Managing Anxiety During a Pandemic

I've been seeing some (understandably) heightened anxiety due to COVID-19, so I wanted to share some strategies for managing anxiety. The following are pretty widely known but useful: 

• distraction (especially with pleasurable activities)

• reduce exposure to anxiety-provoking media

• increase physical exercise

• get enough sleep

• breathing exercises to promote relaxation

• reduce caffeine consumption

• meditate (guided or not)

These next few may be less familiar to you:

1. Cognitive distancing/defusion. This strategy involves working to notice that your thoughts aren't necessarily true, that your thinking is a process that you can observe. Try stating ideas in terms of being a thought. For example, consider a worrying thought such as, "We're going to run out of money." This might seem fully realistic or true, but we've all had thoughts like that seem realistic during a fearful moment only to later realize we were overreacting. By saying, "I'm having the thought that we're going to run out of money," you are taking a step back and inviting an awareness that the thought is not a direct experience of reality. There's a lot more to distancing and defusion, but maybe this example can at least illustrate the concept.

2. Progressive muscle relaxation (PMR). You've probably noticed that anxiety is accompanied by muscle tension -- often most apparent in your neck, shoulders, or jaw. This muscle tension is often brought on by anxiety, but the tense muscles then contribute to sustaining the anxiety -- the mind and body are reminding and encouraging each other to be prepared for a potential threat. Accordingly, intentionally engaging in a systematic process of relaxing those tense muscles engages what's been called the 'relaxation response' -- the body signaling to the brain that there's no need to be on high alert. Here's a video put out by one of the groups at Emory University that does a good job introducing the concept and then providing guidance for how to do PMR. https://www.youtube.com/watch?v=oV_ebOzX8OA

3. Mindful acceptance of the physical sensations of anxiety. Negatively judging the experience of anxiety is common but unfortunately, the more strongly a person dislikes feeling anxious, the more likely they are to fall into a feedback loop that just makes it worse. What happens is that the discomfort or dislike of anxiety is so strong that it becomes a trigger for even more anxiety ("I hate this feeling" or "I'll never sleep if I feel this way" or "I'm going crazy"). This kind of negative judgement of the feeling as something that needs to be avoided or stopped ends up backfiring and resulting in significantly increased anxiety instead. As an alternative, it can help to shift toward a nonjudgmental and present-focused awareness of the sensations, noticing the sensations involved with the emotion in objective terms (e.g. "I feel tightness in my chest, my heart is going quickly") instead of judgmental terms (e.g. "I'm freaking out, I hate this..." etc.). For some people, this idea works intuitively after just a little experimentation with it, but most people have to do at least some work to learn to think this way.

FINAL THOUGHTS: If you're finding yourself really struggling with anxiety, you should consider seeking professional help. I'm sharing these ideas because I've been seeing some friends expressing normal levels of anxiety as we all weather this pandemic. But, if you are someone having what might be considered an excessively anxious response or if your anxiety is impairing your ability to function, then I'd encourage you to consider getting help other than just self-help. Many therapists are offering options for online counseling, and I've seen that some of them are doing so at a discounted rate right now because of the current situation.

The Unique Persistence of Pain at the Holidays

If you have ever experienced an important loss or a mental health issue during this time of year, you may have noticed that every successive holiday season can feel like a small version of living it over again. No matter how well things are going through Thanksgiving, once the calendar turns to December, feelings of dread, sadness, or isolation return. Why do the holidays do such a good job of hanging on to our pain? In this post, I offer some answers to that question in hopes that it well help you make sense of that pattern, find reasons for hope, and take away some suggestions for more complete recovery from your pain. If you have not experienced this yourself, reading this will help you better recognize and offer support for friends and loved ones who may be struggling this season.

1. associations with Christmas Music

The first reason why holiday pain is so stubborn is that there's Christmas music everywhere this time of year — and no, I’m not making a joke about cheesy songs. Music is powerful for influencing thoughts, feelings, and behavior, and songs can take on new meaning when something important happens around them. Music has the power to soak up sentiment and produce it on command, which is why it is used to sell, to inspire, to comfort, and to excite. So when you experience great pain at the holidays while hearing the same few dozen songs, those songs soak it up. And because those songs are almost never heard outside of this season, they don’t get a chance to lose that association with the hard time. In short, Christmas music becomes a mixtape for your time of suffering, and it’s being played everywhere for a month each year.

2. Shorter Days, More Darkness

For those of us in the northern hemisphere, this is the time of year that the days are shortest and we spend the most time in darkness. That lack of sunlight is a primary cause of problems for some people, and even for those who had a different issue initially, the lack of sunlight can make things worse.

3. Routines are Disrupted

Routines are an important part of how we take care of ourselves and function well, and this time of year, a lot of that goes out the window. School wraps up for the year. People travel. Friends you usually see become busy with family obligations. Did I mention it gets dark earlier? The structure and small pleasures that help you along most of the year become sporadic or entirely absent.

Then on top of losing what you are used to doing, there are additional demands on the time that you usually use for rest. Weekends become filled with events — family parties, office gatherings, shopping, and traveling. Not to mention that many parents lose most of a night of sleep between December 24th and 25th. Altogether, these disruptions to routine cause stress, and sometimes, that extra stress tips the scales from ‘okay’ to ‘struggling.’ (And this goes double for people especially sensitive to these changes such as those with various neurological differences.)

4. We’re Supposed to Be Happy; Others Seem Happy

For a variety of reasons (religious, cultural, and commercial), this season tends to be framed as a time to be joyful and happy, so it can be very isolating to feel miserable while all of that is going on around you. In addition to seeing genuinely happy people all over the place (most people do enjoy this season and the festivities), the incessant messaging about being happy can hammer home feelings of shame and thoughts of defectiveness: ‘Why can’t I just be happy like other people?’ Or social like other people. Or outgoing. Or whatever you beat yourself up for.

5. The Holidays are Stressful for everyone

Finally, there are all the reasons that the holidays are normally stressful even without having had tragedy or personal crisis in a previous year. Seeing family can be complicated. Choosing and buying gifts can be significant work. The season can be expensive between gifts and travel, and while some people get bonuses, many of us earn less over the holidays as business activities slow down.

If Not Joy, Maybe Hope

If you've had this experience, I understand how hard it can be, because I went through a version of this myself for years. I want you to know that, eventually, it does get better, even if you just wait it out. However, if you can return to relatively more normal Decembers sooner rather than later, that would be my hope for you, especially if you never received help around the original painful issue. There are many steps one can take that can be the beginning of positive change, but one of the strongest moves against this kind of pattern is engaging in therapy.

I recognize that finding a therapist can be hard, so I recently wrote about finding the right therapist.

For those of you in the Atlanta area, I would be glad to hear from you if you are thinking about therapy or even if you just found this post helpful. I can be contacted through my website, by email, or by phone (470-571-0088) and typically respond promptly.

Wherever you are and whatever your plan for the next few weeks, if you are in this situation, I hope you are at least able to offer yourself self-compassion and some leeway from the guilty thoughts that you are somehow wrong for not being happy. Hang on to hope where you can find it, and remember that this month will pass soon.

How to Find the Right Therapist for You

Any minute now…

Finding a therapist can be daunting. It feels important to find the right person, but because therapy is a private matter and therapists are bound by confidentiality, you won’t find the same kind of reviews and testimonials as you find with restaurants or movies. So how do you find a therapist that is right for you? I’ll offer the advice that has been shared with me by more than one professional and which has worked well for many I’ve assisted with the process.

The first step is to identify what is important to you as you look for someone. For some people, it’s most important to be close to home. Others care more about finding someone with a specific expertise or a strong reputation. Many people will have some preferences about the therapist’s personal characteristics such as ethnicity or gender identity. Personally, I tend to value expertise and overall competence highly. You’ll also want to consider your budget and whether you’ll use your insurance.

With a sense of your priorities, you can begin putting together a list of a few therapists who seem like they could be a good fit. If you are comfortable, you can ask people you trust for recommendations. Maybe a close friend, your doctor, or someone you know who works in the field. Another option is to use internet resources (e.g. search engines, Psychology Today’s therapist finder, GoodTherapy, social media, etc.). Your employer or school may also offer counseling services to consider. You’ll search and browse through these resources with terms that match your priority — ‘low cost therapy’ or ‘therapists near Kirkwood’ or ‘Korean-speaking therapists’ and so on. As you browse through your options, take a look at websites and profiles and see which stand out. By using your resources and reading through what therapists have to say about themselves, you can generate a short list of some people who at least seem promising. (If you’ve struggled to find anyone promising at this stage, you may need to go back to the first step and tweak some parameters, widen the search geographically, or adjust your budget.)

Next, it is time to reach out to the candidate therapists. Phone is usually the best way both for privacy reasons and so you can get a sense of the therapist’s personality. Many therapists offer free phone consultations of 10 minutes or so. You can also use contact forms on therapists’ websites or email the therapists (though email is not a secure method of communication). Be prepared not to hear back from some of the therapists, unfortunately. It is not personal, but some therapists are just not great at returning all calls, especially therapists who are full.

When you do talk to the therapist, feel free to ask them questions. Whatever you are curious about, you probably aren’t the first person. A question I’d recommend is to ask how often they have worked with people like you who were dealing with your issue. If you get a good enough vibe from your interaction, you can schedule a first appointment and get underway. Otherwise, you may want to shop around a bit more.

Once you meet with the therapist for an initial session, you may get an impression in the first meeting about the fit or the lack of fit. However, it is not uncommon for things to take a few meetings to gel. A good therapist will be open to discussing fit and potential issues – even better, many of us will actively invite that conversation. If after a few sessions, things are clicking well and they satisfy your priority criteria, you have found someone that may be right for you.

But there’s one more step! Keep evaluating the therapy process and the relationship with your therapist as you work together. Discuss it with them as you go. If over time you are not making adequate progress toward the goals you had for going to therapy, then it may be time to consider if someone else would be a better fit. Again, a good therapist is more than okay with having that conversation and will even help with providing referrals.

Finally, even if you have found your perfect therapist, your needs will naturally evolve over time along with your goals and your circumstances. Your therapist may still be right for you, or you may decide to change things up. That’s when you go back to the start!

If you’ve read this because you are in the process of trying to find a therapist, you may want to take a look around my site to see if I am a potential fit. If you like what you see there, I would invite you to contact me to discuss further. Even if I turn out not to be the right fit for you, I can probably refer you to some other good options to consider.

(Disagree with any of this? Something to add? Share your thoughts below or drop me a note. I may add or edit your thoughts in if it will make for a more accurate or useful post.)