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Managing COVID-19 Stress and Anxiety

A Conversation with Daniel Z. Lieberman, MD, professor of psychiatry and behavioral sciences

Around the world, the outbreak of the COVID-19 virus has turned lives upside down. Communities are practicing physical distancing and, in many cases, municipalities have ordered the closure of schools, universities, and all nonessential businesses. Daniel Z. Lieberman, MD, professor of psychiatry and behavioral sciences at the George Washington University School of Medicine and Health Sciences (SMHS), discusses strategies for managing the isolation and stress brought on by the pandemic.

What kinds of things should people be doing to maintain a healthy and positive attitude during the COVID-19 pandemic?

Daniel Lieberman (DL):  When you’re stuck at home it’s easy to fall into bad habits, and it’s important not to let that happen. One of the most important things is to maintain a regular daily schedule. Try to wake and go to bed at the same time for a normal work day. Try to maintain normal meal schedules. You want to make sure you aren’t spending half the day with your head in the refrigerator and constantly snacking on junk food. You need to be doing everything you can to try to stay healthy. Maintaining regular sleep patterns supports the immune system. Regular sleep is the easiest thing to fall apart, but the most important thing to maintain.

Social distancing means we don’t congregate in small areas, such as in stores or at events. But there is no reason why you can’t go outside and take walks, as long as you maintain that 6-foot distance from people outside of your household. It’s very important for people to get out of the house, ideally on a regular basis. People who have dogs have a big advantage here, because their dogs require them to take walks on a regular schedule. Other people need to put those kinds of habits in place.

How should parents address the pandemic with their children?

DL: Unfortunately, many of our children are not as well prepared as generations have been in the past have been for something like this. With regard to our children, society has been moving more and more to a protective stance. Many people would call it an overprotective stance; the epitome being helicopter parents. When many of today’s parents were growing up, they were free to run around the neighborhood unsupervised. Parents would say “be home for dinner,” and most of the day they would have no idea where their kids were. Today that’s almost unthinkable. We feel we need to protect our children from any kind of risk or harm. That, a lot of child experts will tell you, is actually a poor strategy. It doesn’t allow children the opportunity to prepare for living independently in a world that happens to contain a substantial amount of risk and danger.

It’s important to understand that growth does not come from safety and luxury; growth comes from adversity. For children who have been overprotected throughout their lives, this is an opportunity for them to experience growth. The first thing is, don’t sugar coat it. Present this as an opportunity for our kids to rise up and demonstrate strengths they’ve never before been asked to demonstrate. Parents can say to their children, “We’ve never faced anything like this in our lifetimes. There are things about this that are frightening, but there are also things about it that are exciting. It’s only when faced with this level of adversity that people have the opportunity to show what they are made of. It’s important to try reach deep inside and see what kinds of strengths we can find.”

Older adults are among the demographic most at risk for the virus. How can adult children talk to their parents about staying safe?

DL: Just doing things like offering to run errands or making older parents aware of home shopping services, such as Peapod or Whole Foods Prime Delivery, that can bring them their groceries and other things so they don’t have to go to stores, is a good way to address your concerns. We need to remember that it’s safe for our parents to go outside and walk around too, as long as they maintain that 6-foot distance. I’ve had patients tell me that their adult children are trying to prevent them from leaving their house for any reason whatsoever, but fresh air, sunshine, and exercise are just as important to older people.

I’ve also talked to lot of younger adults who are worried about their parents, who have told me that their parents are completely disregarding what they are being told [about social distancing and preventative care for COVID-19] and it’s leading to conflict. We all have to remember that we cannot control other peoples’ behavior. We can offer help, we can make suggestions, but in the final analysis the older adults are going to decide for themselves. If we try to prevent them from doing that, all we’re doing is harming those relationships. Ultimately, we need to let [our parents] make their own decisions, even if they are bad decisions.

What can you tell people who are having difficulty managing their stress and anxiety?

DL: The first step is to distinguish between realistic anxiety and unrealistic anxiety. Anxieties that I believe are unrealistic include things like the stock market. The market goes up and down. In 2008 we had the Lehman crash. Many people, including myself, lost up to 50% of their retirement portfolios, and then the market came back. There was one effective strategy that was required: do nothing. Most financial advisors are recommending that people take a deep breath and realize that the stock market goes up and down. The best strategy right now might be to not even look at your 401K.

Another unrealistic anxiety is too much fear about one’s health. It’s appropriate to have some anxiety, that’s what prevents us from acting recklessly. A little anxiety is appropriate, but we really need to put it in perspective. There are some important things to remember here. Most people will not be infected. Among those who are, most will be asymptomatic. Most people who do experience symptoms will not require hospitalization. And for those who do need to go to the hospital, most will have a full recovery. It’s possible that, when this is over the overall mortality from COVID-19 will be less than from the seasonal flu.

What about concerns about the economy and employment status?

DL: I don’t think fears about the economy are unrealistic at all. Economic damage is a very reasonable fear. Unemployment is a major risk factor for suicide.

With reasonable fear, it’s not a mental health issue. We need to find ways to build up our resilience in order to cope with reasonable fears. We do that through things such as getting good sleep, getting exercise, and finding new ways to connect socially. A lot of people are holding virtual coffee breaks and happy hours, where they get together with people through video conferencing apps, sometimes with friends they haven’t seen in years, and share their experiences, frustrations, and anxieties. These are really good ways to manage justified anxiety.