Coronavirus is rapidly becoming a greater source of anxiety and distress for many across the globe. A lot of people may be wondering if their anxiety or distress is normal or warranted for this situation. In this blog, I’d like to dive into the different kinds of anxiety, and then tie it back to this outbreak. If you are reading this a while into the future after this virus clears, there’s still useful information in here for you! If you want to only read the advice on how to deal with Coronavirus related anxiety, skip to the bottom of this blog!
Video: Anxiety: What You Should Know [Especially During Coronavirus Outbreak]
Image: Screenshot from video
MedCircle is a great youtube channel with a lot of different videos on various aspects of mental health. I highly recommend checking out this channel if you are interested on learning more about mental health! In the video I am focusing on today, Dr. Ramani Durvasula dives into the differences between healthy anxiety, and disordered (unhealthy) anxiety. If you have anxiety, this may help you begin to see if your anxiety is normal or not, but I recommend speaking with a mental health professional directly in order to discuss your specific symptoms.
Some people are surprised to find out that there is such thing as healthy anxiety. Think of anxiety as an alarm system, a signal to either get needs met or increase safety and avoid danger. Dr. Ramani says, “Normal anxiety is appropriate to the situation, it’s worry, it’s a response to uncertainty… it motivates us… anxiety can actually enhance performance to a degree… it leads us to mobilize resources.” Anxiety helps motivate us to get through tasks such studying for exams, geting our work done, getting food or other supplies we need, or can even force us to pay closer attention on how we are acting in high pressure social situations like a job interview. “When the thing we are worried about passes, that we let it go, that’s normal anxiety… in the modern world we are all going to have a little bit.” In normal anxiety, the anxiety shows up when it is needed, and goes away. This is a necessary feature of our psychology in order to survive physically and socially. As Dr. Ramani explains, “To live with no anxiety, that would be a little bit problematic because anxiety creates a check and a balance system, it makes us aware.” Some anxiety is a normal response to a stressful situation, and as Dr. Ramani states, “We don’t want to medicalize and diagnose and sort of label normal responses to difficult situations, because that’s when people start second guessing themselves and saying, well maybe I’m broken because I’m anxious, and I’m like “You better be anxious, you are going through a lot and that’s a very appropriate reaction.”… a person has a right to any emotion they are feeling.” In other words, it’s very possible that if you experience anxiety (even anxiety that is definitely not your most comfortable or fun emotion), it doesn’t necessarily mean you have a disorder. Having anxiety is a basic human function that serves a purpose!
Now let’s talk unhealthy anxiety, or disordered anxiety. If you consider the analogy of anxiety as an alarm system, unhealthy anxiety is when that alarm goes off more than it’s supposed to. If that alarm continues to go off more than it is designed to, it puts a lot of wear and tear on the mind and body, as anxiety is caused by a release of stress neurotransmitters (chemical messengers in your brain and body) that can be damaging to the body and brain if released too much. As Dr. Ramani explains, Your anxiety becomes unhealthy when it causes subjective distress or impairment in your life. Here’s an example of the difference: Healthy anxiety will motivate you to study for an exam to get you to prepare, with a thought like “If I don’t study I won’t do well, but if I study I’ll be fine.” Maybe there’s a little bit of anticipatory anxiety in there, thinking about the stressful event that’s about to happen, but during the test you can at least somewhat relax into it and get through it. Unhealthy anxiety on the other hand, could present as a level of alarm that is so intense that it makes you draw a blank during the test, and maybe you can’t remember anything you studied. Or maybe you are spiraling and panicking, and can’t focus on the material in front of you. You might be so worried about the consequences of doing poorly that you can’t be present with the material.
So what are the different kinds of anxiety disorders? There are several that depend on how long the person has had the symptoms, intensity of the symptoms, and potential causes of the symptoms. There are a lot of symptoms of anxiety that can present themselves in different combinations, making for a lot of potential diagnoses. As Dr. Ramani explains, “These disorders are all characterized by anxiety being the key element of the disorder. The Phobias have a specific form of avoidance… people with Panic Disorder have a very strong physiological experience, and then finally Generalized Anxiety Disorder is sort of a wide ranging, wide reaching anxiety about a variety of issues (for at least 6 months).” There is also an anxiety disorder called Agoraphobia, which is “fear of being in places from which escape would be difficult, help would be difficult to get, and there’s the possibility that they could embarrass themselves… Agoraphobia almost 90% of time co-occurs with panic disorder… [this combination] can often occur when someone has a significant stress or loss in their life.” (Note: co-occur means to meet criteria for both diagnoses at the same time.) A common thread through the anxiety disorders, is a lot of self awareness that the anxiety is too much and may not be serving the person with anxiety. “That’s where anxiety disorders can be rather paralyzing, because the person feels like they can’t let it go, they can’t stop worrying, it’s a very helpless feeling… it just sort of spirals.” Learning to rewire that alarm system from having overactivity to healthy activity levels can be very challenging. There are a bunch of different kinds of therapeutic approaches to treating anxiety that depend on exactly what kind of anxiety disorder needs to be treated.
Because of some complicated neuroscience, the the chemical makeup of the anxious brain has some overlap with other kinds of disorders. Dr. Ramani specifically mentions anxiety’s connection to depression: “Most commonly you will see anxiety disorders co-occur with a mood disorder, so anxiety and depression together is a very common combination. There are theorists out there who think that the division between anxiety and depression is somewhat artificial, that it’s similar processes in the brain, and that in some way it is just a manifestation difference, where one person may become very sad, another person may become very worried… we’ll often see these two hanging out together.” The chemical makeup of the brain that results in anxiety and depression can cause similar symptoms, with one major example being rumination. Rumination is being stuck on the certain thought and playing it over and over again, such as replaying a conversation or fight you had with someone, replaying a stressful event, or replaying a mistake you made. Normal rumination stays for a little while then goes away, whereas unhealthy rumination causes a lot of subjective distress and is much harder to turn off.
If you think you may have an anxiety disorder, I definitely recommend speaking with a mental health professional. If you do end up diagnosed with an anxiety disorder, it doesn’t need to be the cause of more anxiety. “All of these diagnoses… it is just the tool to find the right treatment. It’s not this label that we go “This is who you are now”… they are just illnesses, and they are all manageable and they don’t define the person.” Also keep in mind that culture and society can greatly influence mental health, and for that reason, different cultures experience different trends in mental health disorders. Dr. Ramani explains that, “In the United States, anxiety disorders are the most common form of mental illness, that’s not the case all over the world. In much of the rest of the world, mood disorders like major depression are the most common… [the US] is a competitive culture… there are some things built into our culture to endorse anxiety.” If you are diagnosed with an anxiety disorder (and many other different kinds of mental health disorders for that matter), you are far from alone.
For part two of this blog, tying anxiety information back to this current outbreak, I’d like to dive into a second video Dr. Ramani made about managing anxiety related to Coronavirus specifically. Here is the link to the video:
Managing Anxiety and Uncertainty During the Coronavirus Pandemic
Image: Screenshot from video
In this video, Dr. Ramani explains that this virus is bringing up multiple kinds of anxiety for a lot of people: financial anxiety, anxiety over loved ones getting sick, anxiety over how to get childcare, anxiety around scarcity of goods and getting food and supplies we need, and more. Anxiety during this time is connected back to our survival instincts. That alarm system is in high alert for some people right now, trying to help us survive a potentially life threatening situation. So while it may not feel good, anxiety during this time shows that your mind has awareness of the given situation, and is looking to protect you. As Dr. Ramani would say, it's a normal response to a difficult situation.
Here is summarized advice from Dr. Ramani on how to cope with Coronavirus related anxiety and distress:
- Have good reliable sources of information that don’t fuel catastrophic thinking like the CDC, NIH, or WHO
- Touch base with your mental health professional, or reach out to a local mental health clinic for information on how to cope
- Keep structure, especially for children
- Reinforce to vulnerable loved ones to stay away from others, and help them get supplies or translate information for them if they need it
- Adhere to medications as your healthcare providers recommend Distract yourself at home by activities like calling friends
- Don’t get sucked into vortex of watching the news that can lead to catastrophic thoughts
- Practice mindful deep breathing, practice taking deep, slow breathes (Rapid shallow breathing is a symptom of anxiety, taking slow, deep breaths can counteract anxiety physiologically)
- Recognize everyone is going through this too, you are not the only one struggling
- Stay in touch with long distance loved ones and keep tabs on status of what’s going on in their area in terms of risk, protocols for protecting themselves
- Know who you can get support from in your life (for example, people with narcissistic traits may make this situation about them and not be able to help you in the way that you need support)
- Don’t take on other people’s feelings, differentiate your feelings from someone else’s feelings
- Follow social distancing measures and follow protocol on hygiene like hand washing and sanitizing surfaces like organizations like the CDC recommend
- Follow local protocol on if you get sick, you can call your doctor or local clinic to see if you need to come in for medical care
Reach out to us if you need any support, in light of the recent circumstances we have added video and phone sessions to our list of services. Take care of yourself, take care of your loved ones (maybe from afar with social distancing), and be gentle with yourself and those around you. Your anxiety and stress is valid, and very well warranted duWe are all in this crazy situation together!