, and expect a calming effect after about 4 minutes, or ten cycles of 4.4.8 breathing
Breathe IN through your nose for the count of 4; then HOLD your breath for the count of 4; and then breathe OUT through your mouth for the count of 8.   It is important to count the numbers indicated in your head as you do the exercise or it won’t work.


                       ACTION                                                         WHILE SAYING TO YOURSELF   
                       BREATHE IN (through nose)                       IN        2  3  4  
                       HOLD BREATH                                             HOLD  2  3  4
                       BREATHE OUT (through mouth)                 OUT     2  3  4  5  6  7  8


This effective, simple exercise can be practiced anywhere/everywhere so you can use it when needed.  
 

2. CONTROLLED BELLY BREATHING will also restore the balance of oxygen and CO2 in your blood and you will notice again that symptoms start to go away after about 4 minutes.
Sit comfortably.   Put one hand on your chest; one at the bottom of your ribs.  Feel your diaphragm and stomach expand like a balloon with each breath in, while your shoulders stay relatively still.

Then let the air out fully, with shoulders relaxed.  Pause for a second or two and then take another breath.

Keep it slow.  If you find yourself breathing too quickly, mentally say: “one Mississippi, two Mississippi, three Mississippi, 4 Mississippi as you inhale, and then the same for the exhalation of each breath.

As you breathe slowly into the base of the lungs, the diaphragm stretches, and the nerves attached to the diaphragm (vagus nerve) actually trigger the body’s natural relaxation response.

Adjust the numbers in and out so you are comfortable.   Practice this for as long as you can whenever you think of it.

For sudden symptoms, it is useful to start by focusing on EXHALING or blowing out all the air in your lungs and just let them fill up again naturally.  Keep doing this for a few minutes.


SELF TALK  Once we notice symptoms of anxiety, we can alter it’s course by what we say to ourselves about what is happening (“this feels bad but it’s just symptoms of anxiety - they’ll weaken with every slow breath I take”), and focusing on slow breathing.   It can also be useful to develop short positive self-talk statements that you repeat:


“I know these symptoms are going away as I practice my breathing exercise.”
“I have new skills to help me feel more comfortable.”
“It’s such a relief to feel increasingly calm and clear.”
“It’s great to feel calmer with every breath.”
“I get more and more control with every minute.”
“Life is so much easier now that I ____”


 

 

***



ADDITIONAL RESOURCES FOR ANXIETY   


Please consult these websites for additional in-depth material and resources:


  1.  Managing COVID-19 Stress, Anxiety and Depression : https://www2.gov.bc.ca/assets/gov/health-safety/covid19_stressmanagement_5_accessible.pdf  including help that is available in BC.
2.  ANXIETYCANADA
https://www.anxietycanada.com/
3. If you have extended medical you can also get the cost of a portion of psychological services covered for individual sessions with a Registered Psychologist: https://www.psychologists.bc.ca/find_psychologist
 


MORE GENERAL RECOMMENDATIONS AND RESOURCES


In addition to the techniques above, there are a number of more general but equally important suggestions and life-style choices that affect our ability to make our way through these unusual times.
Too much time spent on any media amplifies distress.  Sticking to local information is probably the lowest stress way to stay informed on the things that directly affect you (which we do need to do as the situation progresses so we can stay abreast of instructions, advice, assistance programs etc.).    The B.C. government websites provide updates and other trustworthy information for our province, for example through the BCCDC website.  

If you want to follow national and international news, restrict the number of times you look at it and choose only one or two reputable mainstream national sources such as CBC/CTV (including Government of Canada and British Columbia daily updates) or newspaper websites (e.g. Globe and Mail).

Thoughtful use of the internet and phones are important at the moment in helping us to stay in touch with family and friends, BUT the internet in general, and social media in particular, can be unreliable sources of information that can escalate anxiety, and fuel rumours and inaccurate information about the current health emergency.  


EXERCISE in some way daily for at least 15 minutes to flush out fatigue acids, give you energy, reduce stress, and improve mood.    If you can’t run, bike or walk because you are to socially isolate,  do some yoga, put music on and DANCE!  Do squats, planks, lift weights in a meditative way, run back and forth on your balcony.  Whether or not you “feel” like doing this, do it.

SCHEDULE:  as our thoughts tend to go to “what’s not right, or what’s wrong” when our attention isn’t occupied, it is a good time to set up a schedule for the extra spare time you have now, and follow it, particularly if you are working from home on your computer.   Schedule in exercise, socializing (within social isolation or distancing constraints), practicing stress reducing strategies in this handout, relaxing, work, online tutorials, gardening, and other enjoyable activities.   Revise as needed.

Making peace with “what is” at the moment.   If you find you are in the common habit of wishing that things in your life/the world/yourself/your friend/spouse were DIFFERENT than they are, you are adding to your stress and wasting your energy.  Come to terms with the fact that things are the way they are right now, because they are.  They will change, as everything does. For now, what action can you take to work with your current situation most positively?

Nutrition: Do your best to maintain a balanced diet.  Carb and sugar cravings are more likely when we’re stressed, but the comfort it provides is only temporary.  Add fruit, vegetables, protein etc!

Hydration: Drink enough.  Water is the first choice, but all liquids count except alcohol.

REST, Personal SPACE.   Spend time resting and relaxing with a hot bath, good book, knitting, etc.  Especially if you are living with others make sure you take time outs just for you to have some time and space alone.  If you have children, and there are two of you, make a point of spelling each other off to allow each to have space.  Similarly, arrange your schedule to give yourself (or each of you in turn) the chance to get enough sleep.

Seek out all the positive support and influences possible, to the extent that you are feeling sociable, and minimize negative influences, including friendships that are negative, one-sided, or tiring.  Stay connected through phone calls, texts, video chats etc.    Meet friends online for a cup of coffee etc.  Be supportive of others who are experiencing greater stress.

People are also developing creative alternatives to being on their phones for hours a day, including going old-school, and  making contact by writing letters and making drawings to send by mail to friends and family.  This is an excellent way to spend time, with feelings of well-being and love generated in both sender and receiver.


GET OUTSIDE daily (unless you have been instructed to self-isolate in your home).  Look, listen, smell.  Repeat.  Fully enjoy the beautiful sights sounds and smells of spring.   Being in NATURE boosts immunity, as well as physical and mental health.    Even spending time looking out the window at nature will provide benefits, as will listening to audios of nature sounds, which you can find free online (e.g.https://www.calmsound.com).

Relationships:  There is the potential for more stress and strain as we spend more time than ever with partners, kids, and roommates.  This is a good time to learn and practice straightforward communication (when calm, preferably).  Appreciate that everyone’s point of view is equally valid and work from that point.   We are each responsible for our own thoughts, feelings and actions, and for sharing our perspectives and needs with others.  Otherwise they can’t possibly know.  Speak what is true for you in a kind and straightforward way, without blame or judgement.  That’s all you can do.  Hope they can do the same. See what happens.

FOCUS TIME with children.  This is a good time to set aside 15 minutes a day for each child, in which you make a point of being fully with them in mind as well as body.  Although we can be physically “with” our children for extra hours a day, we are most often in our heads (past, future), on our computers or thinking of something else.  Spend just 15 minutes giving them your undivided attention and do an interactive activity together of their choosing (reading, playing with toys, even if you’d rather not. Not TV). This small commitment of time can make a noticeable positive difference in the household.

Explore quality free online resources in areas of your interest to learn new skills and hobbies with this extra time.  Music, art, baking, knitting, etc etc.  A few examples are:. 

 

The internet is full of interests to pursue.

 


CONCLUSION


In conclusion, I hope that you can apply some of the ideas in this handout to stimulate your increasing awareness of your own untapped inner resources, and all the useful things you can learn to find  calm and clarity in the moment, and some joy in each day, no matter what is going on.  As the saying goes, this is not a dress rehearsal.  This is “it”. The only time we have to actually live our lives as they unfold is right now, so let’s make the most of it.  


There are many free resources on the internet and people are getting very creative and entertaining about getting relevant information out to us in funny ways.   I will leave you with a laugh - a little clip of Pluto the talking dog, who seems to have become the spokesperson for the pandemic –


https://www.youtube.com/watch?v=xYcQg_x_mP4
 

Best wishes.


Penny Hobson-Underwood
 


 

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