Anxiety & Processing COVID-19 Information

For decades, cognitive scientists have been studying how we process both neutral and stressful information. When humans undergo stressful experiences, we tend to process information in ways that either assist us in avoiding discomfort or cause us great discomfort in the service of increasing our physical safety. How you process information about COVID-19 may have profound impacts on both the physical safety and mental health of you and those in your community.

I am writing this entry to attempt to assist you (and myself) with digesting what is happening to us in a way that I believe is adaptive, but may also be uncomfortable. As the pandemic unfolds, we will make ongoing decisions about where we work, where we exercise and how we meet our needs for social connection. These decisions will need to be made on the basis of facts, and to gain access to those facts, you will need to encounter information about things that make you uncomfortable. If you “bury your head in the sand” in order to avoid discomfort, you will likely miss important information that could influence you to behave in ways that minimize other’s exposure to the illness and save lives. If you hyper-focus on catastrophic information, you may fall into hopelessness and apathy, or constant agitation, which could also be dangerous to both your physical and mental health.

We Are Not Supposed to Feel Comfortable Right Now

Being uncomfortable or upset when your community faces a life threatening stressor is not necessarily a mental health problem, but may be an important sign that you are realistically processing information. Since we are a society that is highly focused on reducing discomfort, I think it’s especially important that we do not equate feeling upset and uncomfortable with a “mental health problem”. Our usual response to discomfort or agitation is to try to minimize it with actions such as taking a pill, drinking a beer, exercising, or going to a Psychologist for “skills” in “dealing with anxiety” so that we can get on with our lives. In short, we work hard to train ourselves to ignore the feeling and move on. This makes sense when we aren’t actually in danger. It’s like your fire alarm is going off because the steam from your shower set it off accidentally. You just turn it off and go back to what you were doing. 

The situation now is different. The agitation you may feel is in response to a new threat to human safety and while we have had to deal with illness since the dawn of time, this one is new. We are struggling to figure out how to best stay safe from it and decrease the number of people who die or are injured as a result of it. We are trying to figure out how to avoid increasing scenarios where doctors have to choose who gets a ventilator and who does not. Now is not the time to ignore your discomfort and move forward with life as usual.  

Mental Health Problems and COVID-19

There is also such a thing as taking a bad scenario and mentally making it much, much worse. The fear, “we are going to end up just like the dinosaurs; everyone will die” is an example of how one could acknowledge the evidence that people are dying, but mentally take it to a whole new level, for which there is currently no evidence. If one believed this, they might experience near constant agitation, which weakens the immune system, or a sense of apathy (what’s the point) which could outlast the immediate crisis. Part of the motivation to write this entry is that while 911 calls in the Portland, OR area are less frequent, suicide-related calls have increased forty-one percent since this time last year and twenty-three percent since the ten days before Oregon’s governor issued a stay at home order. Suicidal thinking can increase to dangerous levels at times when people begin to objectify their own lives and see themselves as burdensome to others. We are entering a time of great economic uncertainty, which tends to lead to people objectifying their self-worth. If people begin to think of themselves as not valuable, not important, not worthy of living, we are in for a true mental health crisis. COVID-19 can kill you, regardless of age and underlying medical conditions, but suicidal thinking can also lead to death and other mental health conditions can drastically interfere with functioning.

I know this is hard to read, think and talk about, but I’ll do my best to be gentle, yet still matter-of-fact at the same time. It’s important for the physical and mental safety of yourself and others that you don neither the “rose colored glasses” nor the “dark tinted glasses”, but try to process what is happening to you and your loved ones, relying as much as possible on the facts available to you, rather than either denying or minimizing upsetting information or assuming the worst case scenario as a fact, before it even happens. I know both can be hard, but know that no one has it “figured out”, no one truly has their stuff together, no matter what it might seem on the outside. 

Ways of Processing Stressful Information 

To talk about ways of coping ineffectively with stressful information, I will draw from Cognitive Processing Therapy (CPT), an evidence-based model developed to treat Posttraumatic Stress Disorder. The theoretical basis of the model, however, is helpful for all sorts of conditions.

Cognitive therapy, in general, relies on the theory that people operate in the world based on a set of beliefs about how the world works. Those beliefs start out simple when we are young (e.g., I am safe) and get modified as we encounter experiences that do not match those beliefs (e.g., I am safe when I am not putting my hand on the stove). 

Information is processed in an adaptive way when an existing belief is modified to fit new information (called “accommodation”). For example, “I’m not completely safe, because I can’t completely prevent myself from ever getting COVID-19, but if most of us stay home right now, we will not all get sick at once and overwhelm the hospitals.” Problems arise when a person tries to change the meaning of incoming information in a way that is no longer accurate so that their existing belief can stay the same (called “assimilation”). For example, “I am safe and I don’t need to worry about COVID-19 because I am young”, or “The flu kills more people than COVID-19 has, so I don’t need to change my behavior and I’m still as safe as I ever was.” Other problems arise when the belief is changed too much (called “over accommodation”). An example of over-accommodation is, “The world as we know it is completely over. Nothing will ever be the same again. I will never be safe again” or “If I leave my house, I will die.” 

How to Avoid Resorting to Non-adaptive Assimilation

  1. Recognize that the world is filled with uncertainty right now and work on accepting that. Our minds are set up to try relentlessly to resolve or reduce uncertainty and generally that has been a helpful thing for us humans. However, it’s not possible to quickly resolve many of the uncertainties regarding both COVID-19 and our economic situation. Say things to yourself or others like, “we don’t know for sure, but given what we know so far it seems that…” or “we don’t know yet what will happen and that is very uncomfortable”
  2. As new information is gathered and theories evolve to accommodate the new data, evolve your thinking as well, such as “at first it seemed… however, now it is looking more like…”. Notice when your mind wants to turn away from upsetting or disturbing information. Try to resist that impulse and instead take in the facts and remember that this isn’t supposed to be comfortable. It’s hard. It takes courage, but you are tougher than you think.
  3. Don’t accuse other people of “not having the facts”, argue or dismiss other people’s thinking. Instead, try to see what facts they are basing their decisions on. We are rapidly gaining information and it’s possible they may have encountered information you haven’t yet.
  4. If you notice yourself thinking someone else is “over-reacting”, ask yourself what they know that you may not. Check in to see if you are ignoring any facts in order to make yourself feel more comfortable or justify doing activities that make you feel better. Remember that when things are getting exponentially worse, the right time to change your behavior is before it seems like you absolutely have to. If you are getting accused of over-reacting, you may be right on target.

How to Avoid Resorting to Non-adaptive Over-accommodation

  1. Recognize that the world is filled with uncertainty right now and work on accepting that. Say or think things like, “even though it seems likely that… it’s also possible that…” or “I need to prepare for… but it’s ok to enjoy the moment right now” or “I’ve already lost a lot of what I appreciated before this, but I still deeply appreciate…” Finally, please do acknowledge that no one is a fortune teller and while it is very important for us to make reasonable predictions based on the data we have, no one knows exactly or precisely how this will play out. Accept the uncertainty.
  2. Remember to base conclusions on facts, not feelings. If you are upset, ask yourself what the thought is that goes with your upset feeling. “Nothing is as important as researching information about the spread of COVID-19” or “What if someone close to me gets sick and dies?” Then ask yourself what the evidence is for and against that thought. In this situation, looking for the evidence for and against will not necessarily drastically reduce your discomfort. Instead, it will ensure that you are processing information adaptively and therefore not over-accommodating, making a bad situation worse for yourself emotionally.
  3. Remember feelings and thoughts (or beliefs) are two different things and thoughts can be badly distorted when you are feeling distressed. You may, at times feel scared or very sad and these feelings are valid. However, be wary of thoughts that are extreme or absolute like, “I’ll never recover from this financially or emotionally” or “I can’t handle this” or even thoughts like, “no one likes me” or “I’m completely alone”. If you have these thoughts, don’t automatically accept them as true. Instead evaluate them based on evidence (see step 2). Especially look out for common, negative core beliefs that get activated from this highly stressful situation such as, “I’m not good enough, I’m worthless, I’m unloveable”. Modifying these belies is the focus of cognitive therapy, so noticing them and not buying into them early on could prevent mental health problems from arising or becoming worse.
  4. If you are beginning to think suicidal thoughts, contact the national suicide crisis line by calling 1-800-273-8255. Often suicidal thinking can signal that you want to end this chapter of your life and move on to something better in life, but that your mind can’t figure out how to do that. Acknowledge that you really need and want things to change and that even though it doesn’t feel like it will, things changing is the one constant in this world. If you have begun to doubt your own self-worth, remember that no one can or should be objectifying human life. We need everyone right now.  In the words of Max Ehrmann in “Desiderata”: “Beyond a wholesome discipline, be gentle with yourself. You are a child of the universe no less than the trees and the stars; you have a right to be here”. We are going to lose a lot of people to this virus and we can’t afford to lose you too. Good times are somewhere around the bend or on the other side of the big hill we are climbing, even if it doesn’t feel like it. 
  5. Do something other than research COVID-19. If you are a hyper-researcher (like me), that’s great, but recognize that thinking you need to learn everything about COVID-19 is an over-accommodation in and of itself. It’s a form of the belief, “I’m safer when I have more information”, which is true, but only up to a point. Just like washing your hands 1-2 times is recommended to remove germs, washing your hands 5-6 times in a row probably doesn’t do anything beyond what is accomplished in the first couple times. I know that enjoying your time at home with loved ones, doing projects you’ve always wanted to do and binge watching netflix may seem like an “irresponsible” way to handle a dire situation, but ask yourself if this conclusion is based on facts or feelings. If you feel like you need to constantly be doing something to prevent illness, that may or may not be true, depending on the particulars of your situation. I’ll leave it to you evaluate the evidence and decide for yourself. 
  6. Try to be nice when you notice others relying on assimilation or over-accommodation to cope. We are all going to have different responses and all the responses are human. One sign of a chronically activated stress system is irritability. So try to be gentle and flexible with each other as you coax people into having a safe and adaptive response to the situation. 

All right folks, that’s it for now. Please let me know if you have questions or want to have a dialogue about anything I’ve written. I’m reworking my approach to this topic as I discuss it with clients, friends and family members, so I am open to other information and perspectives as I dial it in.