Tips for Managing Stress and Anxiety During the Coronavirus Pandemic
Updated: Mar 28, 2020
This blog is based on notes (with some additions by BTI) taken during a Facebook Live presentation on March 22, 2020
by Lisa Damour, PhD, a clinical psychologist, bestselling author, New York Times columnist and regular contributor to CBS News. She is the author of several books including “Untangled Guiding Teenage Girls Through the Seven Transitions into Adulthood” and her most recent book “Under Pressure: Confronting the Epidemic of Stress and Anxiety”. She is also the mother of a 16 and 9-year old.
Stress and Anxiety
Damour recommends that if your child tells you they are feeling anxious in these times of Coronavirus, respond “that’s the right reaction in this situation”. Anxiety, Damour explains, is normal and can be healthy. It can be both productive and protective. For example, in the age of COVID-19, anxiety can motivate you to social distance, wash your hands, not touch your face, etc.
Three Stages of Anxiety. Damour explains that anxiety is a highly systematic event that unfolds in three stages:
Body’s physical reaction. This is the ancient “fight or flight” response when your heart races and your breathing changes to be quick and shallow. This primitive response gets oxygenated blood into our muscles, giving us the ability to run or attack.
Noticing the physical reaction. Once the“fight or flight” mode has been triggered, you may notice your body physically responding to your situation, and realize you are now under stress/anxious. At this point, however, if the circumstance for experiencing stress is “positive” (causing “eustress”), instead of negative (causing “distress”), you may want to continue forward. For example you may be at the gym exercising, causing your heart and lungs to work harder Once we notice our reaction, we make a cognitive choice around the stress we experience.
Anxiety. This is the last stage in which your mind runs with anxious thoughts and gets carried away with worries. Your mind overestimates the dangers and underestimates your abilities to manage the situation.
Damour recommends that you address anxiety differently at each of these stages:
Calm yourself and the physical reaction. Take deep breaths in and slow breaths out. Breath out longer than you breath in. Trying alternating between breathing in through your nose and out through your mouth and then breathing in through your mouth and out through your nose. This may keep you more focused on breathing effective. Breathing works! Our primitive brain has given a message to your heart and lungs that says “GO GO GO!” But this nervous system route goes both ways. There are stretch receptors that can detect breathing for evolutionary purposes if suffocating. So you can hack into your nervous system of receptors along a route that runs from your lungs to your brain. The nerves on the surface of our lungs get a message and send a message to the brain to slow the reaction down. Breathing in a way that helps you alleviate stress, however, can take practice.
Reframe the emotional experience. If the breathing doesn’t work, you have the power to make decisions on your emotional response — that you are or are not anxious. For example, you may choose to view the physical reaction as your body readying itself with adrenaline to address what is happening, e.g., with COVID-19 although there is an initial reaction anxiety you can tell yourself that you are still okay — you are ready, game on! This is the same feeling when you are amped or excited.
Combat anxious thoughts. If that doesn’t work and you really have anxiety, then think about what you are frightened about. What is the worst case scenario and if that were to occur, what resources do you have to help? It must be acknowledged, however, some of this “corona fear” may well be proportionate.
Responding to Your Child’s Stated Anxiety. Damour suggests that if your child comes to you and says “I’m anxious and depressed”, ask them to get more specific. Damour explains that anxiety and depression can be “garbage can” terms for emotional distress. Anxiety and stress are not a monolith and need to be broken down. She suggests trying to tease out whether your child is heartbroken, profoundly frustrated, extremely disappointed, etc. Get specific.
Stress. Damour emphasizes that stress, like anxiety, is normal and can be healthy. Stress occurs whenever you are adapting to new circumstances. It is not necessarily “toxic” stress but can be “normal adaptation” stress. The reality is that we are all being forced to adapt to these coronavirus times in a massive way. Stress and anxiety often get mixed up with each other, and in real life, you don’t have to separate them.
“Decision Making Fatigue” on Daily Hassles. With stress, there may be a lot of decision fatigue. It may not be the particular event that causes stress, but all the hassles that arise as a result. Over the past two weeks, most of us have become exhausted by this phenomenon because the old routines we had established no longer work. Damour suggests we respond by replacing our usual routines and decision making processes with new routines. Putting fresh routines in place can require fewer “modifying” decisions to the old routines to exhaust us.
The importance of a new routine cannot be over-emphasized as it will help things feel normal, increase your productivity and help you feel in control.
The number of daily hassles are huge now, e.g., do we have to make another grocery run? How do we check in on elderly parents and relatives? How do I motivate my child to do his schoolwork without nagging him? How do I get exercise? How do I get my work done with children in the next room? How do I keep my business afloat? It's common to question why you are hung up on this little hassle, e.g. if I run the dishwasher so often, who will unload. But each minor daily hassle counts and they all add up on top of the major hassles.
The solution, Damour says, is to get creative and ask for help. For example, who is making lunch? Answer: the kids can make simple sandwiches. She suggests, be bothered by it all but then deal with it and do what you can to minimize it. For example, limit social media if that is adding to more stress. Or check in daily with your social site if it lessens your existing stress by maintaining connections with friends, family members and neighbors.
“Practice acceptance”. Damour points out we can’t change that some of what is happening. We will experience ongoing stressors and will have to live with the Coronavirus Pandemic for a while. She suggests putting into categories what can and can’t change. What we can change, do it!
Positive coping strategies. Since
the stress of the threat of COVID-19 and the stress of a poor economic situation will go on a while, Damour recommends focusing on these four strategies:
Social Connections and intimacy. Maintain and deepen those you have and reach out to others to develop connectedness.
Happy Distractions. Distract yourself with enjoyable pastimes like playing cards, doing puzzles or binge watching Netflix and dumb movies, alone or preferably with your children.
Practice Self-care. Sleep and eat well, exercise and get outside (with social distancing); practice healthy habits that make you feel good. Shower and try not to lounge around in sweats all day. Put on street clothes to feel fresh and better about yourself.
Caring for Others. This is discussed in more detail below.
Negative Coping Skills Include Substance Misuse. By contrast, negative coping skills include:
Retreating into isolation. Cutting yourself from people is counterproductive.
Mistreating others. Taking out your stress on others can be more detrimental than social isolation.
Substance misuse. Be careful not to use "too much or too often". BTI would add that it's critical that parents model appropriate behavior and moderation with respect to your own substance use. Additionally, words matter. Refrain from saying things like “this Coronavirus is stressing me out, I need a [drink, joint, vape or Xanax!”]. Keep any "virtual" cocktail or happy hours with friends in front of your children to a minimum.
Caring for Others. Damour explains that our children fall in this last category of caring for others. As parents we need to help our children deal with the profound and deep disappointment that so many young people are experiencing now, e.g., seniors' once in a lifetime experiences are being ripped away. Validate their sad and upset feelings, e.g., say, “I hate that this happened to you.This stinks. You got robbed”. Provide empathy and language for it. Talk about what they are feeling and “name it” so then it comes down in size.
QUESTIONS. Parents posed the following questions:
What to say to your senior regarding their future when so much is unknown? Damour responded that parents should to think of communication as a song - get your “lyrics” (words) and tune (tone) right. Even though we think the message is what matters, actually the tone is more important. How confident, calm, and relaxed you are in what you say — while being honest in your words — makes a difference. Communicate confidence in your tune. You can say “no one knows how this will play out and unfold. So much is unclear. That said, we will be okay in the end and work through it. You are resilient, adaptive and creative”. In this manner, you haven’t overpromised but have communicated in a comforting tone.
How can we ensure social distancing? Damour pointed out that this is particularly hard
for teens who are addicted to their friends, love them and want to be with them constantly. With Spring here, there still are activities by young (and older) people that can be enjoyed outside six feet apart such as biking, hiking, tossing a lacrosse ball or kicking a soccer ball around (with no defense), or hanging out in your backyard with chairs arranged six feet apart. Parents can say yes as long as teens observe the rules. Also, our kids are getting creative on ways to socialize online.
How do we deal with college kids at home? Damour acknowledged it can be especially challenging for college kids who come home from school to keep up the motivation and there is not much work to do or no job to have. Many will need help to stay engaged. Although they were functioning independently and managing themselves, now they are back under your roof and typically regress. Even older adults do this around their parents. Watch out for college kids slipping back into that space, and try to assist while keeping boundaries.
Young adults have two sides and whatever side you speak to will show up! Damour explained that your young adult has one side that is immature, impulsive, self-centered, etc. and and another which is mature, thoughtful, productive, philosophical, etc. Resist dictating their schedule; don’t demand that they do x, y and z. If you do, you will get an eye-rolling or “you can’t make me do that” response. Instead, acknowledge that they were managing their own schedule, doing so much in college, and that it's hard being home “but you will figure it out.” Say “show me your new routine so I can support you in your new rhythm” or “what do you need from me?” Talk to them as the smart, productive and thoughtful people they usually are and in college.
The same goes for high school seniors who were able to be so independent. They can still continue adulting in close quarters. You can have a companion and fellow helper at home now. Hold high expectations and they usually will meet them.
What about limiting screen time? Screens are their lifeline and it's how they see friends so Damour recommends loosening the reins a little bit. Don’t be against social media but instead be for a good night’s sleep, focus when working, time outside, face-to face interactions — things you don't want disrupted by social media — and then social media be fit in. You can still keep rules such as “no cell phones at dinner time”.
If you see them on their screens too much and going down a rabbit hole then you can say “You and I both know ...” or “I’m noticing that when you are on your phone all day, you don’t feel great at the end of the day. This is what I’m observing, I’m not sure what to do with that observation. My hunch is that you want to feel better. Let me know how I can support you.” Put the problem on them so they are aware of it, want to come up with a solution and do so. Don’t talk down to them.
The same challenges apply to us on screen time. The problem with checking the news on Coronavirus compulsively is there is too much ambiguous information out there and psychological research shows this ambiguity makes us anxious instead of feeling better. The news on the pandemic will be ambiguous for a while and Damour recommends being deliberate about limiting access to the news. Stay in touch and abreast of the news but don’t keep it running all the time. We must either practice self control or install apps where you can block certain sites certain times. There are certain free downloadable apps she uses such as Self Control or Focus.
How to know if your child is in trouble in terms of mental health such as anxiety or
depression? If they are already suffering from anxiety or depression, Damour suggests you will need to watch them carefully.
Being sad makes sense now in these COVID-19 times; sadness and depression are different. Sadness is a rational reaction to losses, especially those which are laid on them suddenly as they experience this pandemic. Remind them when physical health is interrupted, and one becomes sick, they eventually recover. The problem you need to track is making sure they come out of their sadness. Do they manage it, (which is the case if they are mentally healthy) — or does it last?
If the condition lasts, contact a mental health professional. The “telehealth” rules have been loosened now for psychologists and psychiatrists to take care of people online (there used to be requirements of special training and certification). Now state authorities are giving professionals more freedom in this regard. Some clinicians may have a sliding scale or reduced fee for telehealth video consultations. Therapists may be found through your child’s primary care doctor or Psychology Today. Insurance may cover telehealth now (check with the State Board to see if they already have made arrangements).
What about if my child isn’t necessarily sad or anxious but is angry? Damour explains that if your child is being snarky, nasty, angry or otherwise unpleasant, know that you may seem like safe place for them to go to express these feelings and they might be treating you as a punching bag. They have all this ire and no place to take it . But that doesn’t mean you tolerate it. You can respond “I get it. You have the right to be upset but you can’t take it out on me — it's unfair and I don’t treat you that way. What can we do for you to express your anger without me being a punching bag?” Or you can respond “I will pretend you didn’t say that. I know you didn’t mean it. When you want to talk civilly, I’m ready.” Acknowledge their anger but don’t let them mistreat you.
Do I let my kid sleep until noon during the weekday? Damour points out that the silver lining in this is that our children are finally getting more sleep. They need nine hours of sleep every night and few have been getting it. So Damour recommends letting them pay off their sleep debt (e.g., if sleeping 6 or 7 hours a night which many do) but then don’t let very late morning wake-ups continue. For example, if they are sleeping until noon, determine if they are going to bed too late or question what they are doing with their waking time because they will eventually need a routine.
DAMOUR'S PARTING ADVICE
Parents and kids can really cherish and enjoy these unexpected times. Kids can be a delight and it can be nice sleeping in, dressing in pajamas and sweats all day and generally having the stress in our lives reduced. Welcome the pause, the slowing down and their company.
You can say things to kids such as “it's okay to be happy staying home, not suffering with a teacher you don’t like. Look at the bright side - you can pick and choose which friends and classmates you are dealing with.”
With all this being said, Damour acknowledges how worrisome the pandemic is and how others are suffering. She encourages us to maintain a deep appreciation that many, if not most people, are stressed financially. Try not to show children your stress because it will cause them additional stress. Enjoy the closeness with having your children around but still deeply understand the gravity of the situation.