Anxiety During the Coronavirus: Part 4 - Comments and Questions

Photo by Jon Tyson on Unsplash

Whether you’re alone or stuck inside with family consider this: Anne Frank and 7 others lived in a 450 Sq Ft attic for 761 days, quietly, to survive. I think we can manage being stuck in the comfort of our own homes and allowed to go outside for a month or two.  

We are at WAR with COVID-19. Those who have seen combat in war know that fighting this war on the Coronavirus is a piece of cake in comparison. I got this funny text yesterday: FIRST TIME IN HISTORY WE CAN SAVE THE HUMAN RACE BY LAYING IN FRONT OF THE TV AND DOING NOTHING. LET’S NOT SCREW THIS UP. Of course there are things we can do about this other than lay on the couch. I’m writing this blog. You can offer to help elderly neighbors, you can forward my blog to others as well as other helpful tips and guidelines. And the answers to two questions below offer a couple of other ways you can help.

How Can I Help Depressed Friends?

Dave asked “What can we do to help people who are isolated and depressed?” Addressing depression in the face of COVID-19 about this could be a BLOG post if not 2-3 posts. But you want to help a friend. Socialization is a huge predictor of mood. The best thing you can do is to schedule a video chat with them via Skype, FaceTime, Zoom, or VSee. I’m single through this crisis and had a drink with a friend in Texas last night, tonight I’m playing music with a bass player friend, tomorrow afternoon I’m having coffee with a friend and this is all through video chat. Phone is NOT the same. We get MUCH more from video.

Definitely encourage depressed friends to get out and exercise or exercise indoors. Exercise increases serotonin, norepinephrine, and dopamine - all of which improve mood.  With social distancing we’re not even supposed to walk next to someone. But you could schedule a walk in which you both walk and talk on the phone. 

Should I Fear of Take Out?

Cathy is afraid to get carry out. And asks if she’s being silly. Not really being silly, because there is always some risk in nearly all we do. The good news is, the risks are very low because the heat needed to cook the foods kills the virus. So to be on the safe side choose items that are cooked rather than a salad or other cold food items. Microwaving for even a short time, kills the virus, so it’s not a bad idea to microwave it before you eat it. Do used some caution with the containers and sauce packets. Wash your hands after handling the containers. Here is a link to a video of a physician showing what to do after getting home from the grocery store and includes carry out:  COVID-19 and Food.

I believe the risk of driving 50 miles is greater than the risk of getting carry out or delivery. Therefore, I urge you all to get carry out and delivery to keep your favorite restaurants in business and their employees working, especially the locally owned ones. This is something you can do that is helpful.

Should We Do Easter? 

Michael asks if he should listen to President Trump who says the target date to get back to work and resume normalcy is Easter. I urge everyone to avoid taking advice from politicians, friends, relatives, and others who are voicing their opinion. Listen to the physicians and scientists who are knowledgable. Keep in mind that many physicians may know relatively little about Coronavirus/COVID-19. I believe a good expert to listen to is Dr. Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases, who says that “the virus makes the timeline.” He states that the advisable restrictions may vary from region to region, but too soon to say when we can begin to lift them.

Be safe and come back in a couple of days

Jennifer L. Abel, Ph.D. 

author of:

The Anxiety, Worry & Depression Workbook, 

Melt Worry & Relax Card Decks (One for all, one for kids), 

AND Active Relaxation

Anxiety During the Coronavirus - Part 3: Laugh and Cry

Photo by Sandeep Kr Yadav on Unsplash

A good laugh overcomes more difficulties and dissipates more dark clouds than any other one thing.

-Laura Ingalls Wilder

Smile and Laugh

Notice how you feel as you force a smile. Now make yourself frown. Feel the difference? Fake a smile again. Now purposefully fake a long laugh. If you’re like most people, you feel a bit better. Now take a moment to think of something very funny that happened to you or that you witnessed. Or think of something funny that you saw in a movie. My favorite recent funny video is of Pluto the dog on YouTube talking about the Coronavirus. If you can’t think of anything funny click on this link: Pluto. 

Some of you have heard about laughter therapy and may have attended or at least seen a laughter group. Dr. William F. Fry of Stanford University examined and even proved that hearty laughter produces endorphins, which are natural pain killers and improve mood. More importantly during the COVID-19 crisis, he found it actually decreases your chances of developing respiratory infections.

Cry

I’ve been studying stoicism a bit. And contrary to what you may think, the stoics didn’t advocate for holding emotions in, rather they encouraged acceptance of emotions (see my previous blog). So to truly be stoic, let out your emotions. Research supports the value of expressing emotion. Dr. T.D. Borkovec, with whom I worked for 2 years at Penn State, found that people who avoid emotional processing (i.e. hold their emotions in) didn’t enjoy the reductions in anxiety from cognitive-behavioral therapy (CBT) that their peers who freely expressed their emotions did. Also at Penn State, Louis Castonguay found that people with clinical depression who did more emotional experiencing during the course of CBT were happier at the end of therapy than those who experienced less emotion. Experiential therapies and schema therapy are among the type of therapies that help the experience of crying and releasing all emotions. 

Visit It, Don’t Live in It

This Coronavirus is causing a great deal of emotions for many of you. For me, it has been compounded by the fact that my engagement ended on March 10 and less than 4 hours later, I got a call that my mother had passed away. Exactly one week after we buried mom, everyone in St. Louis County, where I live, was ordered to stay at home (March 23).  There are a few reasons why I’m doing really well. One of them is that I cry at least daily, sometimes 3-4 times and sometimes I cry hard. Progress is never linear, but I am crying less with time. I have no doubt that allowing myself to cry enables me to feel good most of the time such that I can write this blog and enjoy playing piano, cooking, video chatting with friends, as well as to sleep, eat, concentrate, etc. While I have brief periods where I feel very sad, I’m definitely not depressed or anxious. My catch phrase for this strategy is: Visit it, Don’t Live in It. Or Visit Your Pain, Don’t Live in It. 

To illustrate this, many people go through this hard time like the photo below. They may try to escape to be only on “The Rest of Your Life” side but they continually carry the weight of the Coronavirus worries. 

When we visit our sadness or other uncomfortable emotions briefly (usually less than 1-30 min/day) and process our pain like this:  

It makes it easier to be like this most of the time:

I liken this to when you feel like sneezing, but you can’t, and you’re on the verge of the sneeze. Then when you do sneeze, it’s taxing, but you feel relieved. Some can relate to haven eaten something bad (not the flu), you’re nauseas, vomiting is very uncomfortable, but you feel relieved after. 

Best of luck! Take care and be safe! 

I’m planning to post another blog post tomorrow to address your questions and post some of your comments. Please e-mail me at abelshrink@gmail.com with your questions and comments. I may not be able to address all of your questions. 

If you’re on FB consider “Liking” my Active Relaxation -The Book page which will provide you with tidbits of advise. However, while I’m writing this BLOG, it will be limited to linking to this BLOG. 

Jennifer L. Abel, Ph.D.  author of:

The Anxiety, Worry & Depression Workbook, 

Melt Worry & Relax Card Deck,

AND Active Relaxation

Anxiety During the Coronavirus - Part 2: Take a Chill Pill - NOT! Better Ways to Manage Anxiety

Photo by Fusion Medical Animation on Unsplash

Whether anxious about the coronavirus or something else, many people reach for substances, like alcohol, cannabis, and other drugs. Drugs like Xanax or Ativan, while prescribed by a physician, are actually more dangerous than pot and alcohol. You need not avoid alcohol, but 1) do not increase your consumption during this, or any other difficult life period, 2) be mindful that while it may calm your anxiety, it’s a depressant that can leave you feeling more blue and give you less energy to do positive things, and 3) with all anxiety reducing drugs, there’s a rebound effect which often makes the anxiety worse once the drug wears off.  Moreover, there are many strategies that are calming, safe, and actually more effective in the long haul. 

“Don’t think about Coronavirus.” That’s terrible advise! Trying to not think about something makes you think about it even more. What’s more if you try to not think about something anxiety producing like COVID-19, you’re even more likely to think about it than when trying to not think about something neutral, like a blue chair. Actually allowing yourself to think about it briefly and then gently moving your mind to something else is key. Gently switching the channel to something better, like a relaxation strategy you already know or some of the other strategies you will read about in upcoming blog posts, is recommended. The following are some relaxation strategies:

Breathing

Forget about everything you’ve heard about how to breathe and instead just observing your breathing. Feeling the air coming in and out of your nose for a few breaths….Noticing the sound it makes for a few more…… Noticing if the air you’re breathing in feels cooler than the air you’re breathing out…….Feeling your lungs expanding as you breathe in……and relaxing as you breathe out….noticing that your belly is rising as you breathe in….. relaxing as you breath out…… Noticing the pauses in your breathing. Noticing a brief pause after you breathe in….and enjoying the longer pause after you breath out. Closing your eyes and just observing this for a minute or two. If you only read this, please go back and try it.

Add, thinking the word peace as you breathe in and calm as you breathe out. During the next quiet pause after you breathe out thinking the number 5. ON the following quiet pause the number 4. Thinking one lower number for each quiet pause, counting all the way down to zero. When you get to zero, taking one more breath and then opening your eyes or switching to another relaxation strategy. You can also visualize breathing in a relaxing color while gently breathing out the color your anxiety feels like it is or use different words instead of peace and calm.

Mindful Acceptance

Fighting anxiety fuels anxiety. So don’t fight it, invite it. This is mindful acceptance. There are several metaphors for how this works, but the most classic is the Chinese Finger Trap.  The harder you try to get out of it, the more it grips you. When you accept that you are stuck and let go of the struggle it’s more comfortable, you’re less stuck, and you can easily use your thumbs to get free. Or if you’re a Harry Potter fan, think of The Devil’s Snare and say to yourself “being Hermoine" if you’re a female or “being Harry” if you’re a guy. There are recordings of acceptance strategies that I usually only give to people who have purchased my Anxiety, Worry, & Depression Workbook.  But during this difficult time, I’m giving them to you today absolutely free. Go to anxietystlouispsychologist.com/free (It’s a hidden page).

Mindfulness

All worry is about the future and all regret is about the past. Therefore, when we are in the moment we are free from worry and regret. One way to be in the moment is to engage in activities that automatically keep you in the present like reading, cooking, gardening, or dancing. Another way is by focusing on your senses.  It’s also helpful to be mindful of your thoughts, as well as labeling your thoughts and feelings. The free recordings I’m giving you include all these forms of mindfulness. 

I have several other relaxation strategies I’ll present in later blogs. For more in depth strategies now, I suggest my aforementioned workbook or my Melt Worry & Relax Card Deck (There’s a kid version too). 

Look for my upcoming blog on coping with the coronavirus: Laugh and Cry. 

Jennifer L. Abel, Ph.D.

Anxiety During Coronavirus - Part 1: Healthy Concern vs. Fear and Worry

Fear can be your best friend or your worst enemy. Fear can protect us. If we didn’t have fear we might drive 130 miles/hour or jump off a 10 story building. Regarding the virus, we would ignore all the guidelines. We’d seldom wash our hands, we’d ignore social distancing guidelines, go to friends’ homes during stay-at-home orders, and might even sneeze out into the air in public. Fear that protects us is good.

However, excessive fear and anxiety can be very harmful. We can follow the guidelines with little or no anxiety. Or we can worry for hours, lose sleep, search the internet for hours, watch the news for hours, get headaches, stomachaches, become irritable, the list of symptoms go on and on. Worse yet, anxiety can actually reduce immune function thereby putting you at greater risk for getting the virus. And did you know that excessive worry has been proven to actually interfere with problem solving? So, managing your anxiety in a healthy way can actually make you safer. 

I’m an expert in anxiety management.* I am NOT an infectious disease or coronavirus expert. I’m writing a blog to help you manage any excess anxiety you may have about the coronavirus. I have a wealth of suggestions for managing your anxiety in the coming days. While this may sound trite, to begin, don’t worry, problem solve. Following the guidelines will greatly reduce the likelihood of contracting and spreading the virus. Anxiety is not necessary to follow the protective guidelines. However, respect for the gravity of the virus and a healthy concern is certainly warranted. Engage in at least the minimum current suggestions which have changed day-to-day and state by state. Decide if you want to follow the minimal guidelines, completely self-or-family quarantine, or do like me and go somewhere in between. 

Knowledge is power, but only up to a point. Stay abreast of the current guidelines, which may be as quick as visiting your favorite website for 10 minutes OR watching a 30-min news program daily. Try to limit your total time engaged in seeking information about the virus to an hour/day, particularly if it makes you anxious.  Definitely limit your news exposure to no more than 90 minutes, unless you previously watched more.  And spend no more than an average of 30 min/day on the internet. Think of the many things you’d rather do, that are safe to do. Next BLOG will be relaxation and mindfulness strategies to help you feel more calm.

*Dr. Jennifer L. Abel has written three books about anxiety management and two sets of therapy cards that are available for purchase on Amazon. She is an international speaker who has delivered seminars in 45 states.

How Does Anxiety Look Different in Older Adults? Tips on What Symptoms Caregivers Should Be Looking For

Guest Blog by Christian Worstell

Photo Credit: Pixabay

While it is normal to feel nervous or worry from time to time, anxiety that is severe enough to interfere with daily life is not a normal part of aging. 

Research into the diagnosis and treatment of anxiety in older patients is somewhat limited; however, it is believed that anywhere between 3% and 14% of seniors meet the criteria to be diagnosed with an anxiety disorder. 

What’s more is that over 27% of seniors receiving care through an aging services organization exhibit anxiety symptoms that negatively impact daily functioning but that do not rise to the level of a clinical diagnosis.

How Does Anxiety Differ Between Older and Younger Populations?

Anxiety and depression are often underdiagnosed and undertreated in older populations for several reasons:

1. Older patients are more likely to emphasize physical complaints rather than psychiatric symptoms when speaking with family or a health care provider.
   

2. Psychiatric symptoms in older adults may be incorrectly attributed to chronic medical conditions or dismissed as side effects of medications.
   

3. Physical limitations and isolation can make it difficult for seniors to access treatment for anxiety and other mental health disorders.

Types of Anxiety Experienced by Older Adults

The most common anxiety disorder among older adults is generalized anxiety disorder, which is characterized by excessive anxiety or worry that lasts for six months or more and is hard to control. Clinical professionals typically look for at least three physical or cognitive symptoms for a GAD diagnosis.

Common symptoms include difficulty concentrating, muscle tension, fatigue, sleep disturbances, irritability, gastrointestinal distress and feeling keyed up or on edge. 

 Other anxiety disorders include:

• Social anxiety disorder. Some people may experience noticeable and consistent fear of situations in which they are exposed to new people or in which they could face scrutiny. This can range from social situations such as meeting new people, eating around unfamiliar people or performing in front of a group.
  
  A diagnosis might be made if the fear or anxiety lasts for 6 months or longer and it causes significant impairment to social functioning.
  

• Phobia. An anxiety disorder characterized by an irrational fear of something that poses little or no danger. For some people, the fear is so intense that they alter their lives to avoid the object of their fear.
  

• Panic disorder. Characterized by sudden, intense feelings of terror that can occur without warning. Symptoms can include shortness of breath, chest pain or palpitations, dizziness, gastrointestinal discomfort, and intense fear or feelings of doom.

Common Causes of Anxiety in Older Adults

Several risk factors can increase the likelihood that your loved one may experience anxiety symptoms, including:

• Stressful life events common among seniors, such as the loss of a spouse or transitioning to a smaller home or a care facility can also trigger symptoms of anxiety and depression.

• Being diagnosed with a chronic health condition.

• Experiencing a shift in how threats are perceived.

• A decline in physical functioning.

• A history of difficult events earlier in life.

• A recent traumatic event.

Treatment Options for Anxiety

If you believe that your loved one is suffering from anxiety, you should encourage them to speak with a trained professional as soon as possible. Counseling, depression screenings and other mental health support services can be covered by Medicare. 

Their Medicare costs could be covered in full, or they may be responsible for deductible and copayment costs, depending on the types of services they pursue and the type of Medicare coverage they have.

In addition to talking to your loved one about their symptoms, a doctor or mental health professional can administer a mental health screening to make the appropriate diagnosis and identify treatment options, such as therapy or medication. 

Author Bio: Christian Worstell is a health and lifestyle writer living in Raleigh, NC

Christian worstell

Getting Through Depression in Your Senior Years - Guest BLOG

This is a guest blog by Teresa Greenhill at mentalheathforseniors.com

Part of the human existence is the ebb and flow of our mental health. We have good days and bad days, and we have good years and bad years. Some of it is circumstantial, and some of it is clinical. For those who suffer from clinical depression, a solution isn’t always easy to find; you can’t simply snap your fingers and make it go away. If you’re a senior suffering from depression, it’s important to get the help that you need so you can successfully manage this condition. Everyone’s situation is unique, and a proper diagnosis should be pursued to come up with the right treatment plan.

Mental Health Overview

Mental Health encompasses your emotional, mental, and social well-being. Positive and negative mental health can vary in degree of seriousness, from something as temporary as a bad day to a mental health disorder that requires treatment. Mood disorders (bipolar), anxiety disorders (OCD), personality disorders (borderline), behavioral disorders (ADHD), psychotic disorders (schizophrenia), trauma disorders (PTSD), and eating disorders are all issues that fall into this realm. For many people who suffer from mental health issues, it could be something as common as depression, generalized anxiety disorder, and stress.

Depression in Seniors

Commonly seen among seniors, depression is a clinical mood disorder that affects how you function in life; for example, life changes could lead to clinical depression in seniors. For some seniors, it starts with losing loved ones, transitioning from a career to retirement, giving up independence and mobility, watching children grow up and move on, feeling lonely and socially isolated, and losing a sense of purpose. Those circumstances can develop into clinical depression. Be sure to pay attention to signs such as sleep and appetite changes, irritability, decreased energy, anxiousness, guilt, hopelessness, emptiness, concentration problems, and suicidal thoughts.

Treatment for Depression

If you’re noticing symptoms of depression in yourself or someone you love, it’s best to seek professional treatment from a therapist, psychologist, or psychiatrist. A mental health provider will be able to diagnose you, provide counseling, and recommend therapy and/or medication to help treat the issue. Therapeutic treatment could include individual and group counseling, psychotherapy, and cognitive behavioral therapy.

Mental Health Insurance Through Medicare

Medicare Part B will cover mental health services provided by a psychotherapist, psychiatrist, clinical psychologist, nurse practitioner, clinical nurse specialist, or clinical social worker in the Medicare network. Family counseling related to your treatment and outpatient substance abuse treatment also falls under Medicare coverage. For hospitalizations, Part A can help cover the hospital stay up to 190 days, while Part B covers the doctor fees. Your out-of-pocket expenses for these services typically include 20 percent co-pay, co-insurance, and deductibles. Make sure you have the right coverage for your anticipated needs as you review your annual plan.

Medicare for Depression

Part B covers an annual depression screening at your PCP’s office and a preventive visit to see if you’re at risk. These visits usually occur at no cost to the patient.

Finding the Right Help

Not all mental health providers are covered by Medicare, so it’s important to make sure the provider accepts assignment. Accepting assignment means that the provider allows Medicare to pay them directly for the agreed upon coverage amount, and the patient is only billed for the deductible and coinsurance. To get the most out of Medicare for your mental health needs, search for a therapist who accepts Medicare. Discuss pricing and billing with them before signing up to be a patient.

Depression is not the end of anything — it’s simply the beginning of a new way of living and coping. Those moments of extreme sadness, hopelessness, and feeling trapped don’t have to take over your golden years. With the right diagnosis and treatment, you’ll soon find relief for your mental health.

Photo Credit: Unsplash

Why Your Efforts to Manage Worry Fail

The two reasons that people are unsuccessful at managing worry are: 1) They wait until the worry has spiraled out of control such that most strategies are ineffective and 2) They try fighting their worry and anxiety.

One of the most important things to understand about the nature of worry is that it occurs in a spiral of interactions between thoughts, images, physical sensations, behaviors, and emotions that interact to a progressively higher level anxiety. By the time most people try a coping strategy, the worry is too powerful for the strategy to be effective and may even make matters worse due to frustration and hopelessness.

The other very important thing to understand about worry is that fighting it fuels it. Daniel Wegener showed two groups of people a photo of a white bear. One group was told to NOT think about the white bear while the other group was told it was okay to think about it. The group that was told not to think about it was more likely to be thinking about it 10 minutes later. When he ran a similar study asking people what they worry about and only telling one group to avoid thinking about their worry. Not only did the group who was told not to think about their worry, worry more than the group who was only asked what they worried about, the difference was even greater than it was with the white bear experiment. So the most common advice we get to manage worry, “Don’t think about it” or “Put it out of your mind” actually makes it worse!

So what can you do to overcome these problems. In short, catch anxiety early/prevent the spiral from getting out of control and avoid fighting anxiety. Over the next several weeks I will go into greater detail about these. But if you don’t want to wait - click here to check out my Worry, Anxiety, and Depression Workbook.