In Focus

How to Manage Your Mental Health during the COVID-19 Outbreak

Do you know what it feels like?”
“What, like it’s Godzilla, King Kong, alien attack: all in one!”
“Kind of... feels like our world is never going to be the same…”
This exchange from Steven Soderbergh’s sci-fi movie Contagion (2011) sounds uncannily real now in a world gripped by the novel Coronavirus disease (COVID-19). The movie depicts the breaking down of government and the public health systems in the face of a new and deadly pandemic, while the U.S. Centre for Disease Control (CDC) struggles to find a cure.



Coronavirus has plunged the world into uncertainty and the constant news about the pandemic can feel relentless. All of this is taking its toll on people's mental health, particularly those already living with conditions like anxiety and OCD (Obsessive-compulsive disorder). So how can we protect our mental health? 
COVID-19 is a respiratory illness caused by a new virus. Symptoms include fever, coughing, sore throat and shortness of breath. The virus can spread from person to person, but good hygiene can prevent infection. Follow hygiene advice such as washing your hands more often than usual, for 20 seconds with soap and hot water (sing ‘happy birthday’ to yourself twice to make sure you do this for 20 seconds). You should do this whenever you get home or into work, blow your nose, sneeze or cough, eat or handle food. If you can’t wash your hands straightaway, use hand sanitiser and then wash them at the next opportunity. To prevent the spread of viruses, practise good hygiene and social distancing. As Coronavirus continues to spread in the world, governments have implemented further “social distancing” measures and asked for all non-essential travel to be avoided.


It would be important to establish structure, predictability and a sense of purpose with these new routines. To keep your psychological wellbeing, schedule self-care each day. Whether you need to change already established exercise, eating and socializing habits, or whether you are using this time to launch a healthy-living routine, the new routines will give you mental strength.


Along with the biological effects of this illness, it is triggering fear, anxiety, anger and feelings of frustration for not being in control of one’s health and safety. We need to be aware of these undercurrents and be thoughtful about how we present and enforce guidelines and rules for interaction. The fear of being out of control and unable to tolerate uncertainty are common characteristics of many anxiety disorders. Hence it is understandable that many individuals with pre-existing anxiety are facing challenges at the moment. Being concerned about the news is understandable, but for many people it can make the existing mental health problems worse.
While physically necessary, labelling a prevention measure “social distancing” in a society already suffering isolation, is troublesome. Loneliness is a by-product of isolation. Add to that feelings of prejudice or blame experienced in some communities during this health crisis, and certainly economic hardship.  Of course, we must employ sound disease prevention practices. We also need to be mindful of the undesired side effects and work to mitigate them.
The government is now advising us to avoid all but essential social contact. This will mean that more of us will be spending a lot of time at home and many of our regular social activities will no longer be available to us. It will help to try and see it as a different period of time in your life, and not necessarily a bad one, even if you didn’t choose it.
In other countries, like Italy and Spain, people are already confined to their homes in nationwide lockdowns, with police using drones to chastise people seen going outside. Isolated, lonely people are more prone to depression, and depression shortens lives. Social isolation is one of the main risk factors associated with suicidal outcomes. Young people and the elderly are particularly at risk. We have also long known that there is a physiological link between mental wellbeing and physical health, and vice versa. Finally, depressed people suffer suppressed immune systems.  Just what we do not want during a viral pandemic.
What is needed right now is physical separateness, but what is also needed in a time of such stress is emotional and mental connectedness. We should encourage communities of all kinds – geographic, religious, hobby clubs, and school related groups – to set up regular forms of non-physical interaction.  Check in on each other via social media or through a phone call.  Our political leaders need to rally us to do what needs to be done as a team, even if not in close proximity.
So, what should you do if your mental health is suffering during self-isolation? Are there ways to ensure you safeguard your emotional and mental wellbeing during a potentially extended period of being alone? A long period of isolation may well be a necessary measure for public health, but it has been acknowledged that it could also have a detrimental impact on people’s mental health. Our physical and mental health are linked so try to create a routine that includes some physical exercise.
The World Health Organization also recommends maintaining your social network during self-isolation: Even when isolated, try as much as possible to keep your personal daily routines or create new routines. If health authorities have recommended limiting your physical social contact to contain the outbreak, you can stay connected via e-mail, social media, video conference and telephone.
As far as possible, try to maintain as much of a routine as you can. Wake up and go to bed at healthy times to ensure you get enough sleep. Do not get drawn into a negative spiral. The most dangerous things for your mental health are having too much time to think about your life critically. When self-isolating, one can get a lot of time to think and it is very common to experience massive life dissatisfaction as a result. You can start off the process feeling calm and not germophobic but gradually you start to morph into this. You get into a constant flow of critiquing your life and yourself, and you really need to avoid those negative cognitive spirals.


As far as possible, try to maintain as much of a routine as you can. Wake up and go to bed at healthy times to ensure you get enough sleep. Do not get drawn into a negative spiral. The most dangerous things for your mental health are having too much time to think about your life critically. When self-isolating, one can get a lot of time to think and it is very common to experience massive life dissatisfaction as a result. You can start off the process feeling calm and not germophobic but gradually you start to morph into this. You get into a constant flow of critiquing your life and yourself, and you really need to avoid those negative cognitive spirals.


One better way of keeping calm and maintaining the mental health is to try and see it as a different period of time in your life, and not necessarily a bad one, even if you did not choose it. It will mean a different rhythm of life, a chance to be in touch with others in different ways than usual.
It is okay to feel vulnerable and overwhelmed as we read news about the outbreak, especially if you have experienced trauma or a mental health problem in the past, or if you have a long-term physical health condition that makes you more vulnerable to the effects of the Coronavirus.
As the news about the Coronavirus pandemic become grimmer, and governments and businesses issue closing or work-from-home directives, many of us are experiencing a variety of negative emotions. We feel anxiety in response to the uncertainty of the situation; sadness related to losing our daily sources of meaning and joy; and anger at whatever forces are to blame for bringing this upon us. As a psychiatrist, I believe following evidence-based recommendations for bolstering mental resilience can help us weather this crisis.
It is normal to be unsettled and concerned about the upending of life as we know it. Humans find comfort and safety in the predictability of the routines of daily living. As our lives have dramatically changed overnight, many are struggling with finding ways to deal with the new reality.
Nobody knows how long the pandemic will last or how long it will be until we can resume our regular lives. Even worse, many people are worried that they may be laid off and lose their livelihoods. The pervasive uncertainty of the situation makes it hard to plan a course of action and creates a high level of stress. To add insult to injury, our typical ways of de-stressing, such as working out in a gym, watching sports, meeting with co-workers or hanging out with groups of friends, have largely come to a halt.
How can we respond to the Coronavirus situation in a way that will preserve our psychological well-being? The following science-based approaches can help.
It is important to acknowledge that a lot of anxious thoughts and emotions will show up during this time, and to accept them rather than trying to push them away or escape them. The same goes for sadness stemming from the loss of our regular ways of living, worry about lack of supplies or apprehension about kids getting cabin fever. That is because avoidance of such emotions will only make them stronger and longer-lasting. Notice negative emotions, thoughts and physical sensations as they come up, look into them with curiosity, describe them without judgment and then let them go. This is an essence of mindfulness, which has been consistently linked to good psychological health.
Although many people escape from reality through Netflix, binging on fast food, indulging in marathon Hum TV viewing, be mindful of over-relying on these distraction strategies. Instead, planning and executing new routines that connect you to what really matters in life is the best recipe for good mental health. It would be important to establish structure, predictability and a sense of purpose with these new routines. To keep your psychological wellbeing, schedule self-care each day. Whether you need to change already established exercise, eating and socializing habits, or whether you are using this time to launch a healthy-living routine, the new routines will give you mental strength.
One thing that is still available to us, unless we experience complete lockdown, is nature. Spending time in nature, whether you are hiking or gardening, positively affects psychological health. It might help to realize that these trying times offer several avenues for psychological growth. Even during social distancing, there is an opportunity to deepen our relationships with the people in our household and beyond. Leverage audio and video technology to stay in touch with others. As the usual hectic tempo of our busy lives recedes, taking time to savour heart-to-heart conversations with family members or friends will probably result in stronger social connectedness going forward.
So how can we protect our mental health? With weeks and months of the Coronavirus pandemic ahead, it is important to have down time. Psychiatrists recommends practising the "Apple" technique to deal with anxiety and worries. 

  •    Acknowledge: Notice and acknowledge the uncertainty as it comes to mind.
  •    Pause: Don't react as you normally do. Don't react at all. Pause and breathe.
  •    Pull back: Tell yourself this is just the worry talking, and this apparent need for certainty is not helpful and not necessary. It is only a thought or feeling. Don't believe everything you think. 
  •    Let go: Let go of the thought or feeling. It will pass. You don't have to respond to them. You might imagine them floating away in a bubble or cloud.
  •    Explore: Explore the present moment, because right now, in this moment, all is well. Notice your breathing and the sensations of your breathing. Notice the ground beneath you. Look around and notice what you see, what you hear, what you can touch, what you can smell right now. Then shift your focus of attention to something else – on what you need to do, on what you were doing before you noticed the worry or do something else – mindfully with your full attention.

This crisis also offers an unexpected chance to check in with yourself. I think that this is an opportunity for slowing down and reflecting on life. What brings you meaning when the noise of modern life quiets down? Have your priorities reflected what truly matters to you? As the usual pursuits of status and money are put on hold, where do you find your life purpose and transcendence?
Finally, keep in mind that experiencing stress and negative emotions can have positive consequences. People who go through very difficult life experiences can emerge from it with a stronger sense of psychological resilience, rekindled relationships and a renewed appreciation of life. Some describe starting to live more fully and purposefully. With care and planning, we, too, can stay psychologically strong during the pandemic and perhaps even grow from this transformative experience.


The writer is a professor, Fellow of the Royal College of Psychiatrists London, Fellow and Diplomate of the American Board of Psychotherapists, and Certified Counterintelligence Threat Analyst. He is currently a consultant forensic psychiatrist in the UK and Shifa International Hospital Islamabad.
E-mail: [email protected]

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