Q AND A WITH PSYCHOLOGIST ANN FAN
Ann Fan is a cognitive behavioural therapist with the following qualifications: LL.B (Hons); (B.A. (Hons) (in psychology); MSc (health psychology); PDip (in cognitive behavioural therapy); accredited cognitive behavioural therapist with the BABCP (British Association for Behavioural and Cognitive Psychotherapies). Here I ask her what we can do to take care of ourselves, handle the anxiety we might be experiencing and how to get used to our ‘new normal’.
But before we begin, let’s start at the beginning. A few weeks ago, the world as we know it changed. We’d heard about the Coronavirus back in December 2019 when we saw the news and were told that China, more specifically Wuhan, had been hit with the virus. China responded and were going into lockdown. Residents were only allowed out to do grocery shopping, having their temperatures checked as they came in and out of the store. They had to give their phone number in case someone later became infected, so those recording it could track everyone who had been in contact with that person. It sounded awful, some of us had friends and family who were being affected, but it felt far away. We sympathized but we didn’t know.
Fast forward a few months. Europe is hugely hit with the virus, America begins shutting down flights, Europe included, U.K and Ireland were exempt. It continues to get worse, U.K and Ireland are now included in the ban and Italy is drowning in the number of cases. America (we don’t know it yet) won’t be far behind. As I write this, the U.S has overtaken both China and Italy with the number of people infected with the virus. I’m now writing this from my home in Los Angeles, as we too are under order for ‘Shelter In’. The 16th of March was the day all restaurants stopped dine-in; gyms, theatres and shopping malls closed. Today, all schools except a few with children of parents working on the frontline, (the true heroes today, doctors, nurses, hospital cleaners, supermarket staff, anyone working every day, risking their own health to enable us to live, to eat, to survive) are closed.
So how are we all handling it? It’s been a rollercoaster of emotions. Many people all over the world have lost their jobs, small businesses are going under and those who have been able to keep their jobs are likely now doing work from home (WFH), which may have before sounded like a dream, but can in actuality be desperately lonely, especially in these days of social distancing and Shelter In place. It’s particularly hard for those living on their own.
For those with kids, it adds a huge challenge, trying to keep young children amused at home, toddlers with boundless amounts of energy, to older kids whose parents are now having to home school their children. That’s right, parents overnight have had to become manager of their own work headquarters and head teacher of their own schools. All the while trying to explain to their children what on earth is going on whilst still trying to wrap their heads around it themselves.
We normally have stay at home parents, we have working parents, and we have teachers, for a reason. It’s not humanly possible for one or even two parents to achieve all of the above. And with no definitive date of end in sight, anxiety and emotions are going into overdrive. So how are we meant to deal with all of this?
It’s going to be a rough time for all of us as we adjust to our new situation. However there are some coping mechanisms we can undertake to manage expectations, and help deal with our own anxiety and mental health during this time.
Stacy Fan: So many people are experiencing a lot of confusion, loneliness, anxiety and depression during this unprecedented time. Can you help us understand some of the feelings that we might be going through?
Ann Fan: Normally we are very fortunate to have the freedom to travel where we want, whether that’s at home or abroad; we’re able to leave our homes at any time of the day or night for pretty much anything we want to do; and weekends are usually about socializing, going to parties and restaurants to meet with friends and loved-ones. Suddenly that has all been taken away; our lifestyles have had to change almost overnight. It’s a shock and has required a massive adaption. In addition, many people’s long-term plans of what they were going to do or achieve this year have had to be cancelled or re-arranged. Examples are weddings, or a long-planned and looked forward to holiday, or celebrating a milestone birthday or anniversary with friends and family. When these are unable to go ahead this can leave feelings of extreme disappointment, which at worst can lead to feelings of depression. A knock on from this are the potential financial implications, and the very real possibility that people may not be able to keep their jobs because businesses are being affected so badly, leading to anxiety and depression.
SF: What are some of the things we can do each day to bring ourselves a sense of normality and to keep ourselves motivated during this time?
AF: Having a routine is important. If you’re working from home this is probably easier because you know what you’re required to do during the day. However, if you’re at home with no work it can lead to a sense of the day being pointless and each day like ground hog day. The first thing that’s important is to get dressed! Don’t sit around in your pyjamas, but put on some comfortable day clothes. Try to keep up your normal self-care routine, such as showering and washing your hair, putting make-up on. These are all important for our sense of self-worth. Have a list of what you want to achieve that day – that closet you’ve been meaning for months to tidy, now’s your opportunity! If you’re able to go out for a walk, do so. Perhaps you can have a regular time-slot where you FaceTime with family. I have heard where people are taking part in on-line quizzes and games and arranging coffee mornings or cocktail evenings shared over the net. If you’re a couple who normally have a regular “date night”, continue to have these, such as cooking a special meal, having some wine and candlelight. Or having a regular movie night. If as a couple you don’t usually do these things, now might be a good time to introduce them! If your finances allow, an occasional on-line purchase of a new item of clothing or jewelery can lift the spirits. And don’t watch too much of the news about what’s going on – stay informed but don’t become over-saturated and over-whelmed by it.
Try to keep up your normal self-care routine, such as showering and washing your hair, putting make-up on. These are all important for our sense of self-worth.
AF: It’s important to remember that anxiety is a normal part of life – most of us experience it at some level for numerous reasons. Anxiety can cause a number of physical reactions such as increased heart rate, shortness of breath, sweating and trembling. This in turn can lead to the individual becoming even more anxious, perhaps even having a panic attack, when people often think they’re having a heart attack. If you’re experiencing physical symptoms, try and control your breathing so you’re not over-breathing, which leads to feeling faint. You can also try “Progressive muscle relaxation”. If your thoughts are really anxious thoughts, a basic cognitive behavioural therapy (CBT) technique is to do some “thought challenging”. This involves identifying what your triggers are for the anxious (or unhelpful) thoughts, what the specific thought is and then find a more balanced, (helpful) thought to counteract it. In the current situation a typical thought might be “I’m going to catch the virus, get sick, and have to go to hospital”. A more helpful, balanced thought might be “I’m at home, I’m doing everything I have been asked in order to keep safe, I’m keeping myself and my family healthy”.
SF: For those who already suffer from OCD (obsessive compulsive disorder), this could be an unbearably challenging time. What tips can you give those struggling to help control it and keep it in check?
AF: This is a particularly challenging time for people who have OCD particularly if it’s regarding germs and contamination fears. Similarly for people with health anxiety, who may be experiencing heightened worry about their health because of the fear of catching the virus. As OCD and health anxiety are both an anxiety disorder, some simple self- help procedures for mild OCD and health anxiety would again be using some of the thought challenging techniques detailed above. Some examples of questions you can ask yourself to help allay your anxiety are: “Is there any evidence for this thought?; is there any evidence against it?; what would I say to a friend who had this thought?; what would a friend say to me about it?; how can I test this thought to show that it’s false”. There are a number of good cognitive behavioural books that can help with both OCD and health anxiety. People who have OCD or health anxiety which is so severe that it affects their normal quality of life should seek the help of a therapist.
SF: For those who are struggling with social distancing and battling loneliness and / or depression, what can they do to help themselves during this time?
AF: We’re very fortunate to have access to technology which enables us to stay in touch with each other. Use this to its full advantage. Enlist a good friend to be your “buddy” at this time so that you can support each other by phoning or using other methods to tell each other how you’re feeling that day. It’s important to remember when you’re having a bad day, that tomorrow is another day when things may look and feel brighter. Reconnect with people you may have lost touch with; or reach out to your neighbour to see if you can help out with practical things, such as shopping, or just simply to check in on how they are. Altruism is great for giving a sense of purpose and well-being.
Perhaps you can have a regular time-slot where you FaceTime with family. I have heard where people are taking part in on-line quizzes and games and arranging coffee mornings or cocktail evenings shared over the net.
AF: None of us ever know what the future holds, even in normal times. Worrying about the future never solves anything, however planning for the future can be helpful. Have you had to cancel plans? - then think of how or when you might be able to put these plans in place again. Plan what activities you’re going to do when you’re allowed social interaction again so you’ve got something to look forward to. Communication is always helpful, talk about your feelings with your partner, friend, mother, father. Everyone is in this together so we can support each other to get through it.
SF: Are there any relaxation exercise we can do to help anxiety during this time?
AF: Many people find Mindfulness to be very helpful. There’s a lot of information on websites about it. There’s a particular exercise called “Leaves on a Stream” (which you can find on-line) which helps relax the mind and dissipates worry. Yoga is also good for physical and mental relaxation. There are lots of apps that can help. There’s one called “Calm” which a lot of people find helpful for relaxation.
AF: Having “me time” (time to yourself) is always important, but never more so when you might be staying at home with the same people for an unprecedented amount of time. If you’re able to, have time alone in a separate room. You could listen to music, read, make a phone call to a friend. If the government rules are that you’re allowed out for exercise, perhaps take walks separately. If you and your partner have children, divide the day up so that each of you have time away from looking after the children so you can pursue a solitary pursuit or interest, such as the ones listed above, so that you will feel refreshed to go back and able to either join in the fun as a family or take over the care of children so your partner can have their alone time.
SF: I think one of the most difficult things for people is that we haven’t been given an end date for our current situation. What are some of the things we can do daily to help with anxiety and that lack of knowing when this might end?
AF: With any form of anxiety or depression it is about taking it one day at a time. What you need to remind yourself is that you are being asked to stay at home to keep yourselves and others safe from this terrible disease. If you are able to look on this enforced period at home as an opportunity rather than a problem it will help. For example, have you always wanted to learn a foreign language, learn about a particular subject, learn a new skill, read that stack of books you’ve been meaning to get through? Now’s your opportunity! We’re very fortunate that we have the technology which gives us ways of keeping in touch and learning on-line.
If you’re able to, have time alone in a separate room. You could listen to music, read, make a phone call to a friend.
AF: There are a number of things that can help. 1. If you are having difficulty sleeping it’s often because when we go to bed and it’s quiet our mind starts thinking about all the things that have happened during the day, what we’ve got to do the next day, what bills we have to pay, even what we’re going to cook the next day! What I recommend to my patients who find they worry when they get to bed is to set aside some “worry time” during the day. This involves sitting calmly and listing the things that are troubling them or occupying their mind. Then write possible solutions and how they are going to be achieved. Don’t do this too close to bed-time or it may still be on your mind. 2. One thing that has been proven to keep the mind active when we go to bed is if we’ve had “screen time” just before we settle down. This activates the mind and brain, so put your phone/laptop etc. away at least half an hour before going to bed. And make sure that you don’t check your phone during the night. 3. One other tip is to do something that you find particularly relaxing such as meditation, listening to calming music or having a relaxing bath. 4. Something that is also well known to keep people awake is caffeine so avoid stimulants before bed. Some people find that chamomile tea is relaxing, or the smell of lavender on the pillow.
SF: What are some of the services (in the UK) available for those who might be struggling at the moment?
AF: One of the good things to come out of this current situation is how people have stepped up to help each other. The community spirit in most areas has been remarkable. For example, the UK government appealed for 250,000 volunteers to come forward to help the NHS (National Health Service). That target was met within 24 hours and a total of 750,000 have now volunteered to help with such things as delivering medicines and driving people to appointments. Psychological services, such as the one I work in and which is part of the NHS, have been asked to adjust the way we are working, so we are doing shift work in order to answer help-lines and carry out assessments for people who phone-in feeling anxious and/or depressed. Business which have had to temporarily close have diversified and are helping with such things as preparing and delivering food for free. In the community individuals have also got together to form groups to collect and deliver food and essentials to the elderly or vulnerable. For those struggling with mental health there are the usual phone services, such as The Samaritans. The list is endless and I feel very proud of how we are coping with this. My sincerest wish is that when we are allowed to get back to our normal way of life, that ‘normal’ will be different – I hope that we are all able to appreciate what we have and each other more. Stay safe everyone!