Category: Mental Health

Coping Mechanisms Against Depression and Anxiety during the COVID -19 Pandemic

by Olga Megwinoff, MD

I did not want to write about anything related to the pandemic given that we are already so saturated by news and information related to it. However, I have realized it’s unavoidable. This pandemic and the ensuing quarantine has changed everything about the world as we know it. Most aspects of our personal, familial and social lives have been upended. Therefore, regardless of what I feel, I think that the most useful thing I can do is to write about coping mechanisms for how to endure the social distancing and the fear.

I want to focus on what we can do to help each other and ourselves as we are starting week 11 of social distancing in NY State. I find myself, my family members, and my patients suffering in one way or another from the direct effects of the fear and social isolation, therefore, I have put together a compilation of simple techniques we can all apply to our lives, especially during this pandemic.

1. Fear and Anxiety

Often our fears are out of proportion to the reality of the situation. Our natural tendency is to over-estimate the risk and underestimate our ability to deal with it. Factors that can contribute to this phenomenon are how much uncertainty there is in a risky situation, how invisible the threat is, how much control people feel they have over the situation, how horrible the possible outcomes are, and how suddenly bad outcomes may occur (Leahy, PhD).

Regardless, the meaning we impose on fearful events contribute to our emotional states. Therefore, changing how we think about these events can reduce anxiety symptoms and improve overall wellbeing. The story we tell ourselves can be a conscious choice where we take a more neutral observer stand point and take into account the context.

You can train your brain not to blend with thoughts, instead to observe them from a distance. If you can do this, then it’s easier to recognize catastrophic or negative thinking. This can be done by monitoring the pros and cons of an event.

For example: “What is the evidence for this thought?”; “Is this conclusion based on facts or feelings?”

We can also monitor and challenge negative anxiety-evoking self statements.

For example: “What are you predicting will happen and what is the likelihood it will actually happen?”; “If the worst case scenario were to happen, what would you do to cope with it?”; “What are the costs and benefits of worrying about this?”

To counter balance your thoughts, it’s also imperative to control autonomic arousal through relaxation. Some examples of this are focused breathing, progressive muscle relaxation, exercise, and visualizations.

Your level of fear is inversely correlated to information. Be smart and know the facts. However, do this while limiting the time you expose yourself to the news media cycle and be aware that “the news” is often full of dramatizations instead of factual information.

2. Coping Skills for Stress During COVID-19

The ways in which individuals respond to stressors attenuate the presence of depressed mood and anxiety. This can influence both the duration and severity of their symptoms (Nolen-Hoeksema, 1991).

People have different coping styles, many of these are learned in childhood. Endler and Parker (1990) suggested that there are three basic coping styles: problem-oriented , emotion-oriented, and avoidance-oriented. Your coping style may stay consistent across different situations and experiences or the coping strategies you use can be varied. They may change over time as you face a particular stressor. For example, you can be using active coping mechanisms but decide to take a mental break because your anxiety is peaking and decide to use denial for a little while. You may stop looking at the news for a few days and get immersed in an engrossing book. While it is obvious that some of these coping strategies are more healthy than others, they all more or less serve the purpose of lessening anxiety in the moment. Nevertheless, while the less healthy coping mechanisms can still help not feeling anxious in the present moment, by suppression and displacement of the real feelings, these unhealthy coping mechanisms eventually can lead to depression and worsening anxiety.

Problem focused coping refers to overt behavioral attempts to modify or eliminate the sources of stress through one’s own behavior.

Examples include:

Active coping: “I tried to find out more about the situation”; “I took some positive action”; “I do what has to be done, but one step at a time”; “ I can’t change the situation but I’m taking action to try and make the situation better.”

Planning: “I concentrate my efforts on doing something about it”; “I have been trying to come up with a strategy about what to do.”

Emotional coping includes behavior or cognitive responses whose primary function is to attempt to monitor the emotional consequences of stressors and maintain one’s emotional equilibrium. One example of emotional coping is positive reinterpretation. This consists of monitoring one’s appraisal of the stressfulness of the event. In other words, someone may try to see the positive side of a situation or draw on their past experiences in similar situations.

Other examples of emotional coping:

Acceptance: “I have been learning to live with this.”
Denial: “This isn’t real.”
Turning to religion and/or spiritual beliefs.
Humor.
Exercise.

Restraint/avoidant coping refers to the degree to which one refrains from acting to resolve a stressful situation.

Examples consist of: “I have been doing something to think less about it”; watching TV, reading, daydreaming, sleeping, substance abuse; “When I have a problem, I like to sleep on it”; “If I find a problem too difficult, I put it aside until I’m ready to deal with it”; “I try to let things work out on their own.”

Additional coping strategies consist of establishing social resources. Social support and willingness and comfort with help-seeking from others (Billings & Moos, 1981; Nadler, 1990) are also likely to influence an individual’s anxiety and depressed mood. One example is discussing your feelings with someone else. Talking to others can be very helpful because it can provide another perspective on the stressor in addition to getting advice about how to solve the problem. While “keeping my feelings to myself” tend to be detrimental in the long run.

3. Social Distancing

Interaction with peers is a powerful and universal human need. Attachment theory (Bowlby, 1980) describes how attachment serves the purpose of reducing anxiety. Attachment is the lasting emotional bond between two people, where one party (in childhood) or both of the parties (in adulthood) tries to maintain proximity to the attachment figure and takes action to ensure that the relationship continues.

Researchers believe that the style and history of an individual’s attachment affect loneliness. Attachment behavior activates when a person feels fear or sadness or contracts a disease. Therefore, during this time of forced social isolation, it is thought that a lack of face-to-face contact and separation from others may lead not only to lack of closeness in relationships, but also to loneliness and stress.

Attachment theory emphasizes that early childhood relationships form attachment styles and influence individual’s views about themselves, others, and the organization of interpersonal relationships. Attachment styles can be defined as patterns of thinking, feeling, and personal behavior in close relationships with a caregiver and other intimate partners. Attachments are made to others and correlates strongly to self confidence, self reliance, and ability to deal with the outside world. Accordingly, absence of an attachment figure makes a person feel lonely and/or anxious. Resulting in a lack of emotional stability. Consequently, separation from our parents, good friends, teachers, and mentors can profoundly impact a person’s emotional wellbeing in the many facets mentioned above.

Henceforth, it’s important we actively work on maintaining current relationships, renewing older ones, and cementing bonds. Consider being more loving and more expressive of love to your family, friends, teachers, and mentors. It’s not an exaggeration to state that your emotional well-being depends on it.

Resources:
Billings AG, Moos RH; the role of coping responses and social resources in attenuating the stress of life events.
J Behav Med. 1981 Jun; 4(2):139-57.

Daniel Brown, PhD, Living Meditation 3/30/2020; Using The Best of Western Psychology and Eastern Meditative Traditions as a Response to the Corona Virus Pandemic.

Charlie Silverstein MD. On My Mind: Coronavirus, fear, and anxiety. blog March 18, 2020.

Brief COPE

Active and Passive Coping Strategies: Comparing Psychological Distress, Cortisol, and Proinflammatory Cytokine Levels in Breast Cancer Survivors
Joana Perez-Tejada
Larraitz Garmendia
Ainitze Labaka
Oscar Vegas
Eneritz Gómez-Lazaro
Amaia Arregi

CJON 2019, 23(6), 583-590 DOI: 10.1188/19.CJON.583-590

Bartholomew K, Perlman D (1994). Attachment process in adulthood. London: Kingsley Publication.

Bowlby J (1988). A secure base: Parent-child attachment and healthy human development. New York: Basic Books.

Erozkan, A., The attachment styles bases of loneliness and depression.International Journal of Psychology and Counselling Vol. 3(9), pp. 186-193, December 2011

Post Traumatic Stress Disorder and Addiction 

By Britt Gottlich, Psy.D.

I often meet with people who say they are unsure of whether they have experienced trauma or not. So what is trauma? Most people define trauma based on how trauma is portrayed in the media. But in reality it is a very subjective experience. Something that may be traumatic for one person may not be traumatic for another. The American Psychological Association defines trauma as “an emotional response to a terrible event like an accident, rape or natural disaster.”

The way I like to understand trauma is based on an individual’s interpretation of the event. As children we live under the assumption that ‘good things happen to good people and bad things happen to bad people.’ When we experience a trauma, often our interpretation of this rule becomes clouded and confused. For example, it could change to, ‘if good things happen to good people, and this happened to me, then I must be bad.’ Therefore, a person’s reaction to a traumatic experience often affects the way they see themselves, other people, and the world around them.

We can’t change or erase a traumatic experience, unfortunately. But what we can do is change the way we interpret it and ultimately the way we understand the world around us as a result of that event. This is where Cognitive Processing Therapy (CPT) can be a useful treatment modality. It helps us identify the cognitive distortions that are derived from our traumas, and using evidence and facts, combat those thoughts with rational ones. 

CPT has been a very effective treatment modality which is often used in treating Veterans with Post Traumatic Stress Disorder or PTSD. CPT is a 12 session behavioral psychotherapy. It has been found to be highly effective in treatment for PTSD. A study conducted in 2017 that studied the effectiveness of CPT on Veterans found that Veterans who completed the 12 session treatment had a significant difference in their symptoms and had a decline in Post Traumatic Stress Disorder Checklist scores than Veterans who did not complete or comply with treatment. Other treatments that are used for PTSD are Eye Movement Desensitization & Reprocessing (EMDR) and Prolonged Exposure (PE). In my experience and training with all the above modalities, I have seen the most improvement and success with CPT.

While there are treatments such as CPT that are very effective in treating trauma, one of the most important pieces in this type of therapy is rapport. It is important in all therapy to have a positive relationship with your therapist where you feel comfortable and not judged. But especially when disclosing a trauma, and going deep into the event, feelings, and cognitions related to it, it is important that you feel trusting of the person providing that treatment.

From my experience working at a VA and currently here at Fifth Avenue Psychiatry, I see that there is a high comorbidity for substance abuse and PTSD, especially when PTSD goes undiagnosed or untreated. VA statistics note that more than 2 out of 10 Veterans with PTSD also have a substance use disorder, and 1 out of 3 Veterans seeking treatment for substance use disorders also meet criteria for PTSD. The American Addictions Center reported that 55-60% of individuals who suffer from PTSD have comorbid addiction or alcoholism. They also note that “people who suffer PTSD are between two and four times more likely to also battle addiction than their peers who do not also struggle with PTSD.”

Again, traumas are not something that can be erased, but they can be something you can learn to live with. You can begin to see the world, people, and yourself in healthier ways again. You may never fully believe that ‘good things happen to good people,’ but eventually you may believe that ‘bad things sometimes happen to good people.’

https://journals.sagepub.com/doi/abs/10.1177/0033294117727746?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=prxa

https://americanaddictioncenters.org/ptsd

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