Managing Stress During COVID-19

In times like these, our thoughts are bombarded with uncertainty and negativity such as “what if’s”, “what’s wrong” and “what do we do”…. Coupled with that most of us are tasked with doing our regular job but also calming the nerves and worries of those we love. All of which adds to the wear and tear on our nervous systems. In addition, such care giving and worry can result in the constant firing of the “fight or flight” mechanism of the sympathetic system, or our stress system. When I speak to patients, I explain to them how the stress system works, it not only protects us but can overload us. The protection of the stress response is to prepare and defend in the face of a threat. When we don’t address these threats, the stress system is overloaded.

I liken this natural survival mechanism as the “filling of the stress bucket”. We all have a stress bucket, each of different sizes, able to manage just a certain amount of stressors. The size doesn’t matter, what we do when the bucket begins to fill up, matters. In a bucket that is filled, there are two choices, overflow or release. When it overflows, there is either distress or physical symptoms. If we find ways to release, (putting a hole in the bucket) the stress response has a way to disperse, making room for the next round.

With this model of the stress system, we need to find ways to put that hole in the bucket.

One of the first things is to realize it is appropriate and normal to be stressed today. Negative feelings are natural. We feel anxiety in response to uncertainty; sadness related to losing our daily sources of meaning and joy; and anger at those forces which are to blame for bringing this upon us. As such, the importance is to follow evidence-based recommendations for bolstering mental resilience to weather this crisis.

  1. The first thing on the table is to accept those anxious thoughts and emotions as normal. Rather than push them away, accept them. Research shows that avoidance of appropriate negative feelings, whether it be worry, sadness, anger, will only maintain them and make them stay longer. The strategy is to “notice” negative emotions, thoughts, and physical sensations as they come up, look into them with curiosity, describe them without judgement and let them go. A hypnotic trick is to visualize those feelings and sensations, tie them to a red helium balloon and watch them drift up in the air until the balloon is out of sight (that gives you a visual with also a mindful activity).
  2. Talk about these feelings in a way that is acknowledging but not ongoing. Adults especially can go off on a tangent. Notice how often your conversation is negative and try to put a limit to it.
  3. Talk to your kids about what’s going on. Here’s a video from a developmental psychologist with instructions about how to talk to kids:

  4. During these times, we are in the midst of trying to figure out what to do with our time and how to live our lives. Indulging in Netflix-binging, cookie indulging, marathon video games or being couch potatoes might be incredibly tempting but aren’t all that effective towards maintaining psychological health. Studies have shown that creating new routines that connect you to meaningful things in life are the best recipe for good mental health. With new routines, structure, predictability and a sense of purpose matters. It’s good to stick to routines for adults and especially for kids. Wake up at the usual time, take a shower every day, eat your meals when you would normally eat. How everyone works and plays at home is best done by planning, knowing that we all need to be flexible and adaptable. Netflix, etc are not bad things to do, just not in abundance.
  5. Science has also shown that exercise, good nutrition and socializing are directly linked to emotional wellbeing. You have to find ways to reinvent and create new ways of self-care. Create a schedule of how and when, such as walking, running and yoga (many classes on-line- some at no charge). As much as you can, get out into nature. Studies have also shown spending time in nature positively affects psychological health.
  6. Reinvent how you connect. This is a tricky one, how to socialize when we are distancing. Some ideas are meeting through a video conference platform or facetime with those you care about, reach out to your loved ones and spend time actually chatting on the phone as opposed to just texting, basically checking-in with each other. I am sure you can come up with ways to connect.
  7. Notice the amount of alcohol you intake. Have you noticed or heard of how the shelves in the wine store are doing? I would imagine they are running low as well. Overdoing it with alcohol can create a habit that reinforces lack of awareness. Use good judgement in how much you drink. Structure helps here too!
  8. Realize that experiencing stress and negative emotions can have positive consequences. Studies show that people who go through very difficult life experiences can emerge from them with a stronger sense of psychological resilience, rekindled relationships and a renewed appreciation of life.
  9. Distraction is not a bad thing at this time. Start a video-conference book club, a family book club where you can talk about the books your extended family is reading; have a song club where you say and maybe sing your favorite songs with your friends.
  10. Show kindness and gratitude. One of the most effective tools in your strategy bag is to be helpful to others. You have heard many reports about how human behavior in the face of danger and disaster is to be helpful to others. This is for a reason. Helping others, especially in the time of a crisis, releases hormones that have the opposite impact of the stress hormone. When we show gratitude toward others, we let them know that their actions matter, which encourages more of the same kind of behavior—not only toward the grateful person but to others. Creating a cycle of altruism is helpful when we are faced with a challenge that affects us all, helping to foster trust in each other and care for each other’s plight.
  11. Create ways that rebuilds your stress response with meditative and mindfulness exercises. One of the most effective means of being mindful is focusing in the moment. Put your attention on an inanimate object for 4-5 minutes. Notice everything about it. Try a picture of a beautiful flower. Notice every detail. Here are a few links that have guided meditations and focused attention strategies. Practice once a day to put a “hole in your bucket”. healthy.kaiserpermanente.org and www.headspace.com/covid19.

If you would like to schedule a Virtual Counseling session please contact: 
Claudia Pascale at CPascale@irms.com  or cpascale2@comcast.net

If you have any other questions about your fertility journey, and would like to book an appointment please reach out to us online or give us a call at  973.548.9900.

Claudia Pascale, PhD, is the Director of Psychological and Support Services at the Institute for Reproductive Medicine and Science in Livingston, NJ. As a psychologist and member of the treatment team at IRMS she helps patients and their families’ deal with the struggles of infertility; provides evaluations for donors and gestational carriers; and participates and oversees a myriad of educational services designed to help patients cope with the emotional, psychological and ethical dilemmas of infertility. She sees individuals and couples for counseling; organizes and offers support groups for multiple themes and offers support for the families of our IRMS patients when needed.

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