Woman in self-quarantine

The novel coronavirus pandemic has prompted unprecedented changes to the ways people go about their daily lives. Donning face masks, engaging in contactless meal deliveries or curbside pickups, and staying at least six feet apart in certain social settings such as grocery shopping are just a few things that have become normal.

While these activities are helping to curb the crisis in the physical sense, it’s important to maintain mental and emotional well-being, too.

“Depression and anxiety, as well as other mental health conditions, are on the rise during COVID-19,” says Wilfred van Gorp, former president of the American Academy of Clinical Neuropsychology in Ann Arbor, Michigan. “It is impacting people’s mental health due to isolation, the fear of contagion — which produces anxiety — and illness or death, financial hardships and the indeterminate nature of this. No one knows how long it will last.

“All these factors combine to make people more on edge and some depressed, highly anxious and even traumatized.”

Learning how the pandemic and the associated fallout is impacting mental and emotional states, what services are available to counsel people, how people can cope on their own, and why it’s important to maintain social connections virtually — all for the sake of better mental health.

Addressing the stigma

Because of COVID-19, the toll on Americans’ mental health is becoming quantifiable and palpable. Many people across the nation are experiencing an increase in anxiety, says Chelsea Woodard, a licensed professional counselor and the Nashville, Tennessee, site director of the Renfrew Center, a treatment facility.

“Anxiety is our bodies’ way of telling us to be alert and prepare us for something in the future,” Woodard says. “When it comes to COVID-19, experiencing anxiety can be helpful — it tells us to take healthy precautions, like good hand hygiene, social distancing and wearing a mask in public places.”

However, sometimes levels of anxiety or fear can become heightened and out of context, she says, making people expect the worst in situations when that’s not actually likely.

“It’s important for those struggling with heightened senses of fear or anxiety to talk about it with loved ones or a professional, to help them devise solutions to best deal with these tough emotions,” Woodard says. “Reminding yourself that taking simple precautions can greatly reduce your risk of contracting or spreading the virus is important to prevent ‘catastrophizing,’ or getting to a place where you might feel incapacitated to continue living your life.”

To also ease fear and anxiety about contracting the virus, it’s important for employers to take seriously the recommendations from the Centers for Disease Control and Prevention to create a safe workplace for everyone, Woodard says.

“Employees need to know they can feel as safe as possible and not have to experience extra worry that they could contract the virus or risk the uncertainty about how not returning to work could impact their livelihood,” she says.

Social distancing, also called “physical distancing,” “isolation” and “quarantine” have made their way into everyday lexicons, too. And they’ve all played a role in shaping mental well-being. For many, social distancing brings feelings of isolation, boredom, hopelessness, and feelings of “no end in sight.” A lack of social support and community involvement can also exacerbate the situation.

“Humans are social creatures,” says Jessica J. Ruiz, chief psychologist and director of behavioral health at the Behavioral Health Associates of Broward County and the Counseling Centers of Goodman JFS in Florida. “Much of our lives and daily activities involve interacting with others in some way. In fact, research has found that people who report having a strong support system tend to fare better than those who do not after stressful or traumatic life events. Relationships and connections are essential to our well-being. Social isolation on the other hand has been linked to depressed mood, anxiety and other behavioral health challenges.”

Van Gorp adds that people who are isolated experience greater anxiety and depression.

“Socialization reduces these conditions and symptoms,” he says. “This is why it’s important to remain social using social media and video — Zoom coffee/cocktail hours, Zoom birthday celebrations, and even Zoom chat — are all important to keep depression and anxiety at bay when people are physically isolated.”

Economic uncertainty is another major mental health trigger, and it is a very real consequence of the coronavirus and its effects.

“Worrying about being able to support oneself and pay bills produces a great deal of anxiety,” depression, anger and insecurity, according to van Gorp. “People become very anxious around money issues and the fear of losing a job or being unable to support themselves or their family.”

Congress approved a $2 trillion COVID-19 stimulus bill in March and extended unemployment benefits, and it is also on the verge of approving a second round of stimulus checks for Americans. While the stimulus money has greatly helped many people, some experts say it just isn’t enough and shouldn’t be the end-all.

“The stimulus package, while certainly a nice thought on the part of our

lawmakers, isn’t simply enough,” says Dr. Prakash Masand, a psychiatrist and founder of the Centers of Psychiatric Excellence in New York City. “Financial issues and debt are already huge stressors for many Americans in the pre-COVID-19 world. Studies find that the unemployment rate among those making less than $40,000 per year is 40%. When you add in job loss or a reduction of hours, the situation becomes much more serious.

“When you look at all the expenses of the average American family, the reality is a few extra thousand dollars on behalf of the government just isn’t going to make ends meet or cut it. Anxiety and depression is skyrocketing around money issues right now,” he adds.

Coping through the crisis

Some people have been unaffected by state shutdown orders and social isolation – some have even enjoyed it — while others are struggling with the changes and are not coping well.

“Every one of us has our own coping style, and some people are more resilient than others,” van Gorp says. “There isn’t one personality type that predicts who will be affected and who will not. I have seen some people who are never the same after a single, major stressor. It often relates to coping style and how flexible and resilient a person is.”

According to Ruiz, perception is sometimes everything.

“While some people may not seem as impacted by the stay-at-home orders, they are,” she says. “Just as there are many different personality types — outgoing, introverted — there are just as many reactions people may have to dealing with the stress and anxieties of isolation.”

Some might act out, becoming outwardly emotional, she says. They could cry, share their frustrations on social media or — worse — become angry and violent. This reaction, in particular, is concerning to therapists, as stay-at-home orders have dramatically impacted and increased the number of domestic violence cases in our country, Ruiz says.

“Others might become withdrawn and retreat into themselves. These people will refrain from any interaction and exhibit signs of depression, such as sleeping all day or loss of appetite,” Ruiz says. “Still, more will find healthy outlets for their anxiety, which is demonstrated by a recent rise in workout videos on social media, artistic and musical expression, and tips on meditation.”

Luckily, there are a variety of resources available for those who could benefit from counseling services, Ruiz says.

“Many behavioral health centers and therapists now offer telehealth mental health services, and insurance companies temporarily cover telehealth services to ensure individuals can get the assistance they need without increasing risk of exposure,” she says. “For those who do not have insurance, many social service agencies and community mental health centers offer subsidized counseling.

Additionally, many of these agencies provide free virtual workshops and groups focused on wellness activities such as mindfulness, relaxation and support groups.”

Masand says Mental Health America has created an extensive list of resources to assist people with various aspects of the virus. The CDC and the World Health Organizations are also great places for mental health resources.

“When it comes to seeking help for mental health around COVID-19, I highly recommend people seek out therapy that is rooted in acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), resiliency training and crisis counseling,” he says. “In fact, at COPE Psychiatry, we are now training therapists around the country in a specific six week protocol around COVID 19 to offer to their patients via telemedicine.”

As far as staying active, maintaining a workout routine, eating right, and otherwise keeping life as normal as possible, Woodard says, people can cope on their own and maintain their mental well-being during the pandemic.

“In a time when your previous schedule has likely been totally disrupted, it’s important to create and follow a new schedule for yourself,” she says. “Being cooped up indoors can lead to a lower mood and feelings of lethargy. Find time to get outdoors to take a stroll or a jog. Follow your body’s cues and give it healthy, joyful movement when it craves it, allowing yourself to rest when it doesn’t. The movement, as well as the fresh air, can both be fantastic ways of self-care.”

Be intentional about creating both time for yourself and time spent with others, Woodard says.

“It’s a great time for self-exploration and finding new things you enjoy doing, including reading, crafting, gardening or new hobbies. All of these methods of self-care are great for rejuvenation during these tough times,” she says.

Van Gorp says to keep a regular sleep/wake routine, get up and get dressed — don’t stay in pajamas all day — get physical exercise, even walking, and socialize with friends via Zoom, Skype or FaceTime.

“Skype or FaceTime will definitely help people cope,” he says. “It’s known that exercise reduces depression in people with depressive conditions. Getting as much exercise and socialization as possible are two key elements for successful coping.”

Ruiz adds that apps like these can help people stay connected to loved ones, check in on grandparents or even coo at a new baby.

“These bonding rituals are what make us human,” she says. “As I mentioned before, we are social creatures, and our need to connect is as much a base physical need as it is a mental and emotional one.”