Recently I was interviewed by Bristol 24/7, as they wanted to get a psychologists' take on the pandemic and what we can do to look after our mental health. You can read the published article here: https://www.bristol247.com/lifestyle/health/there-needs-to-be-more-done-to-protect-and-support-peoples-mental-health/?fbclid=IwAR092BJsu-THM3mxJz38JWO9-LVAOTFW2D9ohE3b1hoplCZ3XAcuVyzfefo
I have copied the original interview transcript below, in the hope that some of you might find the information useful. My take home message for you is this: Be kind to yourself. We are all unique, and we will all deal with this situation in different ways. That is perfectly fine. Try not to compare yourself to others, if you can avoid it. Look after your wellbeing in the ways that work for you, and if you are struggling please, please reach out.
Bristol 24/7 Interview, May 2020
1. Which emotions do people face during the lockdown? Could you explain why they experience these emotions and what they can do about them?
People might be experiencing a wide range of emotions right now. Common difficult emotions might be fear (which may manifest as anxiety), panic, anger, sadness, grief or worry. These are all really normal responses to traumatic situations, and the world is right now in the middle of a trauma. We know that people cope with trauma differently, so that is why one person might be experiencing something completely different to a friend or family member. Some of us have better developed coping strategies than others; some of us might have less to worry about than others. Whatever you are experiencing is something unique to you. We can find ways to cope better that might allow us to deal with these emotions more productively, but the first step is to acknowledge them & not to feel ashamed that we might be finding things tough.
One of the really difficult things is that right now there is so much uncertainty. We are faced with a threat that we don’t know much about, or how long it will go on for. When humans are faced with threat we might go into ‘fight, flight or freeze’ mode. This is a primal response that served us well in times past, when we might have had to survive in the wilds & have been faced with a predator. In our world now it isn’t always that helpful. When we enter this mode, our instincts might tell us to run away, to fight, or to stay still. We become hyper-aware of our surroundings, vigilant against attack. Our stress levels rise, keeping us in this anxious state. If we stay like this for too long, we can become exhausted & overcome with difficult emotions. Becoming aware of this, and finding ways to reduce these difficult feelings, can be beneficial.
There are many small, simple exercises that you can do to help navigate the difficult feelings you might be experiencing right now. When your threat system is in overdrive and you are starting to feel anxious, try to bring yourself back to the present moment. You can do this by ‘grounding’ yourself. This means being right here where you are now, rather than carried away with the whirling mass of anxious thoughts. Take some deep breaths – fill yourself up, & empty the air out completely. Do this a few times, really concentrating on your breath. Take your shoes off and feel your feet in contact with the floor, or try pressing your hands together or stretching your arms widely apart. Use the senses to help ground you: look around for 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell and 1 thing you can taste. Using your senses can be a very powerful way to ground you in the moment. Touch is one of our most important senses, and for those that are isolated this can feel really difficult right now. Try to think of ways you can soothe yourself – maybe run a deep bath and enjoy the sensation of the water holding you, put a hand to your heart, or give yourself a hug.
Other things you can try are short mindfulness/meditation activities, or muscle relaxation techniques. These are all things that only need a few minutes of your time, and might be just enough to move the focus away from what is distressing you. Once you feel calmer and more present, see if you can focus on things around you that you really value. For example, if nutrition and physical health are important to you, focus on making a tasty meal or snack, and really savour eating it. Go for a run or walk, and notice your surroundings as you do. Perhaps you value being a caring parent – can you spend a few minutes really focusing on your children and whatever activity they are engaged in? For more about this and other techniques, here are some useful links:
2. Some people feel an obligation to be productive during isolation. Why does this happen?
One of the ways to get through a difficult situation is to use distraction. This might mean throwing ourselves into things, to keep our minds occupied and away from the sense of threat. Whilst this can work wonders for some people, it isn’t the answer for everyone. Some people might thrive on giving to others during a crisis. Others feel the need to protect themselves and focus on their own world. Others still may be overcome with difficult emotions and might not feel able to be especially productive as the feelings are too overwhelming.
A good reason for some people to be productive is the sense of purpose and achievement it provides, both useful for maintaining our motivation and resilience. The problem at the moment, and one reason why seeing others being productive can be a source of anxiety, is that we all too often judge ourselves by much harsher standards than we might judge others. Being ‘productive’ can be as simple as getting out of bed in the morning, having some breakfast, or calling a friend. We don’t need to be constantly doing, especially in a time of crisis. If that works for you, then great. But if it doesn’t, try to adjust your standards. For example, I have a supportive WhatsApp group with some other school mums, but I have recently had to take a step back from the group. I had some tough days (even psychologists are not immune!) and I was starting to let the pressure to be the perfect parent and homeschooler get to me. I have two young children, one of whom is school age. I adjusted my expectations, and made the focus on ensuring my children are emotionally healthy as much as possible, not on lessons & keeping up with school work. They are always learning, though the skills they might be picking up now are to a greater extent framed around emotional regulation, communication and independent play, rather than maths, English and science. We are surviving, and we are doing this in a way that works for me and my family, and that’s good enough.
The same goes for hobbies. Great if you want to start learning a new skill, or developing an old one. Some people will flourish throwing themselves into these things right now. But if you’re not one of those people that’s ok too. These aren’t ordinary times. If everything is too overwhelming right now don’t put pressure on yourself to do more. Make yourself a cup of tea, give yourself a hug, and know that just getting through the day is absolutely enough to focus on.
3. The media are influencing people’s emotions, sometimes getting them anxious. What can the public do? Is it good to stay aware of the news during this pandemic?
Information overload: this is something I was discussing with colleagues recently. The news is saturated with information about coronavirus and its impact on the world. It can feel like there is no getting away from it. Not only are we living the reality, but we see it at every turn in every news article. Glaring headlines about the death toll, angry discussions about whether people are adhering to the rules or not, endless posturing about when they will find a vaccine. Getting sucked into this leaves precious little time to think of other things, to breathe, to be present in the moment. In a situation where we are feeling the fear, the constant barrage of negative news can heap additional pressure and worry on us. So what can you do? If you can, try to reduce your intake of the news. Do you really need rolling updates? Perhaps once a day for a few minutes will suffice instead. Try to balance the negative stories with the silly or funny stories. Perhaps limit your time on social media too, particularly before bed. Try to create a healthier routine for yourself, where you switch off from all news (and ideally, screens) earlier in the day. If you find it hard, deleting apps from your phone (news, Facebook, Instagram, Twitter, etc.) can help. You can still access these things, but the very fact you will have to actively search for them will perhaps make you more consciously aware of your actions.
4. Should people have a schedule even if they don’t have any obligations at home? Why?
It depends on your interpretation of a schedule. Some structure can enable a sense of control & safety, but too rigid a schedule can lead to feelings of anxiety & a sense of being ‘not good enough’. Some days might feel harder than others, & on those days you might want a more relaxed schedule. For some people, having a structure helps them get through the day & the repetitiveness of life in lockdown. This is a really personal thing. Importantly, whatever structure is in place, ensure it is meaningful and useful for you.
One thing to consider is that we are in a time of high stress, and this means that it may be very difficult to focus on some of our higher level needs. Perhaps you have heard of Maslow’s hierarchy of needs, a triangle of needs that starts with the most basic – Physiological – which means things like air, water, food, clothing, sleep & reproduction, then moves on to Safety (security, employment, resources, health & property), working towards higher level needs such as Love & Belonging, Esteem, and finally Self-actualisation. During a time of crisis and trauma we can’t necessarily focus on those higher level needs that we might usually be working towards achieving. We need to focus on those needs in the bottom one or two layers – physiological and safety needs. Therefore your schedule may look very different to how it might have done pre-covid. Perhaps it just contains things like when you will eat, when you might get outside, what you need to do to prepare for sleep. That is ok. You are surviving.
5. Which one do you think is the main factor of fear during this pandemic? The deaths, the uncertainty, the economic crisis, isolation…?
Again, this will depend upon the individual. Perhaps you are in one of the vulnerable categories. For you, the physical impact of the virus might be consuming your thoughts. For others, the lack of control over their life might be the overarching concern, or the loss of work and income. For many people, particularly now we have been in lockdown for several weeks, you might be feeling the impact of isolation much more keenly. We know that loneliness is one of the greatest contributors to mental health problems, and so something like this can exacerbate those feelings. I know it doesn’t feel the same as person to person contact, but try to connect with people in any way you can, such as through video calls, phone calls, or even writing letters. If you are feeling lonely there are places that can help. The NHS volunteer responders helpline might help, whether you need supplies or just a chat:
or there are other local services doing similar things, either through Bristol City Council (https://www.bristol.gov.uk/crime-emergencies/coronavirus-covid-19-what-you-need-to-know ) or Acorn (https://acorntheunion.org.uk/corona/). Don’t wait to reach out – there are people ready & willing to be with you through this time.
6. Do you think this pandemic is going to cause mental health problems in the long term?
We don’t yet know the full impact that the pandemic will have on the world, but one thing we do know is that mental health services are likely to be busier than ever. Already under resourced and stretched to capacity, this is likely to put a huge strain on the system. Some of the issues that we might see an increase in are PTSD (post-traumatic stress disorder), depression, and anxiety. Dealing with this pandemic may also exacerbate pre-existing issues. As I mentioned earlier, loneliness can have a real impact on our mental health, and these effects may well be long-lasting. Social distancing measures are likely to be in place for quite some time, which many people may struggle to live with. There are also the wider societal impacts to consider. We don’t yet know the true economic or social costs of this pandemic, but they are likely to be deep and pervasive, and this is something that needs to be urgently considered. However, it is not all doom and gloom. Humans are surprisingly resilient – we only have to look at events in history to tell us that. We will bounce back, many people may thrive through making healthy changes to their world because of this situation. For example, it has been wonderful to see the re-emergence of localism and community spirit. This helps us stay connected and to feel safe, and this is something we can consciously carry forward into the new world ahead of us.
7. Who do you think is the most affected target group for mental health issues during this pandemic: Young people, adults, old people, people who live alone…? Why? What can they do?
There isn’t really a simple answer to this question. It is less likely that there will be a certain sector of the population that are more likely to suffer, in terms of age group, but that the issues they face may be different. For example, isolation and loneliness may be more likely to impact on those who live alone, but equally it can affect someone who lives in a busy house but feels terribly alone. Seeing others around us, whom we don’t connect with, can feel even lonelier than being in an empty room. People of working age may be facing issues around loss of income and security. Children may find it hard adjusting to life without their peers around, at a time when these friendships can be so crucial in establishing a sense of identity and belonging. Relationships will be tested due to the lack of personal space many people are experiencing, with loss of the usual routes to get away or let off steam, so we might see a rise in relationship problems. For elderly people, being in one of the most vulnerable categories may be increasing levels of health anxiety and stress, and this may also be impacting on their families who can’t be with them or who are worrying about what might happen to them. And then there are those who have lost, or will lose, loved ones, and will be working through their grief in the times ahead. If you are feeling like things are starting to become too much for you, then try to reach out. Perhaps try some of the exercises discussed earlier, talk to someone you trust, call a helpline (such as Mind, or the Samaritans), or talk to your GP, as they can put you in touch with local mental health services. Don’t suffer in silence – struggling with your mental health is nothing to be ashamed of.
8. What role is psychotherapy playing right now? Why do you think it is important during this pandemic?
When someone is in the middle of a trauma we might not work directly with that trauma, in a therapeutic sense. But a space might be offered to offload and contain the difficult feelings that are being experienced, for the person to get their story out rather than bottle it all up. This might readily apply to frontline staff who right now are dealing with some really difficult situations and decisions. Later work will focus on processing that trauma so that the negative impact over time can be lessened and not lead to further mental health problems.
Accessing therapy can be helpful as it can give you a line of support to help you make sense of the things you are feeling and the ways you are acting. Just having someone who is not part of your usual network to talk to, who can offer a warm, safe and non-judgemental space can be incredibly helpful. Often people find they can open up in a different way with a therapist, saying the things that might otherwise cause them shame or embarrassment. Sharing your suffering can help change your narrative or view of things that have happened in the past, so that they can begin to cause less pain. A therapist can also help someone with techniques to process and manage emotions, which might be particularly helpful in times of high stress, panic and anxiety.
9. Is there an increasing demand on mental health care? How has the Government responded to this need?
Quite quickly after the pandemic started some services were set up to support frontline staff therapeutically, which has been wonderful to see. However, many of these are staffed by volunteers. Whilst this is great, it is not sustainable. Therapists also have lives, families, and basic needs that must be met. Whilst I absolutely believe we need to have a much wider provision of mental health services that are free at the point of contact, there should not be an expectation that therapists themselves provide this for free. It takes a great deal of training to become a skilled counsellor/therapist/psychologist, and this must be recognised. Alongside this, there needs to be adequate support for those offering the therapy, especially at present when we are also living through the pandemic and trying to deal with it as much as our clients are.
I think the government has primarily focused on physical health needs, and this has been justifiable and necessary. However, as we start to consider the on-going impact of the pandemic on peoples lives, not just those on the frontline but in every part of our society, there needs to be more done to protect and support people’s mental health. If we don’t do this society will take so much longer to bounce back from the pandemic, and we will only create further problems for ourselves down the line. People need to know that they can reach out if they are struggling, and that when they reach out, we will be ready.
Dr Jess Walker