Some tips for protecting your mental health during the COVID-19 crisis

Drafted by Adil Sarıbay, 2020-04-04; some additions by Yasemin Sohtorik

Preface:  Please feel free to use this guide and share it, at your own risk.  A similar, shorter one is available in Turkish via BÜREM: https://burem.boun.edu.tr/node/212

The ongoing crisis has made our lives more difficult in various ways.  The following are some tips for reducing the burden on our psychological well-being.  They will not stop the crisis or remove any pain, anxiety or other difficulties it brings.  However, they are simple and well-known to work for managing these kinds of situations better.  However little you can do of these, it should prove better than not doing any of them at all.  Don’t miss the footnotes for some helpful links.

Recalibrate your expectations

These are exceptional times and most of us will not be able to continue our regular pursuits and activities.  It may help to intentionally calibrate your expectations for what you can and cannot do during this period. 

Do not expect to be productive

Times like these are extra hard on our cognitive resources.  People may have sleep and concentration problems, experience intrusive thoughts or emotions.  Try not to place any extra burden on yourself or others in terms of being productive.  Turn a blind eye to “internet advice” in the form of “stop sitting around and do something.”  It is completely fine to simply sit around much more than usual.  If someone like an instructor or employer is placing pressure on you to go about business as usual, gently remind them that this will not be possible and that they also should be more self-compassionate.  Giving up everything is also not an option, but we should expect difficulties and slower pace in continuing our regular activities.

Nobody knows what the coming weeks will look like but it may be wise to expect yourself to have much more difficulty finishing tasks than before.  For instance, if you are a student, we recommend you to reduce your course load by a bit more than you think you should, especially if you have experienced psychological difficulties in the past.  If things go well, it’s easy to compensate for the lost time after the crisis.  There is no harm in having a light semester but a heavy one could put you at further risk of developing mental health problems.

If you find too much unstructured time in your hands, it may be overwhelming not knowing what to do with it.  But as Dan Falk recently wrote, use that time to “look after yourself, and those around you. You don’t have to learn a new language, master a musical instrument, write a screenplay or discover the Theory of Everything. Just getting through what lies ahead is enough.”[1]  If you can establish a small routine and get a bit of work done or continue to progress in a few courses (even just one), that’s great.  But approach the situation gently and put your health first.  Take it one step at a time and adjust your routine to the developments around and inside you (i.e., how you feel).

Pay attention to the changing needs in relationships

Whether you are in the same household or just continuing to keep in contact online, your relationships will require recalibration.  Check with yourself to make sure that you are not having unrealistic expectations from relationship partners.  For instance, this is not a time when they can continue to provide stimulation and excitement.  Instead, most relationships will begin to emphasize functions like soothing the other person when they are anxious, helping each other take care of more vulnerable people (like elderly in the family, children in the household), sharing household chores, and so on.  If the other person continues to hold you to the same standards and expectations as before the crisis, gently remind them that some or all of those will not be possible to meet during this time.

Expect conflict beyond the normal.  You can prepare for this by formulating an intention in the form of “If conflict erupts, I will remind my [parent, friend, etc.] that we should be extra forgiving and gentle.”[2]  This is not a good time to resolve chronic relationship issues.  It may give you extra time to think about them and to have deep conversations, but do not take those options unless you feel extra comfortable with the other person and judge them to be adjusting well to the current crisis.  

Remind yourself that different people have different coping strategies with stressful events. So expect others to have different reactions and courses of recovery. For example, others may feel overprotective and overly worried about your safety. It is important to understand and tolerate differences. Because you differ in how you handle stress, you should not pull you away from family members, friends, and significant others.

Do not hold yourself to unrealistic standards

During this time, it’s okay and even necessary for your topmost priority to be protecting your own health.  If you can manage that, the next best thing would be to protect the health of others via self-quarantine.  No single person (save certain bureaucrats) has the power to drastically alter the course of the crisis but it can be done by collective effort.  This collective effort doesn’t require you to do anything heroic.  Give support to people around you if you can do so safely.  Do not expect anything more of yourself or others. This is not the best time to make drastic changes in your life-style, relationships, and future plans. Avoid making significant decisions and taking unnecessary risks in this stressful period.

Accept Your Feelings

Under stress, particularly when our lives are disrupted, we may feel scared and angry. These are common reactions and will return to normal over time. You may also feel vulnerable and helpless.  It is important to reach out to loved ones (e.g., family and friends) during these times, and seek their support.  Remind yourself that these feelings are expected and common, and you are not going “crazy.”  Talking about your feelings may reduce their intensity.  Even the simple act of labeling a feeling (“I am anxious”) is known to reduce its activation.  Try to accept your feelings and share them with trusted others.

Move around

Exercise is one of the best ways to cope with stress.  However, modern forms of work and entertainment typically entail sitting for long hours, which is dangerous for physical health.  We strongly recommend moving around to compensate for this.  Exercise also improves sleep and these times are particularly tough on our sleep quality and duration. 

You may need to be creative and discover new ways to exercise around the house.  If space allows or if there is a safe outdoors confinement, the best option is to walk briskly and get exposure to daylight.  If space does not allow walking, stretching and yoga are good options.  Video guides for those can be easily found on the internet[3].  The 7-minute workout[4] can be a good way to get some cardio exercise and help blood circulation.

If none of these are possible due to lack of space or physical ailment[5], some simple exercises can be done even without leaving one’s chair[6].

This is not a time to pursue goals such as losing weight or getting fit.  We recommend that you focus on a form of exercise that is safe for you physically and makes you feel good afterwards. Doing it even a little bit will help to manage stress and to maintain a healthy body.

Breathe

Another well-established way to control stress is to breathe deeply.  There are many well-known breathing exercises[7].  Just keep in mind that you do not have to do anything complicated.  Doing a simple exercise for longer durations and doing it frequently and regularly matters more.  It’s also important to be comfortable during the exercise and to not push too hard (i.e., do not breathe too deeply and unnaturally; too much oxygen may trigger panic).

For these exercises to alleviate stress, try to do them for long periods of time rather than just a few moments.  Put your phone away, get in comfortable clothes and find a comfortable place where you won’t be interrupted (as much as possible--some of us lack that kind of space right now; do what you can).

During this time, we do not recommend starting more serious forms of discipline involving breathing.  Specifically, we do not recommend meditation.  Meditation is known to have benefits for mental and physical health but it also brings serious risks.  If you are experienced in a certain discipline, however, we recommend that you continue practicing as long as it engenders feelings of calm and well-being.  Stick with what has proven to work for you in the past and approach novel methods with caution, moving forward in small steps.

Get in “Flow”

Coping with boredom can be just as difficult as coping with anxiety.  Being in a state called “flow” may buffer the negative psychological effects of long-term quarantine.  Flow happens when you are challenged just enough--not too little (which is boring) and not too heavily (which is demotivating)--by a task such that you engage fully with it and lose sense of time.  Even though the evidence on how flow helps people cope with difficult circumstances is not so well-established, flow-inducing activities can help you feel like time is passing more quickly and cope with impatience and boredom during this crisis.  A common example of a flow-inducing activity is physical workout.  If you can manage to continue exercising safely, it’s a good idea both for its flow-inducing potential and for other health reasons.  However, flow can be induced by any task.  Certain repetitive tasks such as knitting may induce flow for some.  For others, it could be crafts and arts (drawing, music).  Modern video games are actually designed to adjust the challenge level to your skills and thereby keep you in a flow state.  Thus, it could be a good idea to play video games, especially if they also afford positive socializing (e.g., playing with family members).  But don’t overdo it; protect your eye health and blood circulation. 

Stay in Touch

The current physical isolation we are going through is different than choosing to be alone under regular circumstances.  The situation has been unfortunately framed as “social distancing.”  However, many people have access to tools that allow them to continue their relationships in some form.  Using these tools to keep in touch with loved ones will help you cope with stress and regulate your emotions.  On the other hand, a chronic state of feeling lonely is associated with many poor health outcomes mentally and physically.  Thus, take action to avoid sinking into such a state.  The elderly are particularly vulnerable in terms of social isolation.  Thus, if you can, try to help your loved ones by frequently calling them.

As stated before, it’s better to avoid conflict, especially on topics that are not relevant to surviving through the current crisis.  A better option is to think of a cherished memory before you call someone and mention it to them; and to focus on your common identity, shared values, and dreams and hopes for the post-crisis period. 

Go Slower

Some of us don’t do well with too much stimulation.  Overstimulation may bring about a higher level of stress and cause feeling overwhelmed by the tasks you need to accomplish.  Make sure to bring in a few slower activities into your day.  However little, it will help.  These are activities that have a clearer beginning and end and they feel more meaningful as they stand on their own; giving you a feeling of completion and satisfaction.  Watching a movie is a slower form of activity than browsing the timeline on twitter or facebook.  Other options are reading a book, engaging in crafts (e.g., drawing for an hour), trying to teach your pet a trick, organizing your drawer, and so on. Preparing a healthy meal is another slower activity that would also contribute to your overall health.  When you have tasks you need to accomplish during the day, try to prioritize them and break them down into small steps to make them more manageable.   

Limit Media Exposure

The news (and people’s responses to news) are piling up very fast on our social media timelines and catching up feels impossible.  Worse, some news are fake and it’s hard to tell them apart.  As we need to stay indoors, most of the news you are exposed to are also practically useless--there’s nothing you can do in response other than feel bad.  You really only need to receive an update from a trusted source once a day.  Instead of limitless media exposure, it’s better to tune in to your trusted source at a chosen time of each day and move one to something else after you are done getting an update.       

Watching news may induce intense distress. It is important to reduce and limit the time spent reading/watching news related to Covid-19. Avoid constant exposure to negative aspects of the news. Try to do things to take your mind off the news, like activities suggested in the other parts of this guide.  It is more important to stay in connection with others, calm the mind, and comfort the body. 

Sleep well

Taking a nap is another option for a slow and restorative activity.  Indeed, protecting your sleep is of utmost importance for your mental and physical health.  Expect interruptions.  Many people will report having difficulty falling asleep and waking up frequently.  When people feel on the edge and anxious about the changes taking place in their lives, they experience more difficulty sleeping, and may have nightmares. However, keeping a bit of sleep hygiene may be possible to reduce these negative effects of the crisis on sleep.  The most important element of sleep hygiene is regular hours for waking up and going to bed.  If you have a strong need to sleep before your scheduled bedtime, take a nap in the middle of the day.  This is better than sleeping in and missing your wake-up time.  Naps in the middle of the day are less disruptive to your biological clock. Try to go to sleep at the same time every day, avoid consuming caffeinated beverages in the evening, relax before bedtime, and reduce alcohol consumption[8].  When you can’t fall asleep, do not spend more than about 20 minutes lying awake in bed.  Sleep is elusive but your chances of getting a good night’s sleep are higher if you stick to these suggestions.

TO SUMMARIZE:

Try to do/remind yourself these as much as you can:

- Go easy on yourself and others--calibrate your expectations about everything

- Move around--it’s possible even in small spaces and exercise reduces stress

- Breathe to reduce stress--it’s a simple and effective tool available to you always on demand

- Engage in activities that make you lose track of time (flow)

- Stay connected to family and friends--connectedness helps you cope with tough times

- Choose slower activities--avoid being overstimulated by social media

- Sleep well--try to keep regular sleeping hours and take naps in the middle of the day if needed

Remember that these activities support each other.  For instance, if you can limit exposure to stressful news, your sleep quality may increase.  Having had enough sleep, you may find more willpower to exercise during that day.  This in turn helps your sleep.  And so on, and you will feel a noticeable difference in how you handle stress as a result.  Small choices and tiny actions matter in the long run.  

Seek Help

The current crisis will be tough on many individuals.  There is and will be chronic stress and uncertainty and this will test our patience and strength.  There is absolutely no shame in needing and seeking help.  Opportunities to receive help may not be as before but you should warn us if you are having serious trouble coping with the current situation.  If you understand that someone you know in our community needs help, please warn us also.  Informing your department chair, advisor, and course instructor about your situation is wise.

For emergencies, BÜREM indicates that Psychiatrist Görkem Yılmaz can be contacted by email yilmazgork@gmail.com and that it’s possible to book an online meeting. 

Best of luck to everyone for getting through this crisis.