It is important for us to understand that as we all are unique individuals, our coping mechanisms during stress are also unique. We all are affected to various degrees in challenging situations like the COVID-19 pandemic. So, we need to tailor the strategies to cope up with the psychological impacts accordingly.
Over a year has passed since the World Health Organization (WHO) declared the COVID-19 outbreak as a pandemic on March 11, 2020. Now, we are going through the terrible second wave of covid-19 which is wreaking havoc in every aspect of our life-- be it physical, social, and financial. It is also dangerously eroding our mental health. The psychological trauma people are experiencing now due to various reasons like losing their loved ones, experiencing painful moments during the infection time -- be it during self-isolation period or during their stay in the ICUs or ventilators -- along with the social stigmas they faced are going to linger in their psyche for a long time to come.
During the first wave of the pandemic last year, a number of studies were conducted in different countries to find out the impact of COVID-19 on our mental health. These studies have shown a very disturbing picture of our psychological aspect - something we rarely want to talk about due to the mental stigmas associated with it. This article attempts to shed some light on this less talked-about aspect of our health so that we can be well aware and take necessary precautions before it is too late.
Every pandemic has brought detrimental impacts on the mental health of the affected population throughout history. According to The Lancet, there was widespread panic, anxiety and depression resulting from the sudden deaths of friends and relatives; stigmatization and social exclusion of the survivors during the outbreak of the Ebola virus. Similarly, another pandemic, the Spanish Flu (1918-1919 ), had left a long-standing impact on the mental health of survivors as a result of the massive and sudden loss of life. This situation plunged many into a chronic state of helplessness, anxiety and depression. The COVID-19 pandemic is no exception to this.
Psychological effect of COVID-19 pandemic
Psychological symptoms of COVID-19 pandemic are most often related to different factors like temperament and attachment style, social support, inadequate information, individual resilience and coping strategies, rumors on social media and social distance. As we hear the news of people getting infected with COVID-19 or losing their liVES as a result of the pandemic, we may quickly have specific and uncontrolled fears related to the infection. Sometimes panic attacks may occur due to intense fear of dying due to infection. Similarly, anxiety disorder with insomnia may hit us badly. The repeated urge to wash hands or washing hands due to fear of possible infection throughout the day and night may lead to obsessive compulsive disorder-like symptoms.
Frustration and boredom resulting from the lack of social interaction as a result of restriction on movement may increase further. Panic attacks may occur due to the fear of dying due to the infection, addiction to the internet as well as substance abuse like drinking alcohol and smoking marijuana are likely during this period among a section of people. In severe cases, the people may show a higher level of depression, which is characterized mainly by the feelings of sadness/hopelessness /worthlessness along with the loss of interest in activities or hobbies. In the case of severe depression, there may be ideation of suicide, sometimes leading to actual suicides.
Various review articles from different countries worldwide during last year's pandemic showed that the overall prevalence of depression was 31.0%, anxiety 32.0 %, and insomnia 38.0%. Higher risk groups were chronic disease patients, quarantined people, self-isolated COVID-19 patients, COVID-19 patients admitted to hospitalS, frontliners and health care workers. People with preexisting psychological problems are likely to suffer more as reaching out to medical professionals is more difficult in this period. The social distancing and loneliness may further exacerbate the problem.
Addressing psychological impacts of COVID-19
It is important for us to understand that as we all are unique individuals, our coping mechanisms during stress are also unique. We all are affected to various degrees in challenging situations like the COVID-19 pandemic. So, we need to tailor the strategies to cope up with the psychological impacts accordingly. We all know the universal principle for healthy well-being is both physical and psychological well-being. Good nutrition helps to fight against the disease acting as a natural remedy, while proper rest ensures relaxation of the body. Physical activity is important not only for physical health but also for mental health as it produces good-feel hormones and endorphins. So, the ERN (Exercise, Rest and Nutrition) can help us to gain better health and this would go a long way to make us robust both physically as well as mentally if we make this our second nature. During lockdown, we can choose physical activities according to our choices like gardening, dancing or skipping, treadmill exercises, yoga and pranayam. Whatever makes us happy and blissful is the best thing we should opt for during the lockdown period.
The next important measure is to be very cautious about the source of information we receive. We need to be cautious about the content as well as the amount of information we receive about the diseases. Our sources of information should be reliable and if some news makes us anxious or panic, it is advisable to avoid them as much as possible. We can ask for information from our family members. If watching TV makes us feel scared, we can opt for reading newspapers. Infodemics should be avoided at any cost and sensational news on social media should be abstained all together.
In order to manage anxious thoughts about infected cases or deaths, we can use the APPLE Technique innovated by anxiety UK groups.
A – Acceptance. This means accepting the situation as it is; neither deny it nor suppress or resist it. Of course, it is easier said than done. But let us remember whatever we RESIST in life PERSISTS. Let us feel the anxious thoughts fully and wholly without escaping to other activities.
P – Pause. Let us pause, be still and take a few deep breaths.
P - Pull Back. Let us remind ourselves gently and lovingly by phrases like “this too shall pass as last year wave" or "Majority of infected are getting cured and death rate is just 1-1.5 % “ or any other phrases as per our choices.
L- Let go. Let us slowly whisper to ourselves “I’m letting this thought go…” We can even imagine floating the thought toward the sky away from us.
E- Explore. Let us explore the room we are sitting in by observing different objects or the color of the wall etc. It helps us to be grounded and be at the present moment.
If we find this technique not effective and continue to be overwhelmed by anxiety, we can use relaxation techniques like Progressive Muscle Relaxation (PMR), where groups of body muscles from toe to head are first contracted and then released, feeling the sensation of deep relaxation.
The use of Deep Breathing Techniques for a few minutes can also alleviate our anxious thoughts and make us relaxed. This is very simple and effective as well. Likewise, visualization of serene scenery (a beautiful garden or sea shore) and experiencing the feeling through all our five senses as if we are at those places can also help us calm down. If we find these techniques not so suitable for us, we can vent our anxious thoughts by writing all our thoughts on pages of a notebook continuously for a few minutes (until all our emotions are vented out), we can then discard the pages so that nobody can see them later.
Similarly, we can dance/sing/listen to our favorite music whenever we feel anxious and down. It helps us to process our emotions and act as catharsis. Art therapy, where we make sketches in such a situation, is also considered an effective way to transform our emotions. If reading or writing articles is part of hobbies, such people can opt for that too. Some of us may feel relaxed or just okay if we share our feelings to our near and dear ones. As there is the presence of virtual means of communication like Skype, Viber, Facebook messenger etc, we can use any of these mediums to share our woes to the trusted ones in our lives. It is equally beneficial to extroverted people.
Different researches have shown that religious activities like prayers and worship, too, have healing effects and boost our mental health. Likewise, spiritual practices like meditations (Raja Yoga meditations, Mindfulness meditation) are also very useful if we like these practices. Meditation classes are easily available online these days. We can enroll and learn these exercises. Youths can also make use of this spare time by enrolling on different self-development programs like Neurolinguistics Training Program (NLP), fast reading and writing training, communication skills training and the like. So, we can take care of our mental health in various ways and be mentally strong during this difficult time so that we can be strong enough to be the backbone of our family and society and happily and boldly sail through this turbulent phase of the pandemic
(The author, a mental health advocate and a psycho-spiritual counselor, serves as President of Aasara Foundation Nepal )