Dr Will Harper, MD, of Harper Health, interviewed Dr Robyne Howard, PsyD, of Lakefront Counseling Group, regarding Covid-19 and mental health. Dr Will is a Chicago internal medicine specialist with 20+ years of experience. He is on the faculty of Northwestern Medicine, named to the Top Doctors list in the Midwest, and writes a highly respected blog on medicine and health.
Dr. Will: What IS anxiety?
Dr. Robyne: Anxiety is a normal human reaction to an actual or perceived stressful situation. Everyone worries from time to time, but when we have significant anxiety the symptoms persist and are intensive enough to interfere with day to day functioning. Anxiety can make it hard to work productively, to care for children or can make it difficult to leave your home. Importantly, anxiety can prevent you from being present, engaged and fulfilled in your life.
Common symptoms include:
- chronic worry or circular thoughts which are difficult to control
- persistent thoughts about worst outcomes
- sleep disruptions or difficulty falling and staying asleep
- avoidance and social withdrawal
- difficulty concentrating
- general sense that something bad will happen
Physical symptoms can also be present. While the emotional symptoms of anxiety can trigger these symptoms, the physical symptoms, themselves, can be the first way we experience anxiety
- increased heart rate
- increased perspiration
- higher blood pressure
- difficulty breathing
Dr. Will: What are the different ways that anxiety presents itself?
Dr. Robyne: Anxiety shows up in a variety of ways. Most people know that they are not themselves. Social interactions can be more strained or avoided. Negative thinking, or worst-outcome thoughts can cloud reasonable, rational thoughts. Irritability and being short-tempered can feel pervasive with a general sense of foreboding and not feeling like yourself.
Mental health professionals categorize the different ways that anxiety presents itself. This helps us formalize the diagnosis so we can choose the right treatments for you. There are several major types of anxiety disorders:
- Generalized anxiety disorder (GAD)is pervasive worry or anxious feelings about a variety of things. People with GAD worry about many concerns, such as health problems or finances and often have a fear that something bad is likely to occur. Symptoms include restlessness, irritability, muscle aches, difficulty concentrating, sleep disruptions and a generally feeling of being on the edge and unsafe.
- Panic disorder is characterized by reoccurring panic attacks with symptoms such as sweating, trembling, shortness of breath or perceived choking, a rapid pounding heart and overwhelming feelings of dread. Attacks often occur suddenly without warning. This often leads to a persistent fearfulness about when the next one will occur. Sometimes people believe they are having a “heart attack” when they are not. (Tip from Dr. Will: Don’t make the diagnosis of panic attack on your own, particularly if you’re at risk or already have heart problems. Literally, a missed diagnosis by you could be fatal. Talk to your provider!)
- Phobias are intense fears about certain objects (i.e. insects or snakes) or situations (getting on elevators or leaving the house) that are powerful, distressing and intrusive.
- Agoraphobia is a particularly relevant form of anxiety due to COVID-19. It manifests by preventing one from leaving their home due to feared, worst-case scenario outcomes.
- Social anxiety is when one is unreasonably fearful of social situations. They feel a deep discomfort with being in social settings, are self-conscious in front of others, and worry about rejection.
- Obsessive-compulsive disorder (OCD) is characterized by chronic, uncontrollable feelings and thoughts (obsessions) that can be combined with rituals (compulsions). Some common examples include compulsive hand washing in response to a fear of germs, or repeatedly checking for errors (i.e. “Did I turn off the stove.”). The COVID-19 epidemic has been a big trigger for folks with OCD around cleanliness.
- Post-traumatic stress disorder (PTSD) can develop after a severe physical or emotional trauma such as a natural disaster, accident or crime. Symptoms include flashbacks of the trauma, nightmares and scary thoughts which interfere with a daily routine and normal functioning.
Dr. Will: What are some general thoughts on how to manage anxiety?
Dr. Robyne: Most people experiencing anxiety try to cope with it by avoiding situations or the experiences or thoughts which make them anxious. However, with COVID-19, the usual ways of managing anxiety (i.e. going to the gym, office, seeing and talking with family and friends, participating in your faith through your church, synagogue or mosque, or out for live music) are no longer available to us in the way they were in normal circumstances.
The combination of living in a world with some real losses and unknowns, and experiencing elevated anxiety, is forcing us collectively to adapt new strategies, both for those with pre-COVID-19 anxiety and those new to experiencing anxiety.
The best strategies to manage anxiety may feel counterintuitive, however research has shown that avoiding feared outcomes can actually backfire and increase your anxiety.
I strongly encourage you to first reach out to your provider to discuss your feelings of anxiety. That way, they can be a partner as you try and work through these emotions. With that in mind, I share here some strategies to manage and reduce anxiety now:
- Keep things in perspective by collecting data and getting the facts. The Harper Health blog is a good resource
- Catch yourself in thoughts that don’t serve you. Examples: you are catastrophizing (“This is a disaster.”) or living in your worst outcome beliefs (“I know I am going to lose my job.”) in ways which are out of proportion to your fears
- Ask yourself if you are catastrophizing. “Am I being reasonable here?” “Is this really a disaster?”
- Think about other ways to understand your fears which are more valid and logical. Challenging irrational beliefs with a more rational and likely outcome based on facts will provide you with a more balanced view of your situation and reduce anxiety symptoms. “The COVID-19 cases have already come down.” “Really smart people are working on treatments and vaccines.”
- Keep track of your thoughts, feelings and behaviors. This will help you to see patterns and when you are more vulnerable to spikes in anxiety. Apps are helpful such as:
- Keep connected to friends and family in a safe way. Stay in touch by scheduling regular video meetings, have an in-home date night with your partner or visit the museums of the world.
- Embrace and lean into your resiliency by doing the things you never have time for – painting, gardening, writing that book, exploring your ancestry, blogging, running etc. Here is a list of resources:
- Use apps which will teach you how to reduce fight or flight responses and develop a mindfulness practice.
Dr. Will: When is the anxiety too much and when should I or one of our patients reach out for help?
Dr. Robyne: Anxiety which interferes with your normal functioning (see above) requires professional help. Reaching out to Dr. Will, Dr. Meg, Dr. Dan or Steph is a great first step in identifying if your anxiety symptoms require professional help.
Clinical psychologists are trained in diagnosing anxiety disorders and teaching patients healthier, more effective ways to cope. There are very useful strategies for reducing anxiety, including Cognitive Behavioral Therapy (CBT), Dialectic Behavioral Therapy (DBT) and Mindfulness to name a few. They are evidence-based and highly effective. Currently most all psychologists are practicing telehealth, where you can have confidential and secure one-on-one sessions via video conferencing.
You need not suffer alone during this challenging time in our history.