Anxiety in the time of the pandemic

As a clinical psychologist in Massachusetts, I have seen symptoms related to anxiety disorders worsening due to the pandemic. Worries about jobs, health, and our own and others’ safety and well-being have shot up. It is normal to have some anxiety at a time like this because it helps us behave in a way that keeps us safe. Anxiety is a natural, hard-wired emotion that helps us anticipate something going wrong in the future and to plan for it.

However, too little and too much anxiety can be unproductive and harmful. For instance, too little anxiety about contracting the novel coronavirus may lead you to be lax and not take appropriate measures to protect yourself. Too much anxiety can hamper other areas of your life and create undue stress. It is important to recognize worsening of symptoms or onset of new ones so you can cope or seek help.

Contamination fears of Obsessive-Compulsive Disorder (OCD) are exacerbated right now because it is harder to distinguish between necessary and excessive cleaning behaviors as the world feels more unsafe and unpredictable.

Persons diagnosed with agoraphobia worry about or avoid places where they feel anxious, especially if it may be difficult to leave or to get help. Social isolation can feel like a relief at times like this but may also cause more anxiety because individuals are feeling trapped at home.

The fear of having a serious medical condition, or the preoccupation with physical symptoms is causing much anxiety. This fits right in with normal worries that a pandemic would elicit. And, those with social anxiety are experiencing more unease about maintaining communication with colleagues and friends. It is harder to reach out, to go out of one’s way, to email or call.

There are some common thinking patterns underlying all of these anxiety disorders.

Mental filter is the tendency to focus solely on negative information that confirms our fears while ignoring opposing information leading to a skewed perception of danger. It is important to look for information to the contrary. For instance, a fever may make you believe you have contracted coronavirus and you worry about worse outcomes. However, you may not be paying attention to information that indicates that you don’t have the virus.

Intolerance of uncertainty is the need to have firm answers, such as when things will return to normal or whether we will be able to control the virus. This leads to impatience, restlessness, and need for resolution. However, focusing on things we can control will help, along with becoming more comfortable with the uncertainty.

Other thinking patterns common to anxiety are jumping to conclusions and catastrophizing. We predict that things will go wrong and it will be catastrophic --“I will lose my job and never be able to find another good one again.” It is helpful to ask yourself “can I be 100% sure that this will happen? And, if it does, will it be the end of the world?” (“I will survive even if I don’t get a good job again”).

Black-or-white thinking involves extreme scenarios – everything will either be fine or be doomed (“either I will not contract the virus, or if I do, I will die”). This ignores other possible outcomes like having mild symptoms, or needing hospitalization but not dying. The problem here is that when small things go wrong, we perceive an immediate shift from safety to certain doom. It also leads to the need for perfection – should thinking - which leads to high expectations from oneself and others.

With the pandemic, you may feel stressed trying to follow all rules perfectly and be intolerant of mistakes by yourself and others. Here, it is helpful to say, “I wish I didn’t make this mistake, but it is o.k. that I did”, or “It would be great if I could keep everything sanitized all the time, but I am trying my best and that is enough.” Identifying and changing these thought patterns takes some time and practice, but can lead to more rational thinking and reduced anxiety over time.

So, to maintain your well-being during this crisis, work on your emotional health. The mind and body are intricately linked, so practicing meditation, yoga, deep breathing, muscle relaxation, or regular exercise can help de-stress. Remember the basics of healthy eating, adequate sleep, and maintaining a routine, which will help with regulating emotions and feeling in control.

If you still continue to feel overwhelmed and experience difficulty functioning in some areas of your life, seek help from professionals. Contact your community mental health professionals, ask for a list of providers from your insurance company, or look up resources on findtreatment.gov. A majority of mental health professionals are now offering intakes and continuing services via telehealth visits, so you may have more access and options. The most important step is to acknowledge difficulties and take care of your mental health.

Pooja Saraff is a clinical psychologist at UMass Memorial Medical Center and assistant professor at the University of Massachusetts Medical School.