The only thing that’s certain is uncertainty…..

The current Coronavirus (Covid-19) pandemic has all the characteristics needed for generating high levels of concern and worry among the public and creating even more stress among those who already suffer from anxiety:

• Uncertainty about what might happen

• How might we be affected?

• How severe might the impact be?

• Concern about friends/love ones

• Anxiety about the short- and medium-term future (e.g. if supposed to be taking exams, doing assignments, research, career, loss of work/income, paying bills, buying food)

All of these are key aspects of the coronavirus situation that cause us to ‘worry’. 

Understanding anxiety and worry

Anxiety is a perfectly normal human, emotional response to a threatening or stressful situation - a fear that something bad is going to happen and we won’t be able to cope. It is a response to an appraisal (interpretation or perception) of a negative situation. Worry is also a natural response to anxiety – a coping strategy that temporarily might reduce the feeling of anxiety, but ultimately does not help because it typically focuses on things that can’t be controlled, rather than what can be controlled.

Worry is a form of ‘safety-seeking’ – an attempt to move away from the threat, to avoid the cause of the anxiety.  But that avoidance can in turn result in more unhelpful coping strategies and behaviours.  For some people their way of coping is to worry – to be constantly trying to anticipate what might happen, to explore in their thoughts all possible outcomes.  Worry is future focused, and if our thoughts are in the future (or the past) then we are not in the present. Yet we can only act in the present.

So, while often worry is used to help lower our immediate anxiety – because it feels as if we are doing something - worry is fruitless. Checking the news, social media, conspiracy theories etc, all become part of the search for ‘evidence’ on which to base ‘understanding’, for example of the threat posed by the virus, and leads to further worry.  We may believe that worry helps, but it becomes an endless search for a solution to a poorly defined problem, or to something that is unanswerable, involving long chains of events that lead to eventual catastrophe.

Anxiety can be truly debilitating. At its core, it involves unconscious appraisals of a situation, typically:

• an over-estimation of the likelihood (probability) and severity of the threat (impact), and

• an under-estimation of our ability to cope (heightening our sense of vulnerability) (see Figure). 

In the case of the coronavirus, what we do know about the virus is that for the majority of people the severity of the impact of the virus is actually quite low – it is a relatively mild to moderate disease for most people, and especially for most younger people without underlying health conditions.  Indeed, it is the relative mildness of the disease for most people that may help explain why it has spread so rapidly, seemingly often going undetected.  So, our ability to cope with a relatively mild disease is likely to be much greater than we might think. 

There are some things that are within our control…..

Collectively, it makes sense for everyone to focus on what is within their control – hand-washing, social (physical) distancing of at least two metres, self-isolating etc - to help protect everyone, and especially those in vulnerable groups in the long term.  This can also affect the actual likelihood of any of us as individuals being infected – the more we self-isolate and practice distancing, the less likely that we will contract the virus and spread it.  These are the things that are within our control (our ability to cope), and the practical things therefore to focus on.  Individually, unless we work in vaccine research, we can do nothing about a vaccine.  Similarly, for drug treatments etc.  But we can all contribute to preventing the spread of the virus.

What about vulnerable groups? Here we must acknowledge that the severity is actually potentially high (not just a perception) and the likelihood of infection, while relatively low, is likely to increase.  But again, we can address the likelihood and the ability to cope – individually and collectively - through taking the right precautions: by hand-washing, by not touching your face, by not hand-shaking, by not socialising in the usual way, by not physically visiting elderly relatives or friends, and so on.  And we also enhance the ability of society and the NHS to cope (and for those in vulnerable groups to cope with infection, e.g. in intensive care, hospital bed provision) by those who are not in vulnerable groups following the guidelines for minimising transmission, by self-isolating if unwell, and helping those less able.

Worry, then, tends to lead to more worry and anxiety whether it be about the virus or about the impact on loved ones, on jobs or money.  But anxiety will pass (because it always does), if allowed to, and not maintained by further engagement in negative thoughts.  If you are anxious, a starting point is to try to acknowledge that you are anxious – “OK, I’m feeling anxious – it’s OK to be anxious, it will pass” – rather than struggle with it (trying to avoid it) by worrying. Try to sit with the anxiety and observe it (yes, I know, it’s easier said than done, but with practice it works). It’s the struggle with anxiety that enhances it. We can do nothing about the uncertainty around Covid-19 other than accept it - we all have to become more comfortable with uncertainty, because we can’t do anything else.  We can instead focus our effort on more productive problem solving rather than unproductive and destructive worry, finding increasingly creative ways to cope with the situation (which will itself pass in time) and build our longer-term resilience.

While we are self-isolating, we also need to find behaviours/actions that are helpful rather than unhelpful for our mental health and well-being, for example:

• Don’t lie in bed for long hours in the morning – as a coping strategy it may temporarily reduce immediate anxiety, but ultimately, it’s not helpful: the less you do the less you want to do, and that leads to low mood, low self-worth, depression.

• Don’t spend hours scrolling through news feeds, social media chatter - switch off your social media and news feeds. Instead check the news once or twice a day for a short time only, and use a reliable source.

• Don’t spend time worrying about things over which you have no control – shift instead to more practical problem solving focused on the things you can control; get creative.

• Do be curious, and critical of what you read, see and hear. Be informed, but not obsessed with information - there is only so much you an handle.

• Do create a schedule, as if you were physically at work or university, and stick to it (even if you amend it which you would do normally anyway).

• Do keep in contact with friends, family, work colleagues - maintain and build networks, people near and far, people who can help you if need them; video chat with someone you haven’t seen for a while.

• Do prioritise – somethings are just more important than others (your health being one of them).

• Do try to make time to do the things you have been putting off for ages, if you now have more time on your hands.

• Do build physical exercise (indoor, in the garden, online classes, or outside if allowed but practising social distancing) into your schedule.

• Do things you enjoy – e.g. reading, exercise, online or board games, cooking (if difficult to find the foodstuffs you want, become creative – try new things, find new recipes online), etc.

• Do be kind to yourself (simple acts of self-compassion) – take time out to relax, practice mindfulness, give yourself a treat.

The one thing we do know?  This situation will pass.  It may take weeks or months, but it will pass.

Take care and stay safe

Bill Sheate, 25 March 2020