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This has been reviewed and updated as of May 15, 2020.
If you’re feeling anxious and helpless about the coronavirus right now, join the club. Anxiety has been very common among our CreakyJoints and Global Healthy Living Foundation members throughout the coronavirus pandemic. Levels are starting to spike again now that many parts of America are beginning to ease restrictions and open back up. These feelings are completely normal, even if if seems like other people think you’re overreacting.
“If you live with a chronic illness and you’re on a medication that affects your immune system, of course you are going to have some anxiety,” says Katie Willard Virant, LCSW, a psychotherapist in St. Louis, Missouri who herself has Crohn’s disease.
Catching the virus, recognizing its symptoms, going to a crowded grocery store or park, taking medications that affect the immune system: These are just a few of the many concerns causing anxiety for our CreakyJoints members. “It’s awfully scary for someone that is immunocompromised,” wrote Michelle W. on Facebook.
‘Adaptive’ Anxiety: What It Means
The anxiety that you are experiencing is what’s called “adaptive” — which means it is a natural and healthy response to the coronavirus. “It means you’re appraising your risk,” says Kim Gorgens, PhD, clinical professor and director of continuing education at the Graduate School of Professional Psychology at the University of Denver.
“Fears about the coronavirus can serve as a reminder to be alert and aware of the ways in which to keep healthy when living with chronic health conditions or disabilities,” says Linda Mona, PhD, a licensed clinical psychologist with Inclusivity Clinical Consulting Services, whose research focuses on the diverse life experiences of individuals living with chronic health conditions/disability.
But if you let it spiral out of control, it can also harm your health. Uncontrolled anxiety can amplify pain, fatigue, and general malaise in patients with inflammatory arthritis and other types of chronic illness, according to Nilanjana Bose, MD, MBA, a rheumatologist at the Rheumatology Center of Houston in Pearland, Texas.
Luckily, there are ways to tamp it down. “Anxiety is like a fire alarm and we can’t really think with the fire alarm going off,” says Dr. Virant. “We’re not in imminent danger [with the coronavirus] right now — there’s no fire — so we want to find ways to turn that fire alarm down.”
We asked top psychologists and rheumatologists for strategies that chronic illness patients can use to ease anxiety about the coronavirus.
Control what you can (and let go of the rest)
“Sometimes anxiety is an attempt to control that which can’t be controlled,” explains Dr. Virant. You can lessen your anxiety by accepting the fact that you can’t always control your life or your body, but you can take back some control by doing what you can to take care of yourself.
For example, you can wear a protective cloth face mask in public, practice frequent hand-washing and other preventative measures, prioritize sleep, and stock up on at least two weeks of food, medications, and other essential supplies in your home.
“If you’re feeling anxious, check in with your doctor for reassurance,” adds Dr. Virant. “Ask: What are some things I should be doing?”
Have confidence in your self-care abilities
If you’re like CreakyJoints member Susan S., you’re likely already doing your best to stay healthy: “I got my flu shot, carry hand sanitizer, wash my hands often — and thoroughly. I don’t hold on the shopping cart with my bare hands,” she wrote on our Facebook page. “Will this be enough? I just know that I’m trying.”
Unlike many healthy individuals, many people with underlying health issues or who are immunocompromised know the proper steps they need to take to keep healthy and prevent infections such as viruses, says Laurie Ferguson, PhD, clinical psychologist and Vice President of Research and Education for the Global Healthy Living Foundation.
Remind yourself: “I’ve been practicing this. This is already how I live so I don’t have to be more frightened,” Dr. Ferguson says.
“Those of us on immunosuppressants are really good with washing our hands and not touching our face — it’s ingrained in us already,” agrees Dr. Virant. “We already have pretty good skills in terms of staying well.”
Mind your media consumption
While it’s certainly important to stay in the know, too much media consumption about coronavirus can harm your mental health, says Dr. Ferguson, who recommends checking the news no more than twice a day.
“You need to walk a line between staying informed and having an eye on global and community risk and information overload, where we’re just steeping in our own anxieties,” adds Dr. Gorgens.
Her solution: Pick two trustworthy sources and schedule a time each day to catch up on the latest coronavirus news — for example, for 15 minutes at 5 PM. Shut off alerts on your smartphone. “There’s no relationship between the amount of energy we invest in worrying about something and the ultimate outcome for it,” she adds.
A similar strategy should also be used for social media, which you should use to “backfill social support so you can feel tethered to your community and constantly reassured” — not to get inaccurate, hysterical, paranoid misinformation, notes Dr. Gorgens.
Ramp up your relaxation strategies
Anxiety can make your heart and mind race, but the first signs of anxiety are often felt in your muscles. Does your neck and shoulders feel tighter or more tense? “When we’re feeling anxious or threatened, we don’t just feel it in our minds, we also feel it in our bodies,” says Dr. Ferguson. Incorporating a few tried-and-true relaxation strategies into your day can help lower stress and anxiety in your body and automatically calm your mind.
Try this breathing exercise. Breath in slowly for a count of five, hold for a count of seven, breathe out slowly for a count of five, and repeat for four or five rounds. “As the body calms down, you’ll notice your mind calm down,” says Dr. Ferguson.
Take a walk — even if you only spend a few minutes in the fresh air and sunlight. “In a frightening time when we feel like there’s anxiety no matter which direction we turn, taking an extra 15 minutes at the beginning or end of the day, or pause in the middle of the day, helps our body to stay a little more balanced,” says Dr. Ferguson.
Read about three ways to create comfort in your daily routine.
Practice guided meditation. Meditation is another proven way to ease muscle tension and anxiety. Dr. Virant recommends finding a good mantra that is calming and authentic for you. Some she suggests:
- Breathe in and breathe out
- All will be well
- May I be safe
- Or come up with one that works for you
Focus on self-care. “Take time to exercise, engage in relaxation, watch a movie, or any other activity that brings you calmness and joy,” says Dr. Mona.
Don’t underestimate the power of sleep
“Sleep happens to be the first thing to go when people are anxious and ruminative about a current circumstance — and a lack of sleep also plays a big role in vulnerability to infection,” says Dr. Gorgens.
The coronavirus is like a canary in your mind right now — and it may be preventing you from shutting off your brain to fall asleep, waking you up in the middle of the night, and stopping you from sleeping in the morning, she notes.
Focusing on good sleep hygiene can help, including:
- Sticking to a regular, relaxing bedtime routine
- Keeping a consistent sleep/wake schedule (even on weekends)
- Keeping your bedroom dark and cool
- Avoiding large, heavy, high-fat meals as well as alcohol or caffeine close to bedtime
- Keeping electronics (TV, phone, tablet) out of your bedroom
- Using your bed for sleep and sex only
Read more here about managing painsomnia during the age of COVID-19.
Know when to seek help
We all get stuck in our own heads, so it’s important to talk to someone to express your fears and get reassurance, says Dr. Ferguson. This may mean calling your rheumatologist, a close friend or loved one, or joining a trusted online community.
It’s also important to recognize when anxiety and fear is becoming unhealthy and you need assistance from a mental health professional, peer counselor, or spiritual leader, says Dr. Mona.
- Your anxiety is interfering with daily life (work, school, engaging in social behaviors)
- You have trouble sleeping
- You are living too much in your head (not enjoying daily life, not able to focus)
- You find yourself running worst-case scenarios — I’ll get sick and then this will happen and that will happen — and you have difficulty stopping or distracting yourself
- You are obsessively paying attention to the media (you’re repeatedly refreshing your browser or constantly watching the news)
- You are isolating yourself (not just social distancing to avoid germ exposure, but avoiding even digital or phone contact with loved ones)
Line up the right resources
It’s important to talk to your primary care doctor, rheumatologist, or other main specialist about telehealth referrals for mental health as well as have some crisis numbers at the ready to help with your anxiety.
“If you’ve gotten yourself wound up — your heart is racing, your stomach is tied in a knot, and you can’t shake the feeling of intense panic — a crisis line can be a great, real-time tool to deescalate [your anxiety] and get you to a point where your feet are back on the ground,” says Dr. Gorgens. A telehealth service, on the other hand, can help you on a more regular basis; for example, a weekly session to discuss your anxiety or other issues.
Dr. Gorgens also recommends the online resource MindTrails, a free University of Virginia program that is designed to give people with anxiety new tools or mind tricks to feel less anxious.
A few crisis lines to consider:
- Crisis Chat: 1-800-273-TALK (8255) or text MHA to 741741
- Crisis Text Line: Text HOME to 741741 for free, confidential crisis counseling 24/7
- IMAlive: online chat service at imalive.org
- National Alliance on Mental Illness (NAMI): 1-800-950-NAMI (6264)
Prepare a script for yourself
The spread of coronavirus will likely mean you’ll need to have some hard conversations with others about respecting your health boundaries. This can be anxiety-provoking for some. Whether you need to turn down a friend’s invitation to go to a park you worry will be too crowded or discuss telecommuting with your manager even as other employees come back in person, having a prepared script can help. Chances are, they’ll be sympathetic to your concerns.
Pat yourself on the back
This is a particularly stressful period and it’s helpful to remind yourself what you’re doing right instead of dwelling on those things you can’t control about the coronavirus. “Give yourself a pat on the back for trying to figure out how to deal with the anxiety,” says Dr. Ferguson, “and whenever you can, take a deep breath so you don’t get caught in a whirlpool mental spiral.”
Check out these mental health resources from clinical psychologist Laurie Ferguson, PhD.
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Interview with Katie Willard Virant, LCSW, a psychotherapist in St. Louis, Missouri
Interview with Kim Gorgens, PhD, clinical professor and director of continuing education at the Graduate School of Professional Psychology at the University of Denver
Interview with Laurie Ferguson, PhD, clinical psychologist and Vice President of Research and Education for the Global Healthy Living Foundation
Interview with Linda Mona, PhD, a licensed clinical psychologist with Inclusivity Clinical Consulting Services
Interview with Nilanjana Bose, MD, MBA, a rheumatologist at the Rheumatology Center of Houston in Pearland, Texas