Although geared at the current COVID-19 pandemic situation, this handout will apply to wellbeing at any time. Anxiety is a normal response to stress, it is inevitable you will feel worried at this time, but this handout aims to help you ensure anxiety doesn’t rise to an unhealthy level.
Initially a resource aimed at my clients, in such unusual times it felt right to share this with anyone who could benefit.
There’s little any therapist can say which will magically disappear your worry. Change usually involves a commitment from you. So, this handout is a proactive approach based on psychological evidence. Try to be patient - like many things, the more you put into it, the more you will get out. Consider working through it with a partner or friend to help motivate you.
There is a checklist and planner at the end to help you
pre-empt problems and be proactive in managing your mental wellbeing.
Where (and how often) are you getting your news?
Consider whether you need to limit your exposure to new reports about COVID-19. Keeping abreast of recent guidelines wise, but are you getting constant exposure the news? Are your sources reliable and factual, or likely to be sensationalising things? Media is business aimed at selling papers or creating internet clicks. Fear and uncertainty grabs attention so they do and will use this to their advantage.
COVID-19 related events are looming very large in the news right now. And this means that the threat that the virus actually presents may be massively over-represented in our mind. (There’s nothing like watching an episode of Crimewatch to send you to bed with a fear of being attacked in your home which is far out of proportion to the actual risk!) Of course, we all need to heed the official advice, but remind yourself that there are many risks surrounding our health and wellbeing. If the news and everyone around us talked about cancer constantly we would find it very alarming. As it is, we usually just accept that the risk of getting cancer is a part of life and we generally tolerate that risk well.
Is your news-searching becoming excessive and obsessive? This is a very natural response when fearful; it can feel like useful problem solving. However, excessive information-checking and reassurance-seeking actually raise anxiety as it keeps the worrying issue in your mind constantly. This causes anxiety to raise its head - uncomfortable mental and physiological symptoms, and then our brain is evolutionarily programmed to be on alert to all possible threats. That means that anything negative or uncertain in your everyday life will then seem a far bigger deal, and your concentration will be affected so you’re less likely to find a useful rational way to deal with any problems! So, reading too much or asking for too much reassurance may actually lock you into a vicious circle of anxiety. In additional, excessive reassurance-seeking means we lose faith in our own judgment and can feel less able to cope.
Focus on what you can control.
Trying to change the unchangeable will inevitably lead to feelings of failure and helplessness. Try to focus on events that you can control. This will give you a greater sense of mastery over your world and reduce general anxiety. So, if there’s any problem (not necessarily COVID-19-related) in your life upon which you could act, then act sooner rather than later. Make a to do list, break the larger problem into smaller achievable steps, seek advice or ideas from others, or do research if necessary. If it can’t be acted upon straight away then schedule when it can. Above all, do not procrastinate on things you can change, the ‘head in the sand’ approach only increases stress in the longer term.
Just for starters, things we have little control over:
government guidelines, other peoples’ actions and opinions.
What’s on your ‘Go-to’ list?
Make a list of ‘go to’ activities that you can look at for quick ideas when you’re struggling with worry, stress, boredom or low mood. They don’t need to be massive things – small things like a few minutes gardening, messaging a friend or taking a bath may be enough. Be creative, be experimental, keep adding to and refining it. Recognise that often you just need to ride the wave which is trying to drag into a bad mood. We call this ‘urge-surfing’ … if you can just get through the next hour or two when you notice yourself feeling stressed, you may prevent a bad spell of low mood or anxiety.
‘You can’t stop the waves but you can learn to surf’.
Mindfulness expert, Jon Kabat Zinn.
Keeping connected when physically apart
We are social creatures and, for most people, social isolation tends to take its toll on mood. Luckily most of us are able to keep in touch with others by phone or online. Make a point of doing this, even if in some small way, every day.
Are there people around you that you can offer support to, even with the social distancing guidelines? Helping others helps us feel connected and is a known way to improve our own feel good factor. If you’re someone who has suffers low mood and has a tendency to withdraw naturally, try to resist this – social withdrawal rarely helps mental wellbeing.
How about trying to be creative about how you can use the additional time you may be spending at home – make a top ten list - and then you could swap/discuss with friends to share ideas? Apart from the obvious ones, I’ve heard ideas such as online training or education courses, language learning, subscribing to ancestry sites to make up a family tree, DIY, or taking online tours of museums. There are many blogs and media articles appearing along these lines if you want to have a search and compare notes with others. Then add some to your ‘Go-to’ list.
Phone calls and messaging may be more appropriate for you if you find yourself spending an unhealthy amount of time looking at links about COVID-19 (or other negative news events) on social media. Look up apps which can help you limit your social media time, if necessary.
Abnormal is the new normal!
Whereas change has an unsettling effect, familiarity is calming. So, if a routine can be easily maintained then do so. For example, if working from home, get up and shower and dress as usual and keep to usual work and sleep patterns, as far as is realistic.
However, this is all about balance. Trying to cling unrealistically to routines that are no longer feasible will leave you feeling defeated and anxious. Try to let go of your preconceived ideas of how daily life should go. These are times like no other.
This unusual situation will end but, for now, everyone’s ‘normal’ has changed.
What’s your take on worry?
Some worry is inevitable, we all do it. But for some it can become excessive, incredibly uncomfortable and disabling. However, even if they don’t like worry, people often hold views that worry is actually useful, and this can make worry harder to change. Try not to confuse your worry with problem solving or with being a caring person. Are there caring people or good problem-solvers who don’t worry as much as you?
Let’s try something. How many hours in the past month have you spent going over the same old issues you always do? Do the maths now – how many hours a day, multiplied by 30 days. What was your answer? So, for all these hours, what great revelations have you come up with? Most people are a bit stumped for a good answer here!
So, let’s further consider excessive worry as a problem-solving strategy. In any uncertain situation there are an infinite number of ‘what ifs’. Worry usually involves trying to think up all the possible future ‘what if’ scenarios and then trying to solve them in advance. The problem with this is that every time you identify and solve a potential ‘what if’, you think up more in the process. Your attempts at reassurance just keep raising more potential problems you hadn’t initially considered. Acknowledge that you are never going to get certainty in any uncertain situation. If you’re trying, you are setting yourself up for failure. Accept that your brain has locked onto an unhelpful strategy. I’m going to suggest some more helpful ones.
Some people have a really strong reaction to uncertainty and will immediately feel anxious when they don’t know the outcome of something. But uncertainty is everywhere in life, and always has been. What would life be like if everything was completely predictable? Make a list of uncertain situations that you worried about in the past that ended up having good or neutral outcomes – hopefully you can see that uncertain does not necessarily equal bad. Even when things do have a negative outcome, people usually look back and say they coped with them far better than they expected.
Accept that negative thoughts are inevitable.
Thoughts around the COVID-19 situation may be at the forefront of your mind. That’s understandable and ok. Try to see your thoughts (negative and positive) as things going through a conveyor belt in your mind – accept that they will occupy that space in your mind until some other thought temporarily pushes them out. Just because that thought is there doesn’t mean you have to take it off the conveyor belt and analyse it, solve it, change it or push it away.
We all have thoughts we’d rather not have. Often thoughts can be quite random.
They are not facts. They do not predict anything.
Notice the thought, then let it be. Trying to push away or block a thought actually makes it comes back stronger. A quick mental experiment for you: Spend a moment imagining what a big pink gorilla might look like. Now spend a minute or two where you’re allowed to think about anything you want but not the gorilla. How successful were you? Chances are the thoughts about the gorilla returned frequently ... far more frequently than if you hadn’t tried to block it. So, rather than pushing away or changing/analysing thoughts, firstly acknowledge that they are there. Remind yourself that they are allowed to be there and that they are not facts nor are they accurate predictors of the future. Then try to do nothing else with them. This involves practise, don’t expect to be great at it without training a while. When you notice yourself over-analysing again just gently bring your mind back to something else, without reproach. Mindfulness meditation can help train you in this process and there are many reasonably-priced books or apps with simple exercises to this end (e.g. Headspace or Calm, but also many others).
What’s your worry monster called?
Bear with me … I’ll explain! This technique is aimed at helping you to distance yourself from your worry process. Excessive worry is not an inevitable part of stress, it is a reaction to it, and one which can be interrupted with practice.
Here's another useful way to think about negative thoughts and excessive worry. Imagine you have a neighbour you regularly bump into on your street. This neighbour is a very negative person, always has a depressing view on life, always has something bad to say about even the best things and the best people, always has a problem for every solution. When you see him on the street, you can’t push him away or ignore him, you acknowledge him and say hello. However, he’s so overly negative, critical and unhelpful that you try not to engage in conversation with him if you can help it. You can still see him still occupying his place on the street but you’re not hanging around right next to him. This is the best way to think of your negative thoughts.
Now, you imagine you have a worry monster just like this. It sits in your head or on your shoulder. No matter what you do or say they will find fault with you. Every time you find some calm or happiness in your life they will pop and day something to ruin it. Spend a couple of minutes imagining what your particular monster looks like, and its expression and tone of voice. And finally, give your monster a name.
Now when you notice you are engaging with negative thoughts, trying to solve unsolvable problems and excessively worrying I want you to view this as coming from your monster and tell it where to go. (I know... it sounds odd, but I have qualifications … honest!). This can be done internally or out loud (one bonus to being in isolation!) What would you say to someone so unhelpful and negative? Would be something like ‘Oh get lost (monster’s name), change the record… heard that one before… I knew you’d say something like that!’. Or maybe there’s more expletives involved! Now try to leave your worry monster to his wittering, like a radio on in the background, while you do something else. Or like that neighbour still grumbling on the street as you walk away. Look at your ‘Go to list’ for quick ideas to help you leave the worry be.
Delay the worry. Set aside an allocated ‘worry time’ (and, ideally, a set place too). This is 15 minutes at a set time, more than 2 hours before bed. The rules are that you do the above strategies and also delay when you carry out any unnecessary worry until your ‘worry time’. You then have 15 minutes to worry and ruminate to your heart’s content – but when the 15 minutes is over, other unproductive worries have to wait until the next days’ time. It’s not obligatory to use your worry time. In fact, many people find they don’t use it – what worried you at lunchtime often doesn’t seem worth focusing on by 6pm!
These techniques for controlling worry don’t work overnight, they need regular practice. You are trying to train yourself out of a habit which may be very well learnt.
Try to be patient with yourself, all these techniques takes time and practice.
A note about OCD
If you have, or have had, Obsessive Compulsive Disorder (OCD) or OCD-type tendencies such as excessive checking, then these may be especially trying times for you. Note that the advice about avoiding excessive information-checking and excessive reassurance-seeking is especially important for you. Try to avoid any slipping back on any of the therapeutic progress you have made. Remember that any short-term relief you feel on returning to your compulsive behaviours may quickly lead to added anxiety. If you scratch an itch it will never stop itching!... and in the same way if you act on an intrusive thought the frequency and strength of the thoughts WILL increase. Try practice the advice above about allowing thoughts to exist without acting on them.
Try to be as kind to yourself as you would to another person. If you engage in a lot of self-criticism then note what you say internally. Can you imagine saying this to another? Have an experiment with a friend where you each write down your self-insults and then say them aloud to each other. Why wouldn’t you usually say these things? Chances are you’ll see that saying overly critical things to someone else is cruel and also unproductive. Even if they have made a mistake, this doesn’t help them improve, it doesn’t help their motivation. This is what you do to yourself when you internally berate yourself excessively – you beat yourself down so you feel like a failure and cannot think straight about anything. Would you expect a child to thrive if you sent them to a school where they got only criticism and never praise?
Follow the instructions above relating to negative thoughts and excessive worry. Also ask yourself frequently –
‘What would I say if a friend had this problem or this thought?
How would I be most helpful to them?’
Note that this doesn’t mean you never acknowledge you’re in the wrong, it’s more about seeing that self-criticism is not a helpful way to deal with this. Do what you can to right your mistake, learn what you need to learn from it then remind yourself that getting things wrong is part of being human.
These unusual circumstances will be putting an extra strain on everyone’s work and home life. Try to actively make a point of taking some small moments out for self-care and relaxation. ‘You can’t pour from an empty jug’ refers to the idea that you can’t keep giving to others (or to work) if you don’t take care of yourself. Add some items to your ‘Go-to’ that include small pleasures or indulgences that are currently possible
During uncertain times, stress levels naturally rise. You may benefit from making time to work on relaxation. This can be just putting aside time to do something that absorbs you and lifts your mood, or you may benefit from specific relaxation exercises. Even if you are very busy, try to take a few moments periodically to slow your breathing and notice if your jaw has become tense and your shoulders have risen. Slow breathing slows down the stress response and helps us to feel less panicky and be more able to think logically. Ideally try to take slow, even breaths – taking longer on the out breath than the in breath. Progressive muscle relaxation is also beneficial. There are lots of online resources on breathing and progressive muscle relaxation, including audio clips which will talk you through the process. Again, don’t expect to be an instant expert, practice makes perfect.
Try to notice what your individual signs are that you are starting to get stressed or despondent. Ask others if necessary. It may be a tendency to withdraw or become irritable, or difficulty concentrating, or it may be physical symptoms like noticing your heart is racing. Noticing the signs allows you to take action and try nip it in the bud.
If you can be physically active then try find ways to do so regularly – whether this is an online exercise class or exercising outside (when possible). Stress hormones flood our body when anxious – the intention is to help us in our automatic ‘fight or flight’ response. But often, as with this pandemic, there’s no clear threat that we can run from or physically fight, so those hormones keep being released with little useful purpose. Physical exercise therefore is the natural way to use them up, release more ‘feel-good’ chemicals and restore balance in our nervous system. It can also help distract from worry, lift mood and give us a sense of achievement. Think in advance about where and how you can fit this in the day.
Planning ahead makes important self-care strategies like this more likely to happen.
What are you grateful for?
Remind yourself during difficult days to look for positives – even very small ones. Setting an alarm every evening to consider 3 small things you’re grateful for can help to increase the amount of positive emotions we feel and shift your mindset before bed.
A useful guide to a wide range of online activities to do during social distancing https://chatterpack.net/blogs/blog/list-of-online-resources-for-anyone-who-is-isolated-at-home?fbclid=IwAR1ob0jNjivjaE8cORrhDK2F8wY6-ZTsflbY7360z2otVaadpCdv2ifkbRQ
Mental Health Helplines: 24-hour confidential listening phone and text service http://www.callhelpline.org.uk/
Samaritans – support available via phone or email https://www.samaritans.org/how-we-can-help/contact-samaritan/talk-us-phone/
Wellbeing checklist and plan
I would recommend you complete one of these lists at least weekly. Consider if you can pair up with someone else (in your own household or a friend online) for this. A buddy system will help keep you motivated and may start some useful discussion and support around these points.
Where is a good place to get my news from? Where is less useful and may be best limited?
What can I realistically take action on or control today? What familiar routines can I usefully maintain?
What can I add to my ‘Go-to’ list?
How am I supporting or connecting with others?
What ideas of normal am I letting go?
Do I have a worry monster I need to acknowledge? What does it look like? What is its name?
What negative or critical thoughts are they likely to throw at me at the moment?
What will I say to them when they do?
What do I criticise myself for most lately?
What would I say to a friend if they had this problem or thought?
What are my signs of being stressed or low? How will I relax, if only for a few moments?
How am I moving my body/ going outside each day? And when?
What am I grateful for? What have I found pleasure or beauty in today?