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COVID-19: Balancing Public Health and Mental Health

We are in unprecedented times, with every day bringing additional grim news reports about the number of new coronavirus (COVID-19) cases and the loss of life. Our provincial and federal chief medical officers are doing incredible work in attempting to control the spread of COVID-19, including putting forward guidelines for hand washing, social and physical distancing, suggestions to work at home if possible, and sharply restricting the size of gatherings.

We are in unprecedented times, with every day bringing additional grim news reports about the number of new coronavirus (COVID-19) cases and the loss of life. Our provincial and federal chief medical officers are doing incredible work in attempting to control the spread of COVID-19, including putting forward guidelines for hand washing, social and physical distancing, suggestions to work at home if possible, and sharply restricting the size of gatherings.

These public health guidelines are necessary to control the spread of COVID-19. The more closely they are adhered to, the quicker this virus will be contained. Getting to the point of containment will probably take weeks, if not months. But we are all social creatures by nature. And following these public health guidelines will obviously result in decreased social interaction and will likely have a negative impact on mental health for many people. With this in mind, what follows are some suggestions to help you adhere to public health guidelines, while still attending to your mental health and overall well-being.

Put Structure Into Your Day

If you have unfortunately been laid off, were unemployed prior to the onset of this crisis, or are now working from home, the structure of the work week has most likely disappeared. For many of us, our work provides scaffolding to the week and generally organizes our day. For example, we usually have a regular schedule for what time we get up in the morning and what time we go to bed at night, and most of us have morning and evening routines that take place around our work day. Because it can be stressful to lose the basic schedule of our day, it is a good idea to try to adhere to the same work-week structure while you are at home.

For example, if you get up at 7AM during the work week, get up at 7AM under these new circumstances as well. If you exercise in the morning and your gym, pool, community centre or yoga studio is now closed, get up at the same time and go for a walk or a bike ride. Have a dedicated space to do your work if you are working from home, and build in breaks during the day just like you would at work (e.g., coffee break, lunch). It may sound silly, but sticking to the same pre-work routine can be an important part of maintaining good mental health in these uncertain times. If you are working at home, dress in work clothing. Go for a walk around the block to arrive back at your (home) office and begin your day of work. When your work day is completed, walk around the block again to arrive back at your home and change out of your work clothes. 

Don’t Shut Yourself Away

Of course, if you have been travelling, are experiencing symptoms or you have been in close contact with someone who is showing symptoms, or been diagnosed with COVID-19, you do need to completely self-isolate for 14 days. However, some people are hearing the self-isolate recommendations and taking it as permission to not leave their home under any circumstance. For people with an anxiety disorder who have difficulty being in public, such as people with panic disorder, agoraphobia, or social anxiety, staying inside where social interaction can be avoided may feel like a holiday. Similarly, if being in public produces anxiety because of associations with past traumas, being asked to stay home may be a welcome change. Although it might be relieving to avoid anxiety-provoking situations, it will eventually lead to more anxiety when these public health restrictions are lifted. You will be out of practice in managing your anxiety. The best way to prevent a relapse of problematic anxiety is to continue to challenge yourself and avoid avoidance as much as you can. Given that stress has increased for everyone, it well may be that it will take less to trigger your anxiety or it may show up in a different way. If you have been practicing the skills of cognitive behaviour therapy (CBT), you will hopefully be better prepared to manage this anxiety. The resources of Anxiety Canada, including the MindShift CBT app, will be helpful to make and enact a plan to continue challenging your anxiety. 

As long as you are following the public health guidelines regarding social and physical distancing (currently 2 meters or 6 feet), it is still acceptable to be in the company of a couple of people (e.g., going for a walk or a run with a friend, sitting outside enjoying the beginnings of spring while having a cup of coffee with a neighbor etc.). These types of social interactions are important to maintain good mental health and well-being. Remember if you choose to engage in these activities you must stay 2 meters or 6 feet away from each other. Please be aware that this current recommendation may change if the number of cases increases and a shelter-in-place order comes from provincial or municipal governments. 

Get Active

It is well known that exercise helps to regulate mood in addition to the obvious cardiovascular benefits. As long as you are not required to self-isolate, exercising outside, if you are able, is highly recommended. Go for a run, a bike ride, a hike or a walk. If you have a dog, they will likely be appreciative of longer or more frequent outings. There are also other ways to be active that don’t involve traditional exercise. If you have a yard or garden, spring is a time when it can use some attention. Now is a very good time to do house projects that you have procrastinated or have not been a priority. If the thought of engaging in one of these projects is overwhelming, break it into small chunks. Setting goals that are time and not task focused can also be helpful. For example, spending 30 minutes cleaning out the garage as opposed to getting the garage organized. 

Find New Ways To Communicate

Most human beings need to spend time in the company of other people. Staying connected and interacting with others is therefore an important way to maintain good mental health. However, the recommendations to stay home run counter to our need to connect with one another. Fortunately, there are lots of ways to meet that don’t involve face-to-face interaction. If you have the technology on your phone (e.g., FaceTime if you have an iPhone, Skype), set a time with a friend for a coffee date. Arrange a happy hour with friends, with each person providing their own snacks and drinks, and meeting virtually using one of the many available video conference platforms. You can also have a ‘virtual’ dinner, watch a movie, or play a game with friends. Gravitate toward social media channels that focus on creating a positive community by providing encouragement as well as suggestions for how to spend your time. At the same time, it is a good idea to step away and focus less on aspects of social media that propagate fear and potentially spread inaccurate information. 

Are You Appropriately or Excessively Concerned?

OCD & Contamination Fears

COVID-19 is a serious threat and we need to be concerned and do our civic duty to prevent the spread of it. Distinguishing between appropriate concern and excessive anxiety can be tricky. Let the public health recommendations guide your behaviour. Don’t allow anxiety to guide your behaviour. For example, recommendations for handwashing is 20+ seconds with warm water. Use this guideline to help you stop hand washing and disengage from the behaviour. Often people with anxiety and contamination concerns do not use outside guidelines to disengage, but rather internal feelings of anxiety which leads to excessive handwashing or other maladaptive behaviours. For example, ‘I’ve just sung happy birthday to myself while I’ve washed my hands but I still feel anxious. Maybe I sang it too quickly. I better do it again’. And so the cycle goes. However, for children it is more acceptable to use these concrete guidelines like singing happy birthday to guage their behavior and ensure a handwash that is of sufficient length.

Health Anxiety

Many people are understandably health anxious in this current context, particularly as the number of COVID-19 cases is increasing. This worry about health can make us feel that we need to be ‘on duty’, looking for early signs of the virus and constantly scanning our bodies for any changes. The role of attention is a subtle yet very powerful contributor to the onset and maintenance of anxiety. For example, if we are looking for signs of breathing difficulty, we are more likely to notice and react to breathing we believe to be labored. Additionally, it is normal for the human body to experience a range of physical sensations. When we are not attending to our physical sensations, they are more likely to go unnoticed. However, if we are on the lookout for early signs of trouble, normal fluctuations in bodily sensations will be noticed and reacted to with fear and anxiety, which further stimulates physical symptoms associated with anxiety. Added to this, if you are on guard for early signs of the virus, it will also be likely that you will misinterpret other body reactions as signs of it. For example, spring is a time when many people have seasonal allergies. The stuffiness that comes with hay fever and the accompanying sneezing could easily be misinterpreted as signs of COVID-19. Knowing that this tendency toward misinterpretation can occur might make it less likely that you will fall for it. In general, if you notice any change in sensations, like coughing, sneezing, body aches, or breathing changes, don’t immediately jump to the conclusion that you are sick: you might be misinterpreting, or paying too much attention, to a normal sensation or body change. Let some time pass, to see whether the sensations dissipate on their own. You might find that many sensations that you experience during this time are not actually signs of COVID-19, but rather a normal fluctuation. Of course, if a physical sensation persists and increases in severity over the course of a couple of days, you can contact a health care professional or your local public health authority.

Generalized Anxiety Disorder & the Fear of Uncertainty

Right now we are living in a time of great uncertainty. We don’t know what the future holds for our health, the health of our families, or our economic well-being. The extent of this uncertainty can be very frightening and anxiety-provoking, and can therefore lead to unhelpful coping behaviours. For example, you might be looking up excessive information about COVID-19 on a daily basis. Although it is a good idea to stay informed in order to hear important updates or advisories, trying to feel more certain about the situation by watching the news all day, or looking up information online and on social media, is not helpful. No one knows yet how this current pandemic will resolve itself in our daily lives, and unfortunately you won’t obtain greater certainty by scouring the internet for more information. In fact, trying to seek out certainty in this manner will likely make you more anxious in the long-run. As such, it is a good idea to stay informed by obtaining your news once a day, preferably at the same time of day, from a reputable news source. 

Another way that many people are trying to cope with their fear of uncertainty right now is through stockpiling. We have likely all been to the grocery store and witnessed the empty shelves, and seen people purchase much more than is required for them or their family. Many people are attempting to hoard food and paper products out of a fear of the uncertainty regarding the future availability of items. However, this panic purchasing has a contagion effect: Once we see people hoarding items, it creates anxiety in others who then fear a scarcity of items, and begin engaging  in similar behaviour. This is a problem for a couple of reasons. First, stockpiling behaviour empties the shelves of grocery stores and pharmacies, which impacts other people who need to shop for necessities, most notably the elderly and those with mobility issues for whom shopping is a challenge. Second, because this behaviour creates anxiety for others, there is a greater chance that people will feel a need to rush the stores, which leads to crowding and a failure to engage in proper social distancing. As with excessively seeking out information about COVID-19, this unhelpful coping behaviour not only doesn’t reduce anxiety or the uncertainty of our future, it can actually make you more anxious and fearful. It is important to keep in mind that efforts to erase uncertainty are futile. Life is inherently uncertain even in the best of times, and we must learn to tolerate some level of it in our daily lives. The more we try to eliminate uncertainty, the more intolerant we become to the bits that remain uncertain.

Loss of Control Is Scary

We are normally quite fortunate to be living in a society where we enjoy freedom of movement and have many options at hand for how to spend our time. Each day in this current crisis brings additional restrictions with multiple cancellations of cultural and sporting events, closures of stores, community centres, restaurants, provincial parks and playgrounds. Although these measures are necessary to control the spread of COVID-19, for some people it will be experienced as a frustrating loss of control. The struggle against the loss of control likely strengthens any negative feelings you have about it, thereby further increasing your frustration, anxiety, or sadness. Rather than focusing on what cannot be controlled, try to focus on what you do have control over – your reaction to it. For example, the absence of traffic on the street can be unsettling or it can be an opportunity to revel in the peace and quiet and the ability to hear the birds sing. Focusing on controlling your reaction to our changing circumstances, as well as to the aspects of your life that you can actually control (such as your schedule, when and what you will eat each day, and how you will spend your time), is an important strategy for managing your mental health during this difficult time.

Be Compassionate With Yourself & Others

Dealing with the current restrictions and the fear of the uncertainty regarding what lies ahead is difficult. We are all in the same big lifeboat. While you are showing yourself compassion for doing what you can do to cope with a difficult situation, remember that the person two meters away from you is in the same situation. Showing compassion to that individual, and accepting the kindness that other individuals show us, just might make it easier to cope.

Thanks to Scientific Advisory Committee members Maureen Whittal and Melisa Robichaud for creating this resource.