Managing Anxiety in a Pandemic: 5 strategies from someone who knows
Written by Sarah Elizabeth McMillan
Living with an underlying health condition isn’t always easy, but add a pandemic to the mix and things really get interesting. As someone with Marfan syndrome (and meeting several of the Marfan Foundation’s criteria for being at risk of serious complications of COVID-19), I can tell you that I’ve had to step up my game at managing my anxiety since the start of the pandemic.
Many of us have been directed by our health teams to strictly self isolate on top of the general recommendations from the Public Health Agency of Canada. It’s no wonder that new and increased anxiety, as well as other mental health challenges, is on the rise. Acknowledging some of the ways anxiety may be impacting all of us right now may be just what we all need to help us ‘keep calm and carry on’. In this post I share some strategies and resources that can help us cope during the months ahead.
So what is anxiety anyway? It tends to have four broad categories of symptoms:
Physical feelings: Fatigue or tiredness; irritability; muscle pains; headaches; stomach pain; tension in parts of your body
Thoughts: Worrying thoughts often start with “what if..”, focus on what might happen, and can be uncontrollable, rapid or focus on worst case scenarios
Emotions: Fear; sadness; anger; frustration; guilt; restlessness; overwhelm
Behaviours: Avoidance; constant checking; reassurance seeking; interrupted sleep/difficulty falling asleep or staying asleep; difficulty concentrating
When we worry excessively or experience anxiety we may feel unable to cope. Panic attacks that can accompany severe anxiety can mimic the sensations of a heart attack or chest pain. (If you’re experiencing new or worsening chest pain please contact 911 or go to your nearest emergency room).
Sometimes, living with an underlying health condition or repeatedly interacting with the healthcare system, like we often have, can heighten feelings of anxiety. There’s a lot of talk about medical equipment like ventilators in the news these days and discussions about whether or not our healthcare system will be able to handle the number of people who may need care. This can understandably create a lot of fear and may even bring back difficult memories for us. Many of us have had our outpatient appointments cancelled or postponed, or are nervous about going to the hospital or having a necessary procedure during this time. For some, having access to our healthcare system is a comfort which now feels like it’s been somewhat taken away and we’re wondering when we will get to see our healthcare teams in person again. For others, who don’t always feel safe accessing care, the thought of getting sick at this time might be especially distressing. I know I’ve fit into both scenarios at times. If you are feeling this way, it might be helpful to reach out to one of your healthcare providers that you trust to have a conversation about it.
That being said, living with an underlying health condition has given us a number of strengths, or what are sometimes called protective factors. These are attributes or skills that help people, families or communities handle stressful situations more effectively. We know we’ve done hard things before - like being diagnosed with a rare genetic condition (and all that comes with it) and yet we’re here, surviving and thriving. Uncertainty is something we’re intimately familiar with already, just in a different way. We’re resourceful - we’ve had to seek out new information, navigate several complicated systems (healthcare, school, social services etc.) and partner with all kinds of professionals. Many of us have had our lives upended, careers redirected, roles changed, felt grief, isolation and fear .. not all that different to what’s happening out in the world right now, except we have prior experience. We’ve already had to adapt to a new normal. What skills or ways of coping did you learn then that can help you now? If you’re not sure, ask someone in your life to have a conversation with you about it.
You may have heard some of the great advice out there on dealing with these uncertain times - control what you can, limit how often you read the news (and focus only on credible sources), remain connected to friends and family. If you haven’t heard of any of these strategies for dealing with COVID-19, I’ll share some useful links in the resources at the end of this post. I would also like to offer some additional tools and describe how they are applicable to those of us living with chronic illness.
Take small steps to help you feel more prepared
No, I’m not talking about stockpiling toilet paper. But because anxiety is so often future-focused, it can help to take some steps now so you can feel more at ease. A health related example of this is creating an easily accessible document with some key information.
This could include:
Your full name, date of birth and provincial health identification number
Insurance provider
Short medical and surgical history
Current medications
Allergies or specific medications that are contraindicated for your condition (link to marfan guidelines)
Doctors name, location and contact information
Emergency contact names and contact information
Having this information on hand in the same place means that if we did get sick we wouldn’t have to locate each piece of information. The easier we can make it to take care of ourselves. Another example is checking our medications regularly to ensure we have enough and can order more before they run out.
Where this gets tricky is that people in general tend to avoid doing things in an effort to reduce difficult feelings of anxiety and panic. What often ends up happening instead is we actually increase our anxiety this way. This is called the anxiety avoidance cycle. If the above task feels overwhelming - break it down into smaller chunks. Start by writing out your emergency contact information. Maybe that’s all you can do for today, that’s okay. You are doing great.
2. Be kind to yourself and curious about how you’re feeling
It’s really important for you to know that feeling some degree of worry, anxiety or other intense emotions at this time is normal, and you’re not alone in feeling this way. Anxiety is our body's way of telling us that we’re in danger. It makes sense that we are worried about COVID-19 as it is a global threat having a very real impact on our lives and potentially even more so for those of us with underlying health conditions. Identifying and naming the feelings and sensations we’re experiencing that could be caused by anxiety, and learning strategies to manage them when they come up can help us cope. You’ve got to name it to tame it! Sometimes we can feel like this anxiety in response to COVID is only happening to us, which can really increase our sense of isolation. I want to reassure you that it’s not - people all over the globe and in our own communities are feeling it too. There is a collective grief occurring right now and that may be compounded for those of us who have experienced loss related to our diagnoses.
When faced with a major stressor, some of us experience the opposite of racing thoughts or feelings of panic. We tend to shut down and zone out instead. You might feel numb, checked out or like what’s happening right now isn’t real. Sometimes we even fluctuate between these two states or fall somewhere in the middle.
Notice what’s coming up for you and when it changes. Approach these feelings, sensations, behaviours with curiosity rather than judgement. Remember, your body has developed these responses to stress to keep you safe. Sometimes we forget this in the moment and can be really hard on ourselves for the way our mind and body responds. Speak kindly to yourself about this, like you would a frightened friend, family member or pet. Self-compassion is the greatest gift we can give ourselves.
3. Ground yourself to bring yourself back into the present moment
Grounding is a really useful tool to calm your mind and body by turning your attention away from what is causing you stress. You can start by placing your feet flat on the floor, bed or couch for a few moments. Feel the weight of your legs, the texture of the surface below your feet, the temperature of the air around them. This is an example of turning your awareness towards our sense of touch. You can do a similar exercise with your other senses: smell, taste, sight, sound by focusing on the small details your mind often leaves out.
If you’ve never tried this exercise before, start slow. Many of us living with longstanding illnesses can feel disconnected from our bodies or hypervigilant towards our bodily sensations. Tuning into our senses can be difficult for us. If you think this might be you - try activities that will amplify the senses that you know already feel good to you - make your favourite meal (notice that delicious aroma, comforting taste), wear your favourite article of clothing (is it soft? A specific colour?) or listen to a great song you love to sing along to (do you like it loud? Or quiet? What instruments do you hear?). Notice and hold on to these moments of joy.
If you put the term “grounding exercise” into Google you’ll find so many other examples. Experiment with them and choose one that works for you.
4. Create a loose routine instead of pushing yourself to be productive
The world is adjusting to a “new normal” and because we’ve likely had to do that ourselves while living with a diagnosis we know how uncomfortable and difficult it can be. But we are also adapting and new routines may be part of that. You’ve likely heard and read phrases going around the internet pushing us to “make the most of quarantine”. If learning a new skill, picking up an old hobby, spring cleaning etc. are activities you’d like to do then great, but this push to be productive with the time we’ve been given (whether it comes from our own inner voice or someone else's) can also feel really shaming. We may feel these messages more deeply because so often individuals' worth in society is tied to their economic output. This leads us to feel like a) we need to perform in order to be worthy and b) it’s our responsibility to overcome the challenges of our health condition. With these weights on our shoulders, it’s no wonder our sleep is disrupted.
Your worth is not defined by how productive you are during self-isolation or quarantine, or any other time for that matter.
That being said, it can be helpful to develop a new routine to give yourself some loose structure throughout the day. Think about your weekly routine before the pandemic and what may be important for you to keep in (with adaptation) and leave out. Maybe you want to wake up a little later but still have your morning tea to start the day. Vary your activities throughout the day to get some movement and intentionally make time for things that bring a smile to your face. Little rituals that we can rely on can help sustain us during difficult times. Lastly, don’t forget to eat regularly and make time for rest knowing that we may need more of it during this time as sleep is essential for our bodies to heal, repair and integrate.
5. Use your experience to help others
The world is now experiencing some of what we’ve already dealt with - fear over their health, social isolation, uncertainty etc.. If you’re comfortable with doing so, this can be a great opportunity to help your family, friends and others by leveraging the empathy and unique coping skills you’ve developed to deal with your own illness. You can be a leader in helping people navigate this challenging time by asking them questions you wish others asked you - how are you really doing? Do you have what you need? And if not, how can you get it? Letting someone know you’re there for them and really listening to what they have to say is a rare and powerful way of connecting.
This might not be for everyone and it certainly should not be all the time (healthy boundaries are important) but it can feel empowering to give where you can. It can also be a chance to educate about how you learned these skills - living with a complex underlying health condition like Marfan syndrome.
I hope you’ve found this post helpful during this challenging time. Let us know what you think. And please remember, there’s no shame in reaching out for help. You are not alone. Contact a licensed medical or mental health professional in your province or local area for assistance.
If you or a loved one are struggling you can call Crisis Services Canada toll free 1-833-456-4566 where support is available 24/7/365. Visit www.crisisservicescanada.ca for more information. If you are experiencing an emergency dial 9-1-1 immediately.
Connect to your peers on Marfan Syndrome Canada Support Group on Facebook.
About the Author:
Sarah Elizabeth McMillan
MA, MSW, RSW
Sarah Elizabeth McMillan is a registered social worker/therapist, healthcare leader and patient living with Marfan syndrome (& co.). She is located in Toronto ON and you can find her online at www.sarahemcmillan.com or @sarahemcmillan.rsw on Instagram.
More Resources:
Free Canadian Phone Lines:
KidsHelpPhone Ages 20 Years and Under 1-800-668-6868 or text CONNECT to 686868
First Nations and Inuit Hope for Wellness 24/7 Help Line 1-855-242-3310
Trans LifeLine – All Ages 1-877-330-6366
Useful Links:
Mental Health and the COVID-19 Pandemic, Centre for Addiction and Mental Health
COVID-19 and mental health, Canadian Mental Health Association
Free Anxiety Resources, Anxiety Canada
Living with worry and anxiety amidst global uncertainty, Psychology Tools
Webinars from the National Marfan Foundation
This is general information about health and related subjects. The information and other content provided, or any linked materials are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment. If you or any other person has a medical concern, you should consult with your health care provider or seek other professional medical treatment. Never disregard professional medical advice or delay. If you think you may have a medical emergency, call your doctor or emergency services immediately. The opinions and views expressed by GADA Canada have no relation to those of any academic, hospital, health practice or other institution.