It was the best of times, it was the worst of times

Responding to Stress and Anxiety During COVID-19
Our response to anxiety-provoking situations and how to get out of survival mode

Cori McMahon, VP of Clinical Services, Tridiuum 

When faced with a situation that we think is dangerous — like the COVID-19 pandemic — our body’s natural reaction to the perceived threat is the fight-flight-freeze response. We might experience increased adrenaline and heart rate, and perhaps muscle tension and sweating. In addition to our body’s preparation to stay safe, we also experience psychological stress responses when we believe something is a threat to our well-being. We can feel anxiety, have difficulty making decisions, and find our attention shifting away from smaller tasks to larger concerns, like how we will make it through the stressful situation.

These two main components of anxiety (cognitive and physiological) play off of one another, creating a snowball effect where our thoughts increase our physiological reaction and our heightened physiological reaction results in increased “worry thoughts” focused on what we’re experiencing. For example, upon feeling an increased heart rate we may think, “Oh no, I’m getting anxious!”  That thought, in turn, will actually result in a greater increase in heart rate. Both the physical and psychological stress can shift us into survival mode. In survival mode, we may find ourselves doing things, or feeling the need to do things, we do not do under normal circumstances.

While anxiety is normal and can serve us well when protecting us in dangerous situations — like reacting quickly in traffic — an anxiety response in the face of COVID-19 can be counterproductive, impeding our ability to do our jobs well and having a negative impact on overall quality of life. Yes, the current environment brings with it some uncertainty and a sense of being out of control of our lives, so heightened emotions in general are to be expected. However, a fight, flight, or freeze response in the current environment is maladaptive. That is, it is not helpful, nor is it necessary. While COVID-19 is a very real concern and requires serious attention, it is different from immediate danger situations such as having a gun pointed in our face or standing on the edge of a cliff about to lose our balance. In those instances, immediate action, or reaction, is required for survival.

Over the past few weeks, I have both read about and personally witnessed how the anxiety response to the COVID-19 pandemic has brought out both the best and the worst in people. I have read harsh criticisms between neighbors on social media, seen video of people fighting over toilet paper in the grocery store aisle, and read national polls that tell us mental health issues are increasing as a result of our shelter-in-place orders and stress. However, I have also seen videos demonstrating peoples’ creativity and compassion — as they play music for one another from terraces, join social gatherings via zoom, and post handmade signs in hospital windows to encourage one another as they face another day on the front lines in health care work.

While we cannot completely extinguish our anxious response in the current environment, there are some things we can do to mitigate the severity of that response and to improve our ability to be more present for ourselves and our loved ones, to do our jobs, and to increase our overall quality of life. To move us away from survival mode, we can follow a few simple principles of acceptance and commitment therapy (ACT).

Using the acronym FACE, first, we can Focus on what IS in our control. I suggest pinpointing a practical physical activity you do consistently, like hand-washing or taking a walk. Second, we can Acknowledge our thoughts and feelings. It is important here to remember that we do not choose our emotions; that they come in reaction to events around us and the lifetime of experiences we have accumulated to date. Next, we benefit from Coming back into our body. When washing our hands or taking a walk, press your hands or fingertips together, slow your breathing, push your feet in to the ground, or stretch your arms or neck. Finally, we can truly Engage our senses while doing these activities. Look around and notice five things you can see, three or four things you can hear, something you can smell or taste, and even things you can feel like your clothing on your body, the temperature, or a breeze outside.

The intentional act of being mindful in moments like these allows us to be present and decreases the space and energy our mind has for anxiety. By slowing our breathing, we can actually trick our brain into thinking we’re calm. So that snowball effect that occurs in the anxiety cycle can actually work in a positive direction!  Slowing the breath leads to a decreased heart rate, which the brain can interpret with a thought more like, “Ah, okay, I am alright”, which in turn perpetuates the body’s calm response.

As we continue to navigate the uncharted waters of the COVID-19 pandemic, may we find small ways to be kind to ourselves as we appreciate that we are not having abnormal reactions to this situation but very normal reactions to a situation that is quite extraordinary.

 

Additional resources:

Trauma and the Freeze Response

Fight Flight Freeze: How to Recognize it and What to do When it Happens

FACE COVID Video – Russ Harris, PhD

FACE COVID Handout