Reprinted from the New York State Office of Mental Health. Click here for a downloadable PDF copy.
Feeling Stressed About Coronavirus (COVID-19)?
Managing Anxiety in an Anxiety-Provoking Situation
March 16, 2020
The outbreak of COVID-19 around the world has led to the spread of fear and panic for individuals and communities. In addition to following physical precautions guidelines, individuals should be taking care of their psychological well-being.
This guide includes tips for the following populations:
- For Everyone
- For Individuals Receiving Mental Health Services
- For Parents, Including Parents of Children with Pre-Existing Anxiety Disorders
- For Caregivers of Elderly Individuals
- For Mental Health Providers
- Reduce anxiety by reducing risk. Ways to reduce risk include practicing good hygiene (e.g. sneezing and coughing into your elbow, sneezing into a tissue and immediately throwing the tissue away, wash hands regularly with soap and water for at least 20 seconds, etc.). In addition, create a plan in case your regular routine is disrupted, such as setting up remote work and alternative childcare arrangements. Setting out a plan can help reduce anxiety by taking charge of the things you can control.
- Manage your information flow by choosing reliable sources and establish boundaries on checking for updates. Getting regular, factual information is important. However, continuously scrolling through social media or constantly refreshing the news is likely to lead to increased anxiety. Pick a few trusted news outlets – such as the state and local health authorities, Centers for Disease Control and Prevention, or World Health Organization – and commit to checking once or twice a day for updates.
- Monitor your anxiety levels. Anxiety is a normal response to a stressful situation and can provide adaptive benefits in many situations. However, when faced with mounting uncertainty, your brain can go into an anxiety spiral that is no longer helpful. Knowing the difference between typical and atypical stress is important. Monitoring your stress level will let you know when you need to seek additional help.
- A typical stress reaction may include: temporary difficulty concentrating; irritability and anger; fatigue; stomachache; and, difficulty sleeping.
- An atypical stress reaction may include a persistent and/or excessive worry that doesn’t lift and keeps you from carrying out your daily tasks. If you experience significant changes in your energy level, eating patterns, or sleeping patterns, difficulty concentrating on normal tasks, prolonged and overwhelming worry and hopelessness, or thoughts of self-injury or suicide, seek out immediate help at 1-800-273-TALK (8255) or text Got5 to 741741.
- Practice good self-care, including exercise, eating healthy foods, and sleeping an adequate amount at night. If possible, spend some time outside. Avoid staying up late to monitor the news.
- Virtually reach out to different types of support networks, such as family, friends, colleagues, faith-based communities, and social organizations to strengthen your overall feeling of connection. Isolation and loneliness feeds anxiety.
- Find meaningful tasks and roles within your support network to channel your anxiety, such as coordinating deliveries of groceries to those unable to leave home, curating kids’ activity ideas for parents working from home, or video calling or calling those who might feel socially isolated. Supporting others is beneficial to the supporter as well.
- Find or create spaces that are not focused on COVID-19. Start a social media thread about other topics, ask friends to discuss other topics, or watch your favorite TV or movie.
- Savor small positive moments, amplify positive stories, and stay optimistic. Try to cultivate a mental wellness practice, such as writing in a gratitude journal, or talking nightly with your family about moments during the day that were fun or enjoyable.
- Take an opportunity to practice mindfulness when managing anxiety. Mindfulness tools like grounding exercises, sensory modulation, and deep breathing may be helpful.
For Individuals Receiving Mental Health Services
As soon as possible, work with your mental health provider on a coping plan. Think about helpful coping skills you can practice daily and be mindful to those coping skills that you may turn to that are otherwise harmful to your safety and well-being. For example, if you know that music, walking outside, reframing your thoughts, and connecting with others are helpful, think about ways you can incorporate those into your daily life. If you know that you might struggle with ruminating, self-injury, substance use, or other strategies that might be harmful to your safety and well-being, identify alternative coping methods with your provider. Write out a plan to help prepare you for heightened anxiety.
Work with your mental health providers on specifically managing anxiety and ask them to help you come up with practical skills that you can rehearse.
Work with your mental health providers on alternative options if your routine services are disrupted. These might include using telemental health services, getting prescription medication, or engaging in supplemental mental wellness activities.
Seek positive peer support. Connect yourself to others who understand your experiences and can assist in problem-solving. If social distancing increases feelings of isolation, look into online peer supports or peer hotlines.
For Parents, Including Parents of Children with Pre-Existing Anxiety Disorders
- Think about and rehearse scripts for talking with your kids about COVID-19. Kids take cues from caregivers about how anxious they need to be about a topic. Seek out resources and media to assist in your preparation.
- Talk about the situation openly. Most kids elementary-aged and up have heard about COVID-19 or coronavirus. Avoiding the topic or providing blanket reassurances is more likely to feed anxiety. If kids bring up the topic, let them know you are glad they brought it up. This increased the likelihood that they will come to you with further anxieties or questions.
- Don’t give more information than is requested. Part of a developmentally appropriate approach is to answer the question your child asks, but not necessarily more than that.
- Check to make sure they understood your response by asking them to repeat back what they heard, and let them know you are open to more questions. Reassure your child that it is normal to feel scared or anxious.
- Help your school-aged child and adolescent set boundaries on their information flow in the same way you are setting your own boundaries. Help them identify factual sources of information and set appropriate intervals to check in. Encourage them to use their media literacy skills to question the messages they are getting from various information channels. Consider limiting media exposure or consuming media with your child so that you can be available to interpret and explain information.
- Keep as many routines intact as possible. For kids who may be out of school and/or have extra-curricular activities cancelled, it is helpful to keep other routines, like mealtimes and bedtimes. To the extent possible, for kids who are at home for longer periods of time, set up a structure. Collaborate with your child to come up with a loose schedule, such as an outdoor activity and lunch prep in the morning, and a movie and homework time in the afternoon.
- Find fun ways to maintain contact with individuals your child is separated from, such as elderly grandparents or classmates at school. Set up opportunities to maintain and even grow connections, such as reading a book to grandparents on video call or sending postcards to friends.
- Encourage physical activity and time outside, where possible. Both staying active and having opportunities to be in nature are helpful with mitigating anxiety and building resilience.
- Use this as an opportunity to teach distress tolerance skills that will be helpful to your kids in any situation. This is a great time to learn about purposeful breathing, guided imagery, distraction, and other skills.
For Caregivers of Elderly Individuals
- Facilitate ways for the individual to maintain social connections. As the elderly have been told to isolate as much as possible, it is likely that social isolation and loneliness may take a toll on physical and mental health. Set up and provide technological assistance for family and friends to stay connected to the individual. Consider coordinating a group of people to check in on a rotation so that the individual feels the support of a network.
- Encourage the individual to stay as active as possible, for both their physical and psychological well-being.
- Help the individual find ways where they can help others, such as calling others to check
- in on them or entertaining grandchildren on FaceTime. Having a purpose and role can reduce anxiety.
- Consider practical ways you can relieve an individual’s anxiety, such as volunteering to order their groceries online or offering to walk the individual’s dog(s).
- In a time of high anxiety, it may be hard for the individual to select reliable sources to get information and updates on COVID-19. Curate a list of reputable media and write them down for the individual.
- Practice self-care and be compassionate to yourself. While caregiving is a demanding and rewarding role at the best of times, being a caregiver during a time of heightened concerned is particularly stressful. If possible, find a way to take small breaks, rotate responsibilities with others, and practice your own mental health strategies.
For Mental Health Providers
- Place a priority on self-care, including getting adequate rest and exercise, eating healthy food, maintaining social connections, and taking time away from service provision as possible.
- Prepare for heightened anxiety in the individuals in your care and prepare your own toolkit on skills and scripts that might be helpful.
- Work with your colleagues to prepare back-up plans for crisis management, such as telemental health or alternate therapeutic arrangements, so that you are prepared if there is a disruption in services. Work with your supervisor and colleagues to rotate functions and cross-train as much as possible
- Set up peer supports, such as peer supervision and consultation, to connect with others who are in a similar situation. Setting up spaces to discuss the toll of vicarious trauma and anxiety is an important part of self-care.
- Seek out professional help as needed. Remember that provision of mental health care during a crisis is challenging and it is critical that you address your own stress and anxiety.