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Emotional Well-Being and Coping During COVID-19

Madelyn Straub

These are unprecedented times. We need to work extra hard to manage our emotions well. Expect to have a lot of mixed feelings. Naturally we feel anxiety, and maybe waves of panic, particularly when seeing new headlines. An article by stress scientist and Vice Chair of Adult Psychology Elissa Epel, PhD, outlines the psychology behind the COVID-19 panic response and how we can try to make the best of this situation.

Our anxiety is helping us cope, bond together from a physical distance, and slow the spread of the virus. So our anxiety - while uncomfortable - is a good thing right now, especially if we manage it well. At the same time, we must effortfully prevent panic contagion and create periods when we can be screen-free and calm, engaging our attention in normal daily activities. Seize opportunities to share lightness and humor. Laughter right now is a relief for all of us!

You can also find moments of hope and resilience all around us despite the uncertainty. For example, a project created by UCSF postdoctoral scholar Nouf Al-Rashid shares stories of resilience and hope in response to the pandemic from individuals all over the world.

It may be helpful for you to make a list of what you can and cannot control right now. In this guide, we suggest radical acceptance of the situations we cannot control, and focus on what we can do.

Tips for everyone

Stay physically safe from the virus

In this case, the biggest safety behaviors (physical distancing and hand washing) which decrease transmission of the COVID-19 virus, are also an integral part of anxiety management. Stay home when you can. When outside the home, wash your hands thoroughly and frequently.

To help us make the thorough hand-washing a new habit, try this: “Wash as if you just chopped up a jalapeno pepper (without gloves) and you now have to put in your contact lenses.” Don't forget the sides of each and every finger, the back of hands, palms, the creases and nail beds, and the back of nails. Wash for at least 20 seconds - as long as it takes you to silently hum the Alphabet Song, Happy Birthday, or recite the Loving Kindness Prayer. If you are a speedy hummer, say it twice.

Limit media to reduce anxiety

By now you have heard this recommendation many times and there is research behind it: Watching or scrolling through the media makes us even more anxious. An excess of news and visual images about a traumatic event can create symptoms of post-traumatic stress disorder and poor health years later, according to research by UC Irvine's Roxy Silver, PhD, and others.

Try to limit COVID-19 media exposure to no more than twice a day (e.g., checking for updates in the morning and before dinner) and try to avoid reading about COVID-19 before bedtime. Take a vow to not forward (and thus propagate) alarming headlines to friends and family.

The media often creates an exaggerated impression of global panic. The reality emerging from research data in Seattle, an epicenter of the outbreak in the U.S., is that most people are dealing with this very well and rising up to help others.

Get and provide warm, comforting, social support by video, phone, or text

This is critical! Taking time to share your feelings and to listen and support others will go a long way. Talking with others who have our best interests at heart makes us feel safe. Use phone, video, text, or email. Fortunately these new highways of social contact are unlimited resources. More than just providing social support about the current crisis, it is a good idea to use these connections to talk about the things you normally would - host your book club online, for example - which can create feelings of connectedness. (See 8 Free Apps to Help You Stay Connected During Coronavirus). Host a dinner using FaceTime or Zoom so you can talk while you eat (and talk about some positive things, not just this crisis). Loving and caring for our pets can be phenomenal stress reduction for us too!

“Social Distancing” is actually a misnomer, it is actually physical distancing while we work hard to stay socially connected. Let’s switch to that phrase!

Find ways of expressing kindness, patience, and compassion

Be extra kind to yourself. This is a hard time for everyone. Humans across the world are sharing this experience with you. We are all in this together and we may all emerge with a renewed appreciation for our interconnectedness. Helping others in need is both critical to get through this well, and also creates more purpose to our days and well-being.

Here are general tips and ways to help others right now:

If you are physically well, there is another important way you can help: The American Red Cross faces a severe blood shortage due to an unprecedented number of blood drive cancellations during this coronavirus outbreak. Eligible and healthy donors are strongly urged to make an appointment to donate and help ensure that lifesaving blood products are available for patients.

Create new routines and keep practicing health behaviors

Routine and ritual are restorative to us. Our brain wants predictable activity so we can relax our vigilant nervous system. Go to bed early and go outside each day to be active. (More information about sleep and activity is available below.) Remember that our activities, thoughts, and mood are closely linked. If you want to change your mood, change your activities and/or your thoughts.

Eat well

Good nutrition helps our mood. Stress makes us seek comfort foods, and in turn high carbs and sugars impact our mood. Many population-based studies show that a Mediterranean diet has been linked to better mental health and stress resilience, whereas a junk food western diet is linked to depression and anxiety. Try to fill your home with fresh produce, frozen vegetables, and whole foods when possible.

If you or a family member is struggling with an eating disorder, please see the toolkit of resources provided by the UCSF Eating Disorders Program.

Work well enough from home

Working from home may be new to you and can have its own challenges, especially in a small home with children. Don't expect to have the same type of productivity as usual. We are all distracted and needing to cope with a different daily life now, while helping others. Reduce your goals for typical work that is not urgent, if possible. Here are some recommendations on how to stay focused and productive during work hours:

Dealing with isolation and quarantine

The psychological stress of sheltering in place when living alone or being in quarantine once infected can be severe. Here are some resources:

Cognitive and somatic coping

Our thoughts shape our physiological stress responses

Acute, short-term stress is not necessarily bad, and, in fact, can be good. We can approach stressors with a positive mental view that we can cope well, that we have the resources. We can also view the physical stress response as one that helps us perform better, such as increasing oxygen to the brain. These are both types of “cognitive reappraisal.” UCSF professor Wendy Mendes, PhD, has shown that teaching students a positive way to view acute stress led to better performance on tests.

Be realistic and fact-based. Since the COVID-19 pandemic will likely go on for months, we need to make sure we are creating breaks and coping well with the stressful events that arise each day. It’s easy to think about the worst outcomes, which are catastrophic, but that creates unnecessary stress arousal and suffering. It can be helpful to think of worst case, and then best case scenarios, and settle on something in between, according to University of Pennsylvania psychologist Martin E.P. Seligman, PhD.

Creating short-term stress in the body, that we recover quickly from, can even be good. It creates a calming effect afterward, stimulating the counter-regulatory stress response. Exercise is one example. A protocol of physical acute stress developed by Dutch extreme athlete Wim Hof has become very popular in many countries. Preliminary studies suggest it is helpful for improving our immune response, and Elissa Epel, PhD, and Wendy Mendes, PhD, are currently studying how it improves autonomic and emotional stress responses and mental health at UCSF. It consists of a carefully guided protocol of hyperventilation and breath retention and cold exposure. Wim Hof is offering the online course free now. If you want to try it, it is important to read his safety tips. One can download the Wim Hof Method app to guide you through the breathing.

The acute effects of deep breathing and cognitive reappraisal are important to use throughout the day. See the breathing techniques described below.

The UCSF Department of Psychiatry and Behavioral Sciences has created videos of strategies you can use immediately to reduce acute stress in the middle of your day. These are often considered trauma-informed strategies. Here are four different strategies for you to try:

Reducing stress arousal through breath practices

Practices that manage stress reactions in the moment are critical, particularly for front line providers. Taking time out during the day, frequently, to self regulate, can be very helpful. Find a breathing technique that works for calming you.

The most basic thing to know is that taking a longer exhale than inhale can help calm your body. Easy techniques include slow diaphragmatic belly breathing (vs. chest breathing), a 2:1 ratio for the exhale (i.e., inhale to the count of 4, exhale to the count of 8); 4-7-8 count breathing, and a common yogic alternate nostril breathing (pranayama). UCSF clinical professor Daphne Miller, MD, has used these techniques to help her and her patients in the hospital or even through Zoom.

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Online stress reduction resources

Different people like different types of stress reduction practices. On this website, we have pointed you to social support (at a distance!), exercise, and sleeping well - all of which build your stress resilience. It also helps tremendously to adopt a daily mind-body practice, like yoga, qi gong, or meditation. Even if it’s only for five or 10 minutes a day, that practice makes a difference. Set a time of day you block out for this on your calendar; if possible, right after waking is a great time for practice. We have highlighted free apps, but there are an abundance of longer practices on the web to do at home for deeper restoration.