COVID-19 ANXIETY MENTAL HEALTH SUPPORT
A digital care guide to help you manage your mental health and cope during a global pandemic. HOUSE OF SELF
Essential mental health support for COVID-19 Created by the team of counsellors, psychotherapists and life coaches at House of Self, London. www.houseofself.co.uk ŠHouse of Self Ltd. 2020
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This is a difficult and uncomfortable time, but it is only temporary.
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Table of contents: Impact of outbreak on mental health Staying safe Ways to support your mental health Coping statements for anxiety Panic and the AWARE method Mental Health during lockdown About online therapy Mental Health resources and hotlines We really hope this small guide will help prompt further curiosity about the ways in which you can support your mental health during this time. Whilst we haven’t been able to include absolutely everything, we hope there is just enough to hold you for now.
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Why the Coronavirus is triggering mental health issues Fear of losing loved ones Increased health and death anxiety Feelings of despair Decreased job security Social isolation concerns Panic from lack of control Increase in mental illness symptoms Fear of going to work Fear of infecting a loved one As humans, we tend to fear the unknown. In the case of the current COVID-19 outbreak, there are many uncertainties. We might find ourselves asking, who is most at risk? Who has it? Should I go to work? What if I have it? What if I pass it onto my parents or grandparents? What happens next? Who do I call when my mental health is declining?
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Uncertainty drives anxiety, so it’s no surprise many are feeling increasingly stressed and anxious. It’s important to remember that everyone reacts to stress differently. Some people may become distant, avoidant or disengaged. Others become worried and enter a state of panic. Some are able to share their worries, others may not be able to. Our response to stress can be varied and complex. We may react to stress in a moment of panic and later wish we had responded differently. It’s vital to remind ourselves that everyone is reacting to world events in the only way they know how to. Some responses to stressors are also a lot more socially acceptable than others. We must remember when someone behaves in a certain way towards a stressful event, it’s likely because they are being driven by their own stress of feeling out of control, helpless or alone. It’s important to choose kindness in these moments. If we look hard enough, we can often see beneath a person’s actions. Are they trying to tell us something? What’s really going on? Assess how you can best support this person during this stressful time.
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How can I keep myself and others safe? Wash your hands frequently Regularly and thoroughly clean your hands with an alcohol-based hand rub or wash them with soap and water. Washing your hands with soap and water or using alcohol-based hand rub kills viruses that may be on your hands. Wash hands after sneezing, coughing or using the bathroom.
Maintain social distancing
Maintain at least 1 metre (3 feet) distance between yourself and anyone who is coughing or sneezing. When someone coughs or sneezes they spray small liquid droplets from their nose or mouth which may contain the virus. If you are too close, you can breathe in the droplets, including the COVID-19 virus if the person coughing has the disease.
Avoid touching hands, nose and mouth Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth. From there, the virus can enter your body and can make you sick. 8 | House of Self | Digital Care
Practice respiratory hygiene Make sure you, and the people around you, follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.
If you have fever, cough and difficulty breathing, seek medical care early Stay home if you feel unwell. If you have a fever, cough and difficulty breathing, seek medical attention and call in advance. Follow the directions of your local health authority. National and local authorities will have the most up to date information on the situation in your area. Calling in advance will allow your health care provider to quickly direct you to the right health facility. This will also protect you and help prevent the spread of viruses and other infections. Information provided by the World Health Organisation. 2020 House of Self | Digital Care | 9
Ways to support yourself during this time Taking care of yourself, your friends, and your family can help you cope with stress. Helping others cope with their stress can also make your community stronger. There are lots of things you can do to support your mental health during this time. Here are just a few ideas you might want to consider.
Tailor social media intake The social media vortex can suck you in. As our free time increases, we will likely find the urge to indulge in all of our accounts, more often. Try to set yourself a certain amount of time to check all of your accounts and then find something else to distract or occupy your mind. Take breaks from watching the news, reading or listening to stories from around the world via social media. You may want to mute accounts that are triggering you and follow more uplifting ones such as The Good News Movement on Instagram (@goodnews_movement).
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Take care of your body Take care of your body. Take deep breaths often, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs. Make time to unwind and relax. Run a bath, put on a film or listen to a podcast you love. Do what you love to help reduce stress.
Maintain social connections online The online world can be our worst enemy or a really great friend, depending on how we use it. Connecting with others online is quickly becoming a valuable way to stay socially active, especially during times of self-isolation. Check-in on your friends who may be isolated before you are and see how they are doing. Use video-calling platforms such as Skype, Zoom or FaceTime to have valuable face-to-face conversations with your loved ones as well as texting, calling and DM’ing them.
Reduce stress in yourself and others Sharing the facts from legitimate sources about COVID-19 and understanding the actual risk to yourself and people you care about can make an outbreak less stressful. House of Self | Digital Care | 11
Give yourself permission to do nothing As we begin to take on more activities at home, start new projects or hobbies it’s also really important to give ourselves permission to do absolutely nothing at all. There is a lot of external pressure to get things done right now. It’s likely external pressures could be overwhelming resulting in feelings such as shame or guilt. Take it easy. You are allowed to do absolutely nothing. Give yourself permission to do nothing.
Understand what you can control A lot of our anxiety right now is coming from feeling out of control in the current situation. It’s really important we consider what we can and cannot control. Whilst we may not be able to control the actions of others, resources available to us, our job stability or the length of uncertainty, there are lots of things we can control. Try saying these out loud: I can control connecting with loved ones I can control what my day looks like I can control the kindness I offer to others I can control taking time for myself when I need it I can control how I support the community
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Create a daily routine A daily routine can help to keep us grounded and can be really helpful when it comes to managing our mental health. It’s also a great way to help us feel more in control of everything. Routines can help us cultivate positive daily habits and allow us the space to build in structure, reducing our overall stress levels. Create time throughout your day to implement exercise, a crafting hour, time for cooking, downtime with your animal(s) or play-time with your children. Whatever it is, try to build these things into a daily routine so they happen at the same time each day or alternate throughout the week.
Make sleep a priority There are lots of ways COVID-19 is impacting our sleep. You may be experiencing insomnia, sleep disturbances or oversleeping but there are ways to help regulate sleep during stressful periods. It may feel tempting to emotionally switch off and take long naps throughout the day but whilst this can be really beneficial for your mood (if naps last between 20-30 minutes), it can also negatively impact our regular sleeping pattern if we are oversleeping during the day. Try to stick to a regular sleep-wake cycle each day and improve sleep hygiene by unwinding a few hours before bed, avoiding phone/tablet/computer use too. House of Self | Digital Care| 13
Socially isolate, physically, not spiritually and mentally Social isolation might be what we need to keep the virus from spreading, but in order to get through this pandemic, we must maintain a sense of community. If you are currently self-isolating or on lockdown you may already be doing some of these things, but for those who are not, preparation is key to reducing your stress.
Call, text, email or DM a loved one It’s important to remember you are not alone in this. You may feel a sense of frustration, boredom or irritation - this is completely normal. It’s more than likely your friends and family are feeling the same way. Reach out to them however you feel comfortable and talk about what makes you feel good. If you need to talk about COVID-19 be mindful that your loved one may not have the mental space to engage because of their own triggers and anxieties. Respect their boundaries by asking if you can have their emotional consent to offload. You might say, “I’m really struggling at the moment. Do you have the mental capacity to listen to my worries?” 14 | House of Self | Digital Care
Do something creative, start a small project or plan things. There can be a lot of external pressures to utilise self-isolation periods to take on huge tasks. People may even put huge pressure on themselves to achieve big things such as learning a new language or writing a novel. Whilst this could be a great time to do things you’ve always wanted to, try to be mindful of what you can cope with right now and stick to things that will make you feel better, not further overwhelm you.
Recognising your privilege Individuals with disabilities, chronic illnesses, older people, people who have language barriers are going to feel isolation more. COVID-19 will hit the poor and marginalised the hardest. Find opportunities to shed light on inequalities and support neighbours, friends and family where you can. Compassion and kindness don’t cost a thing. It can help build up our community whilst improving your wellbeing. Choose kindness, even when it feels hard.
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COPING STATEMENTS FOR ANXIETY
To help you through panic & distress
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I can be anxious or scared and still deal with this.
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Stop, and breathe. I can do this.
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I feel this way because of my past experiences. But I am safe right now.
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I am stronger than I think.
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This is a difficult and uncomfortable time, but it is only temporary.
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This won’t last forever.
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YOU WILL GET THROUGH THIS! Write your own coping thought or positive statement for each distressing situation. Distressing situations: Positive coping statement:
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Panic Attacks: The AWARE Method
How to regain control during panic
Acknowledge & Accept If we can learn to acknowledge the anxiety when it appears, we take away some of its power. Try not to fight the feeling, blame yourself or others. In the same way you might accept a headache, try to accept that you are feeling anxiety at this time. Overcoming anxiety begins with working with, not against, your panic and anxiety symptoms. Wait & Watch Rather than trying to distract yourself, take a moment to breathe. Deep breathing can really help nausea and moments of panic. Before you jump into trying to distract yourself, wait. Use this occasion to observe how your anxiety works and how you are responding to it. As you ‘watch’, fill out a panic diary or jot some notes in your phone to catch important characteristics of your attack. Actions At this point, you have already taken two positive steps to helping you overcome your panic. Next, let’s think about some helpful actions...
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Panic Attacks: The AWARE Method Actions (continued) Belly breathing, also known as diaphragmatic breathing is a very powerful technique. Place one hand on your chest and one hand on your stomach somewhere above your belly button. Breathe in through your nose, noticing your stomach rise. Your chest should remain relatively still. Purse your lips and exhale through your mouth. Repeat It’s important to remember that all anxiety attacks end. However, they can occur again at any time. If one immediately happens after you complete these steps, repeat them. End This is here to remind you that your panic attack will end; that all panic attacks end; that they end regardless of how you respond; that it’s not your job to make the attack end; and that your only job is to make yourself as comfortable as possible while waiting for the attack to end.
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Thoughts on ...
Understanding trauma in relation to COVID-19
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There could be several indicators that you are experiencing what is called a ‘trauma response’ in relation to the current outbreak of COVID-19. As a result, you may be experiencing a lack of appetite, have difficulty sleeping, concentrating and planning ahead. Considering the circumstances, it’s not surprising. Don’t forget to take care of yourself during this time and check-in with how you are feeling each day. If you are feeling “strangely calm” during this pandemic, it could be an indicator that chaos is familiar to you. Although you may be feeling a sense of calm, having previously survived chaos could make you more susceptible to re-traumatisation during this pandemic. It’s important you take care of your mental health, even if you feel like you don’t need to right now.
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Managing Contamination OCD during COVID-19
No Panic is a voluntary charity offering support for sufferers of panic attacks and obsessive compulsive disorder (OCD). Offers a course to help overcome your phobia or OCD. Website: www.nopanic.org.uk
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Obsessive Compulsive Disorder (or more routinely referred to as OCD) is a serious anxiety-related condition where a person experiences frequent intrusive and unwelcome thoughts commonly referred to as obsessions. Obsessions are unwanted intrusive thoughts, images, impulses or feelings, that bring someone’s attention to a threat or perceived danger, hence why they are so horrible and distressing. Obsessions result in a person carrying out repetitive behaviours or rituals, called compulsions, in order to prevent this perceived danger or threat. Unfortunately, instead of solving the problem, compulsions cause additional anxiety and obsessions, resulting in even more time-consuming and mentally draining compulsions. (OCD UK, 2020). OCD carries many complexities and therefore not everyone with OCD will be impacted by COVID-19 in the same way. However, if the recent outbreak has left you feeling more anxious, out of control or increased your safety-seeking behaviours then it may be helpful to remember the following. It’s important for you to follow the public health advice, and if at all possible prevent OCD from taking you beyond what is recommended. However, if your anxiety and OCD dictate that, be kind to yourself, do not feel guilty for going beyond the recommended advice at this time. Take notes of what you are experiencing in preparation for getting back into focus with your support group or therapist once this pandemic passes, and it will pass. You may feel as if you aren’t making progress because it feels as if you are reverting back to old behaviours, but please remember you are in the midst of a global pandemic. Your brain is simply seeking old and familiar ways of coping. This doesn’t mean you are regressing. Be kind to yourself. House of Self | Digital Care | 31
Managing Health Anxiety during COVID-19 Understandibly the appearance of COVID-19 has seen an increase in anxiety but for people who already live with anxiety disorders, global disease outbreaks can be debilitating. Hypochondria, hypochondriasis or illness anxiety disorder is a condition where a person has extreme anxiety about having or developing an illness. Anxiety at this level can significantly impact a person’s life, relationships and overall wellbeing. People living with health anxiety may feel compelled to over engage with information on the disease and how it presents, leaving them in a constant state of compulsive news/information checking. This can reinforce compulsions and obsessions leaving them in a state of panic and ‘high alert’. The biggest drive of illness anxiety is intolerance of uncertainty. 32 | House of Self | Digital Care
“ The state of uncertainty can trigger another prevelant compulsion, reassurance checking. If you are struggling with health anxiety, or an increase in health anxiety related symptoms as a result of COVID-19, it’s important to remember that the risk of getting coronavirus in the UK remains low. As hard as it may be, try to limit your news intake. Googling symptoms and searching twitter feeds for the experiences of others will only increase your anxiety. One of the biggest ways to help yourself overcome the intense anxiety surge you may be experiencing right now is to try to accept that nothing in life is certain. This, of course, is easier said than done, but if you can remind yourself each day - you may feel a slight moment of relief. - Keep as active as you can, follow an online yoga class or try out some breathing/grounding techniques - Try not to seek unessessary medical advice - Self-isolate but don’t cut yourself off from the world - Download a distracting app or game on your phone - Keep a thought journal to manage your worries Book recommendation: ‘Overcoming Health Anxiety’ by David Veale and Rob Wilson. House of Self | Digital Care | 33
WAYS TO SUPPORT YOUR MENTAL HEALTH DURING A LOCKDOWN 34 | House of Self | Digital Care
Protecting your mental health during a lockdown Being in a lockdown can be psychologically challenging and the isolation that comes with it can be emotionally tough. It’s really important to implement ways to socially interact with friends and loved ones during this time and there are plenty of ways to do that without seeing them in real life.
We may be experiencing a social interruption, but we don’t have to have a spiritual or emotional one. Stay connected. We’ve put together a few ideas on how to stay connected and take care of your mental health during the current lockdown.
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HOW TO SUPPORT YOUR MENTAL HEALTH DURING LOCKDOWN 36 | House of Self | Digital Care
Readjust, mindfully Change can be stressful, but it’s also inevitable. It’s important to connect with yourself in the present moment to help you cope. Journaling can help you stay in line with the bigger picture and help to relieve stress and worry.
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Manage your expectations It’s unlikely the period of lockdown will offer you the creative freedom you’ve long dreamt of. External pressures to write a novel, learn a new language and take on multiple online courses have raised the bar and the expectation we’ve put on ourselves to over-perform is high. Don’t underestimate the emotional and physical load that comes with a pandemic.
Go easy on yourself.
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Reframe it Being on lockdown can be psychologically challenging and isolation can be emotionally tough. Approaching the situation with an alternative perspective can relieve stress. Reframe “I am stuck inside” to “I finally have the time I need to work on myself and the things I love”
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Manage stress It helps to be mindful that you have likely switched to a new mode of being. COVID-19 could be impacting your daily habits, sleep and overall mood. Each person will have a different survival response to the current pandemic. Some may experience increased anger, irritability or aggressiveness. This is commonly known as the ‘fight’ response. Some may experience a desire to run away. This could be from their physical location, job or current relationship. We call this the ‘flight’ mode. Some may experience what we call the ‘freeze’ response. This can include disassociation or feeling stuck. It’s possible to dip in and out of experiencing all of the above. The important thing to remember is that all of these experiences are valid.
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Here are some things to help you manage your stress, no matter what your stress response may be. • Practice good sleep hygiene by avoiding blue lights before bed (phone, iPad, laptop etc) • Try and stick to your regular sleep-wake cycle • Limit alcohol intake and choose nutritionally rich foods where possible • Try new exercise routines or focus on breathwork • Limit news intake • Connect with friends and family as often as you can • Implement a good self-care routine
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Socialise, virtually Virtual coffee breaks and dine-ins via video calls are a great way to stay connected with the ones you love. Host a long-distance movie/TV watch party with friends by using the Netflix Party extension (chrome only) or download the Houseparty app and provide a spontaneous virtual gathering for you and your friends to socialise. Remember, there is a lot of expectation and pressure to socialise online. You absolutely do not have to engage if you aren’t able to or don’t want to. People who already live with mental health disorders such as Body Dysmorphia or experience anxiety relating to body image issues or low self-esteem may experience increased negative feelings around this kind of pressure to socialise via video calling. It’s OK to say no and use other forms of communication to remain connected with the ones you love.
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Create a zen zone No matter how small your home or living space, there is always a spot, corner or area you can transform into your own sacred space. Your zen zone is the place to journal, meditate, breathe or unwind. This is a pressure-free zone. A place for you to centre yourself. It’s also a great place to practice daily gratitude.
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Online therapy Don’t neglect your mental health needs. There are lots of therapists and counsellors providing vital support via secure video calling, email, text and WhatsApp. Working online is slightly different to working faceto-face because online we haven’t got the little in-person clues that we all pick up on when we meet with another person face to face. Here are some of the ways counsellors and therapists may work online. *Please be advised that each therapist will have their own unique way of working and so may differ to our examples.
Video Counselling Video counselling takes place on a secure platform such as Zoom for Telehealth or VSee. These platforms are medical-grade, encrypted, HIPAA compliant and offer good reception. FaceTime, Signal and WhatsApp video calling can also be used as they are encrypted (not HIPAA compliant). To use this type of counselling, your computer or phone must have a camera and microphone. You may also need to download relevant apps. House of Self | Digital Care | 51
Telephone Counselling Telephone counselling can also be useful, especially if you don’t like communicating via video platforms. FaceTime and WhatsApp also offer audio calling, just ensure you have a good connection to WiFi and your phone speaker is in working order.
Email Counselling Some counsellors offer email counselling. This is carried out by counsellors replying to your concerns, therapeutically. You will usually arrange an email exchange by securing an appointment with your counsellor beforehand. We use Protonmail for email counselling. This is a free phone app and can also be downloaded on your computer. It is very easy to set up and ensures end-to-end encryption, meaning your emails are completely confidential, safe and secure.
Instant Message Counselling Instant message counselling (also known as Webchat) is carried out at a pre-arranged time using an instant messenger application. The most secure platforms for this are Zoom for Telehealth or VSee. Signal is also encrypted and secure. Instant messaging allows you to receive instant real-time responses from your counsellor or therapist after you have mutually agreed a time to ‘webchat’.
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Prior to Online Therapy Prior to your online therapy session, you would pre-arrange a time with the counsellor or service you have opted to go with. Sessions would usually last for 50 minutes. However, due to COVID-19, lots of therapists are offering alternative options such as 30 or 20 minutes. You will be expected to set-up or download any relevant apps prior to your session commencing. Fees and Payment: Your session would most likely be paid for prior to your session commencing. Fees will vary depending on experience and expertise. Terms & Conditions: Be sure to thoroughly read through any counselling contract sent to you and consider cancellation and ‘poor-connection’ policies. How to find an online counsellor or therapist? There are lots of platforms to help you find the most suitable therapist for your current needs. Here are a few to get you started: www.counselling-directory.org.uk www.psychologytoday.com/gb/counselling www.bacp.co.uk/search/Therapists
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Essential mental health crisis resources & hotlines We have compiled a list of mental health resources and crisis hotlines operating during COVID-19.
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Samaritans
Whatever you’re going through, you can call the Samaritans any time, from any phone for FREE. Call 116 123 or email jo@samaritans. org (response time 24 hours).
Mind Infoline
The Mind Infoline provides an information and signposting service Call 0300 123 3393 or text 86463.
National Domestic Violence Hotline
Call 24-hours a day, for free and in confidence. Call 0808 2000 247. If you are in an emergency situation, please dial 999.
Shout
Get 24/7 help from the shout team of Crisis Volunteers. Text 85258. Shout is the UK’s first free 24/7 text service. It’s a place to go if you’re struggling to cope and you need immediate help.
LGBT+ Switchboard
Switchboard provides information, support and referral service for the LGBTQIA+ community. Call 0300 330 0630 (Open 10:00-22:00)
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The Mix
The Mix offer a range of essential support for people under the age of 25. Call 0808 808 4994 (4pm - 11pm daily). Visit www.themix.org.uk/get-support
Childline
If you’re under 19 you can confidentially call, email or chat online about any problem big or small. Freephone 0800 1111 (24 hours)
CALM
CALM run a free, confidential and anonymous helpline as well as a webchat service. Call 0800 58 58 58 Open 5pm - midnight 365 days a year. www.thecalmzone.net/help/get-help/
Anxiety UK
Charity providing support if you have been diagnosed with an anxiety condition. Call: 03444 775 774 (Monday to Friday, 9.30am to 10pm; Saturday to Sunday, 10am to 8pm)
If you need immediate help, please call emergency services on 999 or The Samaritans on 116 123. For a global list of mental health related helplines, please visit: www.mentalmovement.co.uk/i-need-help
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House of Self recommendations ... Inspiring Podcasts
Oprah’s SuperSoul Conversations Unlocking Us - Brene Brown Esther Perel original audio series (www.estherperel.com/podcast) On Purpose with Jay Shetty The Knowledge Project Nobody Panic
Books
Daring greatly by Brene Brown Dealing with anxiety - Trigger Press Notes on a nervous planet - Matt Haig The Power of Now - Eckhart Tolle Feel the fear and do it anyway - Susan Jeffers
Uplifting Instagram accounts @goodnewsmovement @lalahdelia @emeraldandtiger @about.the.good.life @quoteoftheday @thehappynewspaper @sadgirlsclub @yallaroza
Insta workouts/yoga/meditation @foodandlycra (home fitness) @bethefittest @esthermarieyoga (yoga) @surreyhillswellness (wellbeing) @ciaralondon (home fitness) @dogamahny (yoga ‘Doga’ with your dog) @mrandmrsmuscle (home workout)
Apps
Gratitude Plus (gratitude journal) Monument Valley 2 (puzzle/game) Insight Timer (meditation) Stay Alive (suicide prevention support) Recovery Record (eating disorder recovery management) CBT Thought Diary App
Extra
Gratitude Plus (gratitude journal) Monument Valley 2 (puzzle/game) Insight Timer (meditation) Stay Alive (suicide prevention support) Recovery Record (eating disorder recovery management) CBT Thought Diary App
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Essential mental health support from HOS The current COVID-19 (Coronavirus) global situation is affecting us all. Our psychotherapists, counsellors and life coaching team are standing by to provide you with online therapy and support through these difficult times. We understand how challenging self-isolation and social distancing is to mental health and we are here to support you. All of our therapists are experienced in delivering secure and completely confidential online counselling using Signal, VSee & WhatsApp Video. If you are interested in online counselling or receiving online mental health support from House of Self, please get in touch with us on hello@houseofself.co.uk or by calling on 0203 488 4682. We are currently operating a sliding scale for fees. Our therapy teams have volunteered to offer a limited amount of free support for people working in the NHS. This is our way of contributing to our society, and our community, at a time when our services are needed the most.
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Access our counselling support from anywhere in the world.
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Find home, within you. www.houseofself.co.uk ©House of Self Ltd. 2020