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Improving Mental Health During COVID-19


Jerome Perera


MD, Psychiatrist

North York General Hospital


Clinician-Teacher

University of Toronto

Improving our mental health will help us to get through the COVID-19 pandemic.  Given that our usual supports and outlets may not be as accessible, I hope the following are helpful to you (some will serve as reminders).  Your health condition, personal situation, or emotional state may impact your ability to carry out these suggestions.  That's okay, do what you can.


Calming the Stress Response


Anxiety is part of our “fight-or-flight” response where resources are sent to areas of the body to deal with a perceived threat (eg. increasing heart rate and blood pressure - to supply our muscles).  It diverts energy away from organ systems involved in recovery, digestion, and immune function.  This is meant to be a short-term survival strategy and can be damaging to the body if there is chronic stress.


It is essential that we give our mind and body frequent breaks with healthy coping practices.  As we develop more familiarity with them, we can deploy these methods more effectively (even automatically as the brain becomes more accustomed to turning down the stress response).  It is possible to improve our ability to manage stress even during difficult times.


Start With


Focus on making it through today.  As difficult as it might be, it's important to try to let go of yesterday’s regret and tomorrow’s uncertainty.  What we do have is this moment.  What we can control includes acknowledging feelings, shifting focus of thinking, and modifying behaviours.


Remember to speak kindly to yourself - consistently.  Validate any progress that you make in your particular circumstance.  Keep going, but don't push yourself too much.  If overwhelmed, "just do one" (1 task, chore, report, or email).  If your energy is depleted, the bare minimum is enough.


Connect with others to prevent prolonged periods of isolation (over the phone, through video, or online groups).  If you're feeling alone or know someone who is, reach out.


Find ways of unplugging from the news.  Try not to read or watch it for hours on end, especially if the media are reporting about distressing events.  Some news may sound alarmist because "panic sells".  These stories and images will trigger anxiety and impact your well-being and sense of hope.  Consider muting social media posts on the topic.  Watch out for misinformation (be equally critical of mainstream and alternate theories).  Consume the news for quick and important updates from reliable sources a couple times a day.  This will be sufficient.  Limit discussing topics related to COVID-19.  Spend the rest of your time on things that are uplifting (and within your control).


Listen to energizing, instrumental, or natural sounding music.  Be careful with songs that have harsh or depressing lyrics.  Express your emotions through dance and movement.  Sing.  Explore any form of art.  Write in a journal.  Share laughter or a smile.  Watch a lighthearted movie or documentary about overcoming the odds.  Read inspirational quotations ("When surrounded by darkness... become the source of light...").


Feelings will fluctuate from one extreme to another.  It is normal to experience "negative" emotions and it's okay to let them be.  A relaxing practice may help to reduce their intensity.


Resist the tendency to believe or judge every thought that arises.  Sometimes, they may be inaccurate (i.e. cognitive distortion).  The human mind can also produce thoughts of death or suicide as a solution to unbearable problems.  However, in the case of serious mental health difficulty, biological factors may contribute to these thought patterns.  Remember, your circumstance and internal state will eventually change, as it always has.  A solution may take time or might be just around the corner ("it's darkest just before dawn").  Even if there are no apparent solutions at the time, you will eventually adapt to your situation.


We tend to act our best when we feel our best.  Distraught human behaviour usually has some form of pain or fear beneath the surface.  We can't rule out the possibility that the person driving erratically is rushing to hospital to see a loved one.  Tailgating or cutting them off in-return magnifies all of our problems.  The impact of fear on our health and interactions is likely to cause significant harm during this pandemic.  Compassion can help to break these cycles.


Regarding panic buying - clarify the facts around shortages and ask yourself if you really need the item before following the crowd.  Resist the urge to hoard (versus reasonable restocking).  Although it may provide short-term relief of anxiety, hoarding can compromise your financial situation, take up vital space in your home, and may not actually provide significant benefit.  Most importantly, it causes hardship to others who also need those items.  If we shop with consideration, there will be fewer shortages.


This is a high risk time for conflict.  Eliminate toxicity, drama, or aggression.  When life feels fragile, the ripple effect of these behaviours is far reaching - a reminder to be sincerely kind to each other.  Take occasional breaks from people you are living with.  Where there's a difference of opinion, a bit of "active listening" goes a long way.


Lifestyle 


How you start your day is key.  Set the foundation before jumping into tasks or flooding your mind (with news, social media, emails, and texts).  Take 10 mins for a mindful practice (meditation, affirmations, visualization, gratitude, or stretching).  You could pair this with enjoying a cup of coffee/tea, then transition into your day.


Eat as healthy and balanced a diet as you are able to.  Keep well hydrated.  Try to limit refined or added sugars (to reduce inflammation, moderate insulin levels, and support the health of your digestive system).  Fried or greasy foods can also take a toll on physical and mental health.  Cooking your own meals can be a mindful and rewarding experience.  Try a new recipe.


Practice good hygiene.  Wash your hands properly, but don’t over-do it to the point where your skin breaks down (perhaps if you've been at home for several days without exposure to the public).  Follow physical distancing recommendations.  Reassure yourself that you are doing your best.


It's important to prioritize rest and recovery.  However, try not to spend extended periods of time in bed thinking about problems.  Avoidance as a coping strategy could make matters worse.  When distress takes over – one option is to shift focus to an essential task or nourishing activity.


Establish a daily routine with the help of a personal calendar.  Shower and change into day clothes.  Take prescribed medications.  Maintain regular mealtimes.  Keep your home environment tidy as clutter can increase discomfort.  Limit screen time.  Schedule to-do-list tasks into specific days and celebrate accomplishments, even if they are minor.  Consider brain training apps to keep your mind active.  Look into additional tips if you are working remotely.  These actions will also make the eventual transition back to "normal" life much smoother.


For parents juggling the incredible task of around the clock childcare, modify expectations and re-assure yourself that you are doing what you can.  Schedule the day with consistent times for play.  Managing your own anxiety, meeting your children where they are at, being truthful, providing a sense of control, and making the best of a new normal are some strategies that you can utilize to help your children cope.


The elderly are especially vulnerable during this time.  Depending on your relationship and their health, set a predictable schedule for phone calls.  Listen patiently as they tell their stories (even if you’ve heard them many times before).  Centenarians have survived the 1918 Flu Pandemic, Great Depression, and both World Wars.  They may have some wisdom to share.


Recreational drugs can be hard on the body, worsen anxiety, and impair the immune response.  Aim for moderation and reduce use if you can.


Regular exercise, at least a few times a week, is essential.  Benefits include stress release and improved overall health.  Order basic fitness equipment for the home or take advantage of what you already have.  Explore social media broadcasts and online video for home exercises that don’t require equipment.


Waking up at the same time everyday will make it easier to fall asleep at night.  Set a gentle sounding alarm.  Limit daytime naps.  Turn off the news and social media at least 1 hour before going to bed and do something relaxing instead.  Try affirmations, sleep meditation clips, or progressive muscle relaxation at bedtime or if you wake up in the middle of the night.  Establish good "sleep hygiene".


Affirmations 


Affirmations are self-strengthening statements that we listen to, think, or say.  They plant healthier thoughts in our mind and help to reduce the impact of 'negative thoughts'.  Affirmations reduce stress and guide us toward the reality that we want.  As we practice affirmations regularly, more comfort is developed with them and healthier thought patterns flourish.


Affirmations can be practiced daily – first thing in the morning and as you're going to bed.  These tend to be times during the day when the mind races with worry.  There are materials online that you can read or listen to.  More powerful methods include reading them aloud (maybe even while looking in the mirror) or record yourself saying them with relaxing sounds playing in the background (and then listening to it).  The experience might feel like being with a supportive coach or friend.  Give it a try.  Here are a few examples:


"I am in the present moment.  I believe in myself and in the strength of the human spirit.  Our society, country, and the world will overcome this.  I am an essential part of the process.  Even if things are difficult now, I trust the overall path that my life is taking.  I'll start with what I can do today.  I accept the situation I am facing.  I am confident in my ability to take necessary precautions.  Even if I don't see them now - there are solutions to my problems.  I embrace all of my emotions.  I let go of the past.  I practice gratitude and forgiveness.  I look for examples of kindness around me.  My level of motivation is increasing.  I feel greater amounts of happiness.  I trust my intuition.  I am doing my best.  I effectively handle stress.  I adapt and focus on solutions.  I persevere.  I act from a place of love, compassion, and peace.” 


How do you feel reading this?  Use it as a template and modify with your own personal affirmations.


Meditation and Mindfulness


Deep breathing stimulates relaxation (parasympathetic nervous system).  Research shows significant benefits, such as improved resilience and health, from a breathing meditation practice (even just a few minutes at a time).  The goal is to bring the focus back to breathing every time your thoughts drift away.  Do this often enough and it becomes easier to let go of thoughts, focus on the present moment, and achieve a state of relaxation.  Try a 21-30 day "meditation challenge" or use an app to develop consistency.


Mindfulness helps us to ground in the present moment - not the past or the future.  It involves paying close attention to our senses (water temperature, aroma of a meal, etc).  It also involves observing - without judgment - our continually changing thoughts and emotions.  Mindfulness allows us to do our best with the current moment.  It creates space for processing emotions, connection, and creative solutions.  More information can be found through the Centre for Mindfulness Studies and Mindfulness Everyday.


Progressive muscle relaxation is a technique that is effective for stress.  It is based on the principle of tightening one muscle group at a time, followed by a relaxation phase with release of tension.  It helps to shift focus from thinking to the body.  Try searching for this technique online.


Yoga or gentle stretching combines mindfulness with physical benefits.  It could help to relieve tension in muscles and joints after a long day at home or working an essential job.  There are many free videos available online.


Look into the emerging field of sound healing (as with temperature, our cells are thought to perform at their best within a specific range of sound frequencies).  Notice to how variations in sound might affect how you feel.


Spend some time outside or in nature – even if it’s a private area with some trees or grass.  Our biology functions best when it’s in contact with the earth (this is aptly termed “earthing”).  It’s partly why we feel almost immediately better after a hike or going camping.  Take some time to breathe fresh air.  Watch the sunrise and feel the warmth of its energy on your skin.


Visualization 


Visualization helps to re-frame our worry about the future.  This method is used frequently by people preparing for high pressure situations (eg. elite athletes).  Visualization allows the brain to rehearse an event and can help to improve performance.  By shifting energy away from problems we can focus on solutions and desired outcomes, even if the goal is to survive a crisis.


If you are worried about a particular circumstance, run through the events in your mind as to how you would handle it and overcome it.  Or imagine an ideal future that you want (create a "vision board").  How does it feel being there?  Soak in those feelings.  Spend a few minutes doing this regularly.


Gratitude 


Catch negative thought spirals early.  They consume excessive time and energy.  Write (or type) one thing per day that you’re grateful for, even if it’s a simple life pleasure, basic necessity, act of kindness, or personal achievement.  The list will grow.  Re-read it.


A state of gratitude can improve our health and ability to survive difficult times.  A vast majority of us may have taken aspects of our lives for granted prior to COVID-19.  We can change those habits and cherish what we currently have.


Explore 


You can use this as a unique opportunity for growth.  Learn a new skill.  Try out a new hobby.  Read the books you’ve always wanted to.  Expand your horizons, even for brief periods at a time.  At the very least, it will help to distract the mind.  Here are some options:



Find Meaning 


Certain perspectives acknowledge the nature of suffering.  It is universal.  No living being is spared from it.  And so, it could serve a purpose on this life journey.  Even the tree may forget about the benefits of rain during a thunderstorm.


Modern society’s current approach is avoidance of suffering (events, experiences, emotions) versus some acceptance of it - which then opens us up to the possibility of growth.  Those who have overcome difficulty speak to the depths of what they gained.  You may relate to this.  During the process, profound sadness or fear can overwhelm and persist.  It also may take time to grieve loss.  We can at the same time feel encouraged to move through it all.


Worst case scenarios may lurk in your thoughts and they can be difficult to control.  Remember that the human spirit can overcome immense difficulty.  Many of the strategies above can help us to center back to the present moment.  Do what you can and take it day by day.  Often times, our worst fears do not come true.  And if they do – resist the tendency to focus on how horrible or tragic the situation is.  Acknowledge the situation and encourage yourself with thoughts like “I am capable of getting through this”.  Affirmations can be useful in these moments as well.  


Establish meaning when things feel hopeless or futile.  Spend more time on stories involving human kindness or triumph as opposed to destruction.  Consider exploring (or reconnecting with) spiritual sources of purpose and relief.  SuperSoul Conversations are interviews with prominent and accomplished individuals from diverse spiritual backgrounds who overcame great difficulty or found meaning in challenging circumstances.  Go through the list and choose episodes with titles that stand out to you.


Explore a variety of approaches so that you expand your "toolkit".  Find what resonates with you by looking through materials by leaders in the field of wellness.


Advocacy


This pandemic seems to be having a humbling effect on many of us.  The busy pace with which we lived our modern lives did not usually preserve our mental health.  Collectively, we weren't treating ourselves, each other, the creatures we share this planet with, and the Earth itself with much regard.  Perhaps we can appreciate the wisdom of ancient and indigenous cultures.  How did they establish harmony between people and with the natural world?  Similarly, what can we learn from people living in 'blue zones'?  What could we incorporate into our own lives?  We will eventually have an opportunity to establish a "new normal".


The quality of our food impacts our molecular biology, brain function, and mental health.  Current factory farming methods subject animals to high levels of lifelong fear and stress, different from what animals are exposed to in the wild.  Their immune systems are weakened resulting in frequent use of antibiotics.  Cramped conditions fester emerging diseases.  Their meat surges with stress hormones (which we then ingest).  Similar concerns can be raised for how we grow our crops.  Bio-diverse farming methods incorporate natural ecosystems into food production.  In addition to being more ethical, food quality could improve - along with our health.


There might be a tendency to feel depressed with everything that seems wrong in the world today (eg. decisions driven by profit or popularity as opposed to values).  The solution to this is not to turn a blind eye but to be an agent of change, as those who preceded us did.  Consider advocating for something that is important to you, even if it's simply being aware of what we purchase or who we vote for.  Advocacy can have significant mental health benefits (by giving us a greater sense of purpose).  If you’ve done advocacy work before, consider re-igniting your passion for it.


Every act of charity helps society to overcome this pandemic.  Charitable acts can also help boost a sense of connection and hope.



There is a bigger picture.  Each day, more and more people are talking about how humanity and the planet are going through dramatic changes, hopefully for the better.  Like a "phoenix rising from the ashes", we are an important part of this global shift.


Persevere 


The combined human experience is full of stories of people like you who overcame what at first seemed impossible.  It could be that everything you have gone through in life has prepared you to work through the challenges you are currently facing.


Change is usually difficult.  And even though the "strongest steel is forged in the hottest fire" it needs to be cared for.  Be kind to yourself.  Reach out to those in need.  Be kind to others.  Each one of us is a vital part of the collective human family.  If more of us feel uplifted, then we improve our chances of a better future.  We are experiencing a unique period in human history.  Let's work together to promote our resilience.


Please feel free to share this website with those who might benefit from it.  If your level of distress persists, speak to a doctor or mental health professional.  The section below contains more information and mental health resources.  Wishing you improved health and wellness during this time.

RESOURCES


Free Online Tools



Virtual Counselling (Phone/Video) - providing free or reduced fee services:



Apps 


  • Meditation/Sleep: Headspace, Calm, Insight Timer, Stop Breathe Think
  • Addictions: Craving to Quit, Quit That!
  • Suicide Prevention: LifeLine App, MY3
  • Mood/Anxiety: Woebot, Mindshift CBT
  • Mood Tracker: Daylio, Pacifica
  • Fun: Happify
  • Kids: Smiling Mind
  • Therapy: TalkSpace
  • Stress Management: Sanvello, What's Up
  • Websites: cbtbooklet.com, DBT Self Help


Families 



Addictions



Essential Needs



Domestic Abuse/Violence 



Crisis Numbers 


If you have tried the strategies above and you continue to feel prolonged, high levels of distress (including thinking about a plan for suicide or homicide), please reach out to your mental health care provider.  Other options are:



Hope can be found.  There is help available.