Month: May 2020

The coronavirus pandemic has thrown countries and individuals into the throes of newfound challenges and stress. While the initial waves of the pandemic were focused on mitigating the spread of the viral contagion, there is increasing focus on the mental health implications of the pandemic experienced by individuals, families, and whole communities. Some individuals may experience heightened anxiety, anger, frustration, or ruminate about their own health and that of their loved ones. Others may find that these negative feelings manifest themselves in physical and behavioral ways ranging from gastro-related issues to more severe expressions such as substance use and abuse, self-harm behaviors, and suicidal behavior.

In this blog, we will focus on building a survival toolbox that addresses your needs both within yourself and externally. The ways that we have utilized for comfort in the pre-pandemic days may not be available to us now. However, we now have opportunities to build a toolbox and grow new tools for survival. Use the 3S-inside-out survival toolbox checklist included at the bottom of the blog to help you identify and monitor your areas of strength and need.

Self-Regulation

With the stay-home restrictions, you may experience your feelings more acutely in the absence of everyday distractions. One way to self-regulate is to identify the feelings you are experiencing and connect with them instead of pushing them away. For example, you could say to yourself ‘I feel sad.’ Invite yourself to experience the negative (examples include anger, pain, disappointment) and positive feelings (examples include content, peaceful, joyful) throughout the day and identify at least three emotions daily. You could verbally say these feelings to yourself or journal them, and while you may be curious as to why you are feeling a certain way, why’s not important in this process. Owning and accepting your feelings is an important part of self-regulation.

Another way to regulate yourself is to breathe. Although this is seemingly basic, breathing is a powerful tool for enhancing circulation in your body, supplying your body with oxygen to do its important work in your body, pairing with the blood in the system to provide energy and remove waste material. However, deep mindful breathing can also refresh your brain and mind. One breathing activity you may try is to take a deep breath in through your nose and take your time to exhale all of that breath through your nose. Allow yourself to breathe deeply during intervals throughout the day especially when you feel overwhelmed or experience an emotional roller coaster. Perhaps you could also try breathing into your feelings.

Support Networks

Humans are social creatures and are ever inclined to connect with others. One of the major implications of the pandemic is that it breeds a sense of isolation with the lack of face-to-face social interactions. Some individuals live with friends, roommates, their families, or significant others but there are others who live all by themselves. The felt sense of isolation may not only be experienced for those who live alone but may also apply to those who live with others and yet feel alone and disconnected.

Brene Brown (n.d) defines connection as the energy between individuals when they feel seen, heard, and valued; a non-judgmental space is created where they can both give and receive freely to each other and enjoy the nourishment from this relationship. When individuals experience this connection, there can be significant gains. For those who are living with others, there may be opportunities to foster connections by creating or building some rituals daily. Simple rituals may take the form of joining by preparing meals, enjoying take-out food together, or even having a dance chores party. As long as the rituals happen at about the same time daily and are enjoyable activities, one can benefit from these events. For those who are living alone, there may be opportunities to reach out to family and/or friends via Zoom or other virtual technologies to engage in a casual conversation or join interactive online games together. All is not lost if we do not have people we can connect with. With the onset of the pandemic, new support groups have been created and people are now meeting virtually to provide connection and support to each other during these times in the community. Additionally, you can reach out to a therapist to build your support network during these uncertain times.

Self-Care

Self-care is commonly associated with ideas that are grandiose in nature such as going for a spa treatment or a vacation. However, taking care of yourself in small ways is also a form of self-care and during this pandemic; these small ways of caring for yourself may be more significant than before. Some of the less common self-care ideas include movement and bursts of hope. Movement can range from gentle stretches to high-intensity workouts. How about incorporating movement in your day if you do not enjoy exercise? Gentle stretches can invite energy into your body and awaken your senses. Have you tried including bursts of hope in your day? Bursts of hope can take the form of finding an inspirational quote and jotting it down for the day or finding one good thing that has happened throughout the day. Reflecting on these bursts of joy can make for a heartfelt experience.

You have what it takes to build your inside-out survival toolbox. There are no limits to growing new tools. Try it out!

My 3S-Inside-Out Survival Toolbox Checklist

Place a check against each of the key and sub-key items and see what your survival toolbox looks like in terms of areas of strengths and needs!

□      Are you self-regulated?
– Are you taking at least 5 to 10 deep breaths daily?
– Are you in touch with your feelings? Identify at least 3 emotions a day.
– How are you expressing your feelings (journaling, talking to someone, etc.)?

□      Are you well-supported?
– Do you have family and friends to connect with in-person or virtually at least once a day?
– If not, are you a part of a community support group?
– If not, can you identify a community support group to join?
– What other supports can you think of?

□      Are you engaging in self-care?
– Are you taking care of yourself physically?
– Are you including bursts of hope daily?
– What are other ways of taking care of yourself?

References:
Mental Health America. (2020) Owning your feelings.
https://mhanational.org/owning-your- feelings?fbclid=IwAR2I2rp37g48q3jtbF-uzzJGQljX37OyXLdQnxmlqs4DQIFfXV8flDjAkf8K1c
Munzel, T., & Daiber, A. (April 28, 2020). Public mental health: A key factor in dealing with COVID-19. Open Access Government.
https://www.openaccessgovernment.org/public-   mental-health-a-key-factor-in-dealing-with- covid19/86125/?fbclid=IwAR1djmDtygDtIsU4j1lkXvT0Z9LN7FIo1wiFtCE3U08Lrt2X        AXMBRnMpct8
Onneby, H. (2019). A first aid kit for when life falls apart. Tiny Buddha.        
https://tinybuddha.com/blog/a-first-aid-kit-for-when-life-falls- apart/?fbclid=IwAR3Lw_v97LPEPOgo9XeqCLTg5-Kn3bMH3XWpst_qYcciOPff-apDQJcWlJI

Written by:
Isabelle Ong, Ph.D., LCMHCA, NCC (USA)
Clinical Mental Health Counselor & Psychotherapist for Individuals, Children, Adolescents, and Couples

Anxious, bored, frustrated and lonely are some of the emotions people have described since the COVID-19 circuit breaker first began in Singapore. These emotions are not uncommon as many around the world have reported similar feelings since COVID-19 reached pandemic proportions this year.  There is now a growing body of research that demonstrates the effects of imposed isolation on psychological and physical wellbeing, and more importantly, offers ways of managing and countering its effects on our human psyche.

Brooks and her colleagues (2020) at King’s College London recently conducted a review of studies investigating the psychological impacts of quarantine adopted during the periods of Ebola, SARS, MERS and H1Ni influenza. Their review revealed that some of the common effects of long-term quarantine and isolation comprised anxiety, low mood, depression, stress, irritability, insomnia, and acute (and post-) traumatic stress symptoms. Factors that were observed to heighten people’s psychological distress included longer periods of quarantine, fears of infecting self and/ or others, loss of physical and social contact, loss of usual routines, having inadequate supplies, and lack of clear and adequate information from health and other government agencies. These effects were observed even three years after the quarantine and were most pronounced among those who had direct exposure to the high-risk situations (i.e., healthcare workers) or a history of psychiatric illnesses.

What might the reasons for this extent of psychological distress? Firstly, Slovic and Peters (2006) reported that certain factors are more likely to increase (perceptions of) fear such as when the threat is novel or unfamiliar, there is a lack of control over the threat, and when the threat involves a sense of dread. Further, Holman and colleagues (2014) described that while communication of information is essential and useful, we need to be mindful the amount and type of exposure to information because stress and anxiety can be exacerbated by too much media. Management of stress is therefore crucial (Garfin, Thompson, & Holman, 2018) especially since imposed isolation can increase the likelihood of negative psychological outcomes for individuals, especially if the quarantine period is extended or indefinite with no clear time limit (Brooks et al., 2020). Imposed quarantine can be an oftentimes isolating and lonely experience, with those who have strong social relationships 50% more likely to survive compared with their peers who have poor or insufficient social relationships (Holt-Lunstad, Smith, & Layton, 2010).

Given these facts, what might we do during quarantine you may ask? You may wish to observe the 3Cs of Choice, Control and Certainty in making this period of imposed isolation a little more comfortable..

Choice: Imposed isolation and social distancing is not a pleasant experience for most, so let’s instead choose a more helpful mindset  – perhaps this can be an opportunity for reflection and taking a step back from the hustle and bustle of our daily lives, or a time to practice gratitude for the little joys and pleasures that we do have. Keep in mind that this sacrifice that we’re taking is one that will keep ourselves, loved ones and others in our community safe.

Control: Continue to exercise control over aspects of our lives that we reasonably can, such as picking up a new skill or activity, setting goals you can work towards during this period of working from home. Intentionally make varied and intentional choices when it comes to meal times in what you may cook or choose to takeaway or Grabfood.  Don’t forget to control your intake of COVID-related news and limit it to reputable reporting sources.. keep a rein on that wandering mind and don’t let it catastrophise!

Certainty: Create a routine for yourself and stick to it – remember to include both achievement-oriented and pleasurable activities including exercise and leisure. Make dates with your loved ones, friends and family to Zoom or Skype, or to play Animal Crossing together, and consciously maintain your social support and friendship networks. Rest a little easier in the certainty and security that you’ve got your act together, and that life still goes on in spite of all the uncertainty around you.

So make realistic and flexible choices that allow you to maintain control and achieve certainty. Remember, we are all in this together.

References

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., et al. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet, 395, 912-920. https://doi.org/10.1016/s0140-6736(20)30460-8

Garfin, D. R., Thompson, R. R., & Holman, E. A. (2018). Acute stress and subsequent health outcomes: A systematic review. Journal of Psychosomatic Research, 112, 107-113. https://doi.org/10.1016/j.jpsychores.2018.05.017     

Holman, E. A., Garfin, D. R., & Silver, R. C. (2014). Proceedings of the National Academy of Sciences of the United States of America, 111(1), 93-98. https://doi.org/10.1073/pnas.1316265110

Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A metanalytic review. PLOS Medicine, 7(7): e1000316. https://doi.org/10.1371/journal.pmed.1000316.

Horesh, D., & Brown, A. D. (2020). Traumatic stress in the age of COVID-19: A call to close critical gaps and adapt to new realities. Psychological Trauma: Theory, research, practice and policy, 12(4), 331-335. http://dx.doi.org/10.1037/tra0000592.

Netburn, D. (2020, April 29). Feeling drained by coronavirus quarantine? Science can explain why. The Los Angeles Times. https://www.latimes.com/science/story/2020-04-29/what-science-tells-us-about-the-psychological-impacts-of-coronavirus-isolation

Slovic, P., & Peters, E. (2006). Risk perception and affect. Current Directions in Psychological Science, 15(6), 322-325. https://doi.org/10.1111/j.1467-8721.2006.00461.x

Weir, K. (2020, March 16). Seven crucial research findings that can help people deal with COVID-19. Retrieved from https://www.apa.org/news/apa/2020/03/covid-19-research-findings

Written by:
Dr. Daphne Goh
Clinical Psychologist