Managing Mental HealthDuring COVID-19

Prepared for the NYC Family Resource CentersLearning Collaborative

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Today• What are we going through, really?• Collective trauma: We’re all in this together• Grief and loss during COVID-19• Anxiety, stress and panic• What’s in our control and why it matters?• Coping strategies to get through• Finding support

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What’s really going on?

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Right now• Information overload• Information changes every day• Politically charged• Scarce resources• Unsure/afraid of the future• Massive change in routine, who we see, how we connect• Having to work in new ways and in new environments• Loss of work• Isolation, social distancing

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Collective Trauma

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What is trauma?

Trauma is the response to a deeply distressing or disturbing event that overwhelms an individual’s ability to

cope, causes feelings of helplessness, diminishes their sense of self and their ability to feel the full range of

emotions and experiences.

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What is collective traumaA collective trauma is a traumatic psychological effect shared by a group of people of any size, up to and including an entire society.

Traumatic events witnessed by an entire society can stir up collective sentiment, often resulting in a shift in society's culture,

mass action and how we experience stress as a community

A survey of people subject to quarantine during the SARS outbreak in 2003 found that nearly 29% experienced traumatic stress.

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Examples of collective trauma• World War II• Flu of 1918 pandemic• The Atomic bombings of Hiroshima and Nagasaki• The attack on Pearl Harbor• Columbine• SARS epidemic• Los Vegas shootings• Countries that had suffered extreme political oppression• Countries in generational wars• September 11, 2001 attacks in the United States• Halabja chemical attack killed 5,000 Kurdish people• And… many others throughout history

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How does trauma impact us?• Increased uncertainty and fear of the future• More likely to be operating from the survival areas of our brain• Our thinking becomes much more black-and-white• Difficulty planning or thinking ahead• Rumination – flashback memories• Difficulty regulating our emotions, and we become less able to make

decisions• Constant, unrelenting fear of our safety and a loss of power and control.

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Anxiety, stress and panic

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What is stress?• Normal reaction the mind has when changes occur• Your body reacts to these changes with physical, mental, and

emotional responses• You can experience stress from your environment, your body, and

your thoughts, external stimuli like the pandemic.• Positive life changes such as a promotion, marriage, buying a

home, or the birth of a child produce stress

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Stress triggers through the COVID-19 lens• Fear and worry about your own health and the health of your loved ones• Changes in how we get exercise and how we use our bodies every day• Changes in how we eat and choice of foods• Changes the way in which we work• Loss or fear of employment• Difficulty sleeping or concentrating• Worsening of chronic health problems, stress impacts our immune system• Increased use of alcohol, tobacco, or other drugs• Triggering existing mental health conditions• Developing new mental health concerns• Fear of death

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Anxiety• Anxiety is your body's natural response to stress. • The manifestation of fear or apprehension about what's to come.

• A survey of Chinese citizens published in February found that 42.6% of respondents experienced high degree of anxiety as a result of stress related to the coronavirus outbreak• Anxiety related to the coronavirus is to be expected.

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Common thoughts that provoke anxiety• You or someone in your family will get sick • Your investments, such as retirement or college savings, will be

negatively impacted • You will lose income due to a workplace closure or reduced hours • You can’t find COVID-19 testing• You will put yourself at risk of exposure to the virus • Isolating creates loneliness which creates stress and axiety

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Panic attacks• A study in Arch Gen Psychiatry indicated that one in four

Americans will have at least one panic attack at some point in their lives• There’s an significant increased level of stress due to all current

uncertainty which cause increased panic• Panic attacks come on suddenly and typically last only 15 to 20

minutes• Some symptoms of panic are similar to symptoms of Coronavirus

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What anxiety and panic attacks feels like

Shaky Man is taken from the book by Bev Aisbett (1993) “Living with IT: A Survivor’s Guide to Panic Attacks”

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5-4-3-2-1 Grounding Technique• Acknowledge FIVE things you see around you. Maybe it is a bird, maybe

it is pencil, maybe it is a spot on the ceiling• Acknowledge FOUR things you can touch around you. Maybe this is your

hair, hands, ground, grass, pillow, etc.• Acknowledge THREE things you hear. This needs to be external, do not

focus on your thoughts• Acknowledge TWO things you can smell. if you cannot automatically

sniff something, walk nearby to find a scent.• Acknowledge ONE thing you can taste. What does the inside of your

mouth taste like, gum, coffee, or the sandwich from lunch?

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Grief and loss during COVID-19: Based on the 5 Stages of Grief – Elizabeth Kubler-Ross

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Loss can trigger grief during COVID-19• Loss of intimacy• Loss of potential physical safety• Knowledge that loved ones are safe• Social distancing, quarantine, and feelings of isolation lead to loneliness• Changes in daily habits and routines• Special plans and events that have been canceled• Loss of income through retirement accents and other investments• Sadness over how the pandemic will affect the world – vicarious grief• Loss of trust in the system or leadership• Fears for the future

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The Importance of Control

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Locus of positive control• How we think about and react to our health and safety and personal

assessment and level of risk• Studies find strong locus of control positively correlates with improved

physical and mental health and quality of life, especially during times like these• Makes us more likely to make wise choices such as maintaining safe

social distancing, wearing a face mask, or frequent handwashing• Strongly sense of control will enhance emotional resilience in the face

of COVID-19• Lessen the intensity of our anxiety and despair by changing our internal

narratives

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Improve your sense of control and ability to endure• Accept circumstances that cannot be changed and focus on what

you can alter• Modify your definition of a "good day" to meet the current reality

of the situation• Problem-solve and set achievable goals within the new

circumstances in your life• Evaluate the absolute risk of contracting the virus • Recognize the benefits of accepting a certain level of risk in order

to maintain as much of your normal routine as possible

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Coping during COVID-19

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We all know this part…• Wash your hands regularly for 20 seconds, with soap and water or

alcohol-based hand rub• Cover your nose and mouth with a disposable tissue or flexed elbow

when you cough or sneeze• Avoid close contact (2 meters or 6 feet) with people you are not

isolated with• Stay home and self-isolate from others in the household if you feel

unwell• Wear a mask when you can’t practice 6-foot physical distancing

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If you have kids at home• Remain calm, especially when around your kids• Lay a foundation for open communication• Be honest and accurate• Be reassuring• Create a safety plan which will be of comfort• Avoid blame and look outh for stigma• Stick to routines• Be developmentally appropriate

Source: Centers for Disease Control, Child Mind Institute, Unicef

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Take care of your mind

• Develop and keep your regular routine as much as possible• Identify that which you have control over• Take breaks from watching, reading, or listening to news stories,

including social media• Manage fear of the future by staying in the present• Know your triggers and red flags

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Take care of your mind• Be compassionate with yourself and others• Combat unhelpful emotions by staying busy—both mentally and

physically• Shift negative self-statements to statements to more optimistic

ones• "this is a terrible time" to "this is a terrible time, but I can get

through this.”• Practice meditation and mindfulness activates that bring you joy

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Take care of your mind - “Chunking”• Bite sized pieces of information and experience• We naturally segment large amounts of information• We naturally chunk info like phone numbers• Without chunking, we get overwhelmed and our brains tend to

shut down• Focusing attention on that is right in front of us• “One day at a time”

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Chunk your worries• Break tasks into doable amounts, which increases the likelihood

of positive outcomes• Focus on whatever bite-sized piece of a challenge that feels

manageable• Set a time stamp for how far ahead in the future you will let

yourself worry• “I can’t see myself doing this for another three months, but I can

do it today and this week”

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Chunk your work• Set limits on your schedule to avoid overwork and/or

procrastination• Maintain your old work routine including lunch and breaks• Segment the morning from afternoon from evening• Set deadlines for productivity• If you’re finding your workload is overwhelming or untenable as a

result of COVID-19, or working from home, reach out to your supervsior for guidance

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Take care of your body• Prioritize sleep, watch for sleeping too much or sleeping too little• Participate in regular physical activity• Watch your alcohol consumption. It’s easy to drink more while at

home• Limit screen time, especially at night• Relax and recharge• Practice “box breathing” – breath in for 4 seconds, hold for 4

seconds, exhale for 4 seconds

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Connect with others• Reignite old connections• Do something for others• Support a family member or friend, especially those who are older

or have other risks• Zoom or Houseparty• Use the old-fashioned telephone

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Reach out for help• Use social media to contact a close friend or loved one — even

though it may be hard to talk about your feelings• If this resonates with you, reach out to a minister, spiritual leader

or someone in your faith community• Call your primary care provider or mental health professional to

talk about your anxiety or depression and get advice and guidance• Contact organizations such as the National Alliance on Mental

Illness (NAMI-NYC) for support and resources

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When might you need more professional help?• Having trouble functioning at home or work for two weeks• Suffering from severe fear, anxiety, or depression• Unable to maintain close, satisfying relationships• Experiencing terrifying memories, nightmares, or flashbacks• Avoiding more and more anything that reminds you of the trauma• Emotionally numb and disconnected from others• Using alcohol or drugs to numb your feelings (self medicating)• Feeling profound grief over a loss due to COVID-19

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Thank You!Jessica Feldman

Director of Programs and ServicesNational Alliance on Mental Illness – New York City Metro

505 8th Avenue, Suite 1103New York, NY 10018

Phone: 212-684-3365 ext. 206Email: jfeldman@naminyc.orgHelpline: 212-684-3264