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Dealing with Stress, Anxiety, and Grief during COVID-19

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Zoom conversation between Joshua Gordon and Francis Collins

If somebody had told you last year that that our country, along with the whole world, would soon be facing a major health challenge like the coronavirus disease 2019 (COVID-19) pandemic, you’d have thought it almost unimaginable. Yet here we are.

To help flatten the pandemic’s deadly curve, a great many of us have been asked to remain at home. I have been faithfully adhering to that recommendation—I haven’t been to my office or lab at NIH in almost three weeks, though I can’t remember a time where I have worked harder. While helping to protect ourselves and others, this physical distancing can affect our mental well-being.

Recently, I had an opportunity to discuss these aspects of COVID-19 with Dr. Joshua Gordon, Director of NIH’s National Institute of Mental Health. Our conversation took place via videoconferencing, with him linking in from his home in the New York area and me from my home in Maryland. Here’s a condensed transcript of our chat:

Collins: So, Josh, tell me how you’re doing there. How’s everybody coping?

Gordon: Right now, my family and I are doing fine. My daughter and I are ensconced here at home, both working from home. She’s finishing up high school online and my wife works for New York City. She’s an essential employee, so she’s still going into work but, fortunately, she’s able to make sure that her workspace is very sparse and she’s able to commute by herself.

Collins: I’m glad you’re okay. Exactly how do you name this kind of stress that everybody’s feeling right now? Is it fear? Is it anxiety about being put in such an area of uncertainty? Is it just grief, the sense that something really profound has happened here and we are losing things in terms of our ability to move around freely? Certainly, we also grieve deeply about the suffering and the death that we see.

Gordon: For different people, it’s different combinations. I know that I feel anxiety for myself and my family in terms of our health. But it’s not just anxiety about contracting the coronavirus, it’s also fear and anxiety about what’s happening to society, what’s happening to our economy, what’s happening to our friends and relatives.

And then there is tremendous grief. We’ve acknowledged that we’ve all lost something already. Right? We’ve lost our normal day-to-day interactions. We’ve lost our ability to physically connect with people and it makes it more challenging to socially connect with people. And we’ve lost that sense of certainty and self-power.

Collins: Talking to my wife Diane about this, I think the grief part of it was something we were both feeling, but hadn’t quite named. Somehow being able to talk about it, experience it, and not try to run away from it turned out to be helpful.

Gordon: Yes, it’s important to talk about it. For most people, it’s a matter of being able to talk about your feelings, get it out into the open, and hear from others that are going through the same thing. They’re your friends that you’re Zooming with, they’re your parents or grandparents that you’re talking to on the phone.

Collins: I hope everybody will feel a little more free to be honest about what they are going through. Maybe sometimes we try to just be tough and keep it all to ourselves and don’t want others around us to be influenced, if we’re talking about our own emotions. But we need to share those things. Besides that, what other things, can be helpful to people who are trying to cope with the current circumstances?

Gordon: One important thing is to focus on the facts. There’s a lot of rumor, there’s a lot of hyperbole out there, and there’s a lot of, frankly, uncertainty. But to the extent that you can, learn and share the facts about the virus. If you know what’s happening, it reduces the uncertainty.

At the same time, one can get so taken up with reading the daily news, listening to the various news conferences that are going on, checking the websites, etc., that it becomes all-consuming. So, it’s really important to set aside periods of each day where you turn off social media, you turn off the TV, turn off the news, and do something that you enjoy. It could be art, it could be exercise, it could be picking up the phone and talking to someone about something other than COVID.

The other thing that’s really important is to take care of your body in addition to your mind. Taking care of your body can help your mind do better. So, yoga, exercise, resting, naps, regular meals, all these things can be helpful. Alcohol is often used as an escape mechanism when you’re feeling stressed. That can be a little tricky or dangerous, so try to avoid drinking excessively.

Connecting with others is really important in this day of physical distancing. I like to call it physical distancing, rather than social distancing, because I think we can be socially intimate and physically distant. So, connect with others, reach out to people, use digital tools, use telephones, use email and text, write a letter.

Collins: A letter?

Gordon: Yes, why not? I haven’t gotten mail for three days. Just saying. So, write a letter, connect with people that you can unwind with, that you can get joy from.

Collins: My wife Diane just stepped in and I want to have her to come over for a minute and say something about this, because I think part of the grief we were feeling was this disconnection from face-to-face interactions with people. Diane’s a very sociable person and this is particularly hard when you’re so isolated in one place. But she came up with something yesterday that seemed to be a help.

Diane Baker: Yes. I’ve got to say, the shelter in place order here in Maryland just surprised me. It took me down a couple of notches and I can’t say it was warranted, I was like I can’t take this. Even though it’s what we’ve been doing, it just emotionally really got to me. And so a friend came up with this idea. She went for a walk in her neighborhood, I went for a walk in my neighborhood, we pulled our phones out and we had a conversation. Even though it was cold rainy day, we didn’t mind it because we were talking to each other. So, we’re going to try and do that on a regular basis.

Gordon: You’re right, your social connectedness really helps. Like I can reach out to my parents in North Carolina, I can reach out to my brother in Philadelphia. We’ve had almost nightly Zoom get-togethers and I actually feel like I’m seeing my relatives more these last couple of weeks than I have in months.

Collins: That’s interesting. We’ve done that too. Every Sunday now we have a Zoom meeting with my daughters and my grandkids.

Diane Baker: The other thing I think it’s done is forced us to be more intentional about our communication. I think that’s something we take for granted. For instance, I have this book club I’ve been a part of for a long time, but we always talk books and politics and topical issues. Now, I’m starting to reach out to them on email and say, “Hey, I’m having a real tough time,” and we’re supporting each other in a way that we haven’t before. It’s been very nice. I’ll let you guys go on..

Gordon: Nice to see you, Diane.

Collins: I think we all feel this urge to do something, to try to contribute in some way. In many ways, we feel a little paralyzed by the fact that we’re stuck indoors and all of the things you might like to do might be risky for yourself or other people. What can we do as far as actions to help other people?

Gordon: Those of you who are working directly on COVID can take a lot of pride in the fact that you’re contributing to that mission. But everyone is contributing to that mission by staying home. I would add a more practical bent to all this, which is that it is important to set goals and priorities for yourself. Finally, there are volunteer opportunities that can be done remotely. There are donations that are being accepted. So, I encourage you, if you feel so moved and have the means to do so, contribute in that way.

Collins: Parents are worried about their kids in terms of how this is affecting them. So, what kind of advice can you give to parents about how to interact with children in this very unusual situation?

Gordon: Kids are, I’m sure, feeling anxious. First, recognize what they’re going through. Talk to them about it, find out what’s concerning them.

Kids always surprise you. They’re not necessarily anxious or worried about the things that you’re anxious or worried about. They might be worried about getting COVID, but they might also just be worried that they’re going to miss their best friend’s birthday next week. So, if you find out what’s bothering them, then you can help them. You can have them Zoom a happy birthday song or connect in some other way.

Reassuring them can help. But, more importantly, it’s just answering their questions as honestly as you can. When you don’t know, admit that you don’t, but say that you’ll be there for them.

Collins: Everybody is facing a certain amount of stress, anxiety, and grief at this time, but it hits some people even harder. What would be the signs that this is getting into a circumstance that might require some additional help?

Gordon: Let’s talk about how we recognize when this might be a thing that we can’t deal with and that is sending us over the edge. I went out grocery shopping last Friday. I managed to find a mask to wear and gloves, but I actually couldn’t take it. I was so anxious. I bought a few things and I had to leave. I felt in me something I’ve really never felt before. My heart started racing, I started breathing fast. I was getting a panic attack. That was something pushing me over the edge in ways that I hadn’t been challenged before.

If that happens to you, recognize it and seek help. So, what are the signs? We’re all feeling anxious, but if you feel so anxious you can’t get your work done, you actually can’t do the thing that you set out to do, reach out for help either from a friend or from a professional. Other signs would be you’re starting to withdraw from people, having trouble sleeping, change in appetite, change in physical energy levels, or starting to become irritable or angry.

For those with pre-existing mental illnesses, it’s really important that they reach out to their providers and find ways of connecting. Every mental health provider that I know of right now is moving to telehealth sessions. Not everyone is used to teleconferences, not everyone knows how to use them. So, plan in advance with your provider how you’re going to contact with them so that you can get the help you need when you need it. Make sure that you have enough medication in-house and work out with your pharmacy how you can get it delivered rather than having to go pick it up, whether that’s from a mail order pharmacy or getting your local pharmacy to deliver to you.

Finally, there are hot lines. For those experiencing distress with the COVID epidemic, the Substance Abuse and Mental Health Service Administration has the Disaster Distress Helpline. That’s 800-985-5990 or text “TalkWithUs” to 66746. For those who are really struggling, and are thinking of hurting or killing themselves, there’s the National Suicide Prevention Lifeline at 800-273-8255 or you can text “HOME” to the Crisis Text Line at 741741.

Collins: Before we close, I’d like to talk about how, despite the stress, the anxiety, and the grief that we’re all feeling, we might somehow learn something pretty significant about ourselves during this pandemic. Can you say something about that?

Gordon: One thing we know is that resilience isn’t necessarily about something you already have. It’s something that you learn, that people who’ve been through challenging times and risen to the occasion, they learn from that. They become resilient. They learn how to get through challenging situations in the future.

For many of us, this is an opportunity to learn more about ourselves and how we can grow as people, as human beings, and as fathers and mothers and daughters and sons. This is an opportunity to prove that we can respond to an emergency like this in a way that is thoughtful, in a way that is caring, and in a way that contributes to improving the situation for all of us

Collins: It does call us, doesn’t it, to focus on things that in our daily rush of business as usual, we neglect to think about. What are we really here for? What’s the meaning of all of this? What is our responsibility to try to make the world a better place?

I’d predict that all of us who are living through this COVID-19 experience will look back on it as a time of special significance in terms of what we learned about ourselves and about the perspective of what really matters in this world. So, yes, it’s stressful, it’s full of grief and sorrow, but maybe it’s a way in which you can gain something to carry forward. Josh, thank you so much.

Resources:

The Disaster Distress Helpline, 1-800-985-5990 (Substance Abuse and Mental Health Services Administration)

National Suicide Prevention Lifeline, 1-800-273-8255

Crisis Text Line, 741741

Coping with Coronavirus: Managing Stress, Fear, and Anxiety, Director’s Messages (National Institute of Mental Health/NIH)

Stress and Coping, Coronavirus (Centers for Disease Control and Prevention)

Coronavirus (COVID-19) (NIH)

15 Comments

  • Nancy Rene says:

    This was helpful and reassuring. I look forward to reading your blogs, very well written. You and Dr. Fauci are holding us together in the midst of catastrophe. Thank you.

  • Kathryn Bender says:

    We live in Florida in a community of older adults and work with caregivers and their loved ones with Alzheimer’s Disease or dementia. We are both Certified Dementia Practitioners and I am an RN. We volunteer with 2 groups to offer Memory Cafes that are suspended for now. We are seeing the dementia worsen with the isolation and are responding to requests for help. Do you have any information about the effects of staying at home on dementia/Alzheimer’s Disease? I would sincerely appreciate any comments or references you might offer. Thanks

  • S. Walker says:

    Thank you so much for this message, … I needed to read it… I feel that it will reinstate hope for everyone internationally. Empathy is the key to find HOPE.

  • John Hasty says:

    On the positive side of all of this is that the upcoming vaccine for 19 will be the best ever against a Coronavirus in recent history. We are much smarter today than just a few years ago. The world has eradicated smallpox and I predict that we are on the verge of eradicating the influenza.

    • susan ransome says:

      Thank you, Dr. Collins, Dr. Baker, Ms. Collins.
      I wasn’t going to read this blog, but I’m glad I did; it’s very helpful.
      I realized a week or 2 ago, that what I had been feeling was a sense of “dread.”

      Ms. Baker, I love your comment about talking to a friend while you and your friend shared a similar activity (walking in different neighborhoods)! what an excellent idea: “synchronizing sensorimotor and emotional-cognitive activities” with a loved one! That’s fabulous. I’m going to try to do that; thank you.

      Dr. Gordon, your advice about kids is really great: “more importantly, it’s just answering their questions as honestly as you can. When you don’t know, admit that you don’t, but say that you’ll be there for them.”

      That is so reassuring. At any age, we look to experts like you to help us– especially during an earth-shattering/ life-shattering period like now. I am grateful to have compassionate, honest experts like you all.

      And Dr. Collins, I love what you say: “What are we really here for? What’s the meaning of all of this? What is our responsibility to try to make the world a better place?

      I’d predict that all of us who are living through this COVID-19 experience will look back on it as a time of special significance in terms of what we learned about ourselves and about the perspective of what really matters in this world. So, yes, it’s stressful, it’s full of grief and sorrow, but maybe it’s a way in which you can gain something to carry forward.”

      I think you are absolutely right that we should ask what is our responsibility to make things better?

      Now, I am going to be the pesky gnat, and proceed:
      I hope you will forgive me, Dr. Collins, but I am worried that
      –there may be 60,000 or so of us who will not be able to look back (perhaps downgraded from “100,000 to 200,000”); that
      –they will never be able to carry anything forward.

      What is our responsibility to them?
      I think we have an opportunity now, to see if our current strategies are optimal– to formulate the best, most effective response in this war against SARS-CoV-2, in order to achieve the best outcomes.
      Can we refine and revise control measures over time, based on real data locally, and nationally?

      Why is it that American results in this war are so different from results in parts of Asia?
      Are the daily statistics we get– the “situational awareness”– the result of our decision-making to date?
      Could our decision-making change in real-time, so that we can get the optimal results achievable? before we have to look back after-all-this?

      Could ineffective policies regarding Isolation and Quarantine at home be driving the spread of the Covid-19 Pandemic “unnecessarily”?
      Could a change in Guidelines result in better outcomes– by achieving more effective Isolation and Quarantine (in temporary healthcare facilities), outside the home?

      I worry that the greatest sorrow and grief could be if we have to say in hindsight:
      1. there was evidence that better options were available;
      2. better results were had in Asia, using more effective methods of Isolation and Quarantine; and that 3. we had the chance to modify our Guidelines based on real-time evidence– but our policy makers decided not to make that change.

      I hope that will not be some of the things we will carry forward.
      I am deeply grateful for the opportunity to have your insights, and to share my worries.
      Please forgive me for anything remiss.
      I am so glad that you and the NIH will continue to be here for us.

  • Shankar Ramaratnam says:

    Many a thanks to you Sirs/ Madam. The blog was informative. Social distancing, hygiene & face masks are the vaccine & councelling that would go a long way tackling the Covid19 Virus World wide. Together we will overcome this malaise. . .
    Take care and God Bless.

  • Louis Korman, MD says:

    Thank you. I have forwarded this to all of my colleagues who are out here trying to care for our patients, our families and ourselves. Maybe we are hearing the language of God. I hope we are listening and understanding.

  • Nancy Janitz says:

    I am receiving Epidural Cortisteroids injections and the effects are very important to my immune system that is the very important issue in this Pandemic; also my family is dealing with the loss of my grandson and my family In Bergen County, NJ and they have Immune Diseases! The very very difficult thing is that we all are very Overwhelmed with this and the News with the President is very very Harmful to the already Mental Health Issues and the People who have lost loved ones in this Country is the very important time for The NIH Agencies to be the Best Source of our society and we all need to get the information to Help the people in Mental Health And Anxiety; not including the Grief that’s widespread in the USA and after this Is over the Medical Providers will need to get the help of the Mental Health Professionals to Deal with what they have witnessed in this country! PTSD is a very very important part of this issue!

  • MAURICIO SOLORZANO says:

    Blessings as we come into love and a new way of living on Earth that is better for the planet and for all humans (once we get through the rocky period). May we remember this and come into love for all humans, holding the planet in light.

  • mosi says:

    this article is very knowledgeable..thank you so much for sharing this stuff…

  • Sonika R. says:

    Hello! Every step we should take to fight back against anxiety and depression explained by you very clearly. Your tips are an ideal solution for us. Thank you for sharing this informative blog. Keep posting.

  • jbarrycp says:

    I lost my temper and talked strongly to our nurse.
    made peace later on, but I am sure it was stress from being
    in quarantine in this community of 31 people. 2 test positive.
    Music seems to help me very much, plus phone calls from friends.
    Call a friend it will make your day, and thanks for all
    our health workers

  • Paduraru Alexandru says:

    hello friends. It is a very good blog, I follow all the articles …

  • leslie haskin says:

    As a 9/11 survivor, anxiety is triggered for when I’m in fear of the unknown. Where did the virus start? Is it a conspiracy? What’s coming next? What does this mean for my family? I find that when I stop trying to answer every possible scenario, I feel much better. I’m learning to deal with life as it comes and live it as fully as I can. No fear and no regrets.

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