Your 3 step plan for managing post-COVID anxiety

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This is a guest post from Brandon Ulmer of Elevation Process.

Are you feeling a little anxious and stressed about the thought of leaving your home lately? If you are, know that you are not alone. This phenomenon is something that people around the world are increasingly grappling with, as countries attempt to emerge from the crippling effects of the COVID pandemic. As more and more people get vaccinated, it feels as though there is an increased pressure to “get back to normal” and to resume life pre-pandemic. Feelings of uncertainty and anxiety are certainly something that I see among people in my practice these days, and the intent of the article today is to provide you with 3 helpful steps in learning to manage this anxiety.

Step 1: Learn to keep arousal low with relaxation

It is important to identify what we are talking about when we discuss anxiety. Anxiety certainly is not fun to experience and can cause us to encounter many uncomfortable sensations. Reactions such as heart palpitations, increased breathing/heart rate, sweating, butterflies in the stomach, increased awareness etc. are all part of a normal response to stress and form what is commonly referred to as your “fight or flight” response. This response is particularly important and has allowed us to adapt and survive in situations where we normally would remain largely ignorant of the potential dangers surrounding us. The response can become overly active though, and problematic when the heightened awareness and fear begin to dictate the direction of our daily lives.

When I speak of arousal then, I am simply referring to the physiological arousal (i.e., the physical/psychological sensations described above) that comes from the fight or flight response. Learning to manage this arousal is a fundamental first step in wrangling anxiety. Fortunately for us, the internet has made access to relaxation related material and exercises easier than ever before. At the click of a button I can access, for free, thousands of potentially helpful exercises to manage this arousal. Research has shown that these exercises work, but that for them to work we need to do them. Making time to engage in the practice, as well as working them into our daily routine, can be extremely helpful in forming a habit. Once relaxation become a habit, we become far better at identifying arousal levels within ourselves early and take the necessary steps to do something about it before it escalates further. 

Step 2: Start to think about your thinking 

Psychology, as a discipline, has always suffered from the inability to accurately measure mental activity. Afterall, how does one go about measuring a thought or an emotion in the same way that one could measure other naturally occurring phenomena (think gravity or heart beats per minute). The practice of medicine, therefore, has tried its utmost to distance itself from something that cannot be measured (mental activity) in favor of things that can (the degree of break in a bone under x-ray). The problem with this attempt at absolute objectivity is that we simply cannot separate our brains from the rest of our body. The uncomfortable reality for medicine is that we are (and have always been) feeling beings that think, rather than the opposite. Since our thoughts and emotions are highly subjective, and changing all the time, it would therefore be a mistake to discount their impact on our daily lives and functioning. The content of your thoughts matter. Thoughts have an important role to play in modifying our emotional response to the events that are happening all around us daily. Yet how many of us are taught ways of managing the constant stream of internal dialogue that we all experience? If this skill is so important, why aren’t we all taught how to do it?

Read Brandon’s previous guest posts:

Sleep and chronic pain

The power of distraction

The what, how’s, and why’s of pacing

This skill is a fundamental tenant of Cognitive Behavior Therapy (CBT). There is an incredibly good chance that, if you have attended therapy sessions in the past, you will be familiar with at least part of this skill. Also, as is the case with any skill, it gets easier with practice when used on a regular basis. It is beyond the scope of this article to describe how to engage in this practice, but for those that are interested in learning more, you can access the program we put together on managing chronic pain here. While this program specifically addresses pain, many of the strategies discussed apply to everyone’s daily life and are particularly relevant for those experiencing heightened levels of anxiety.

Step 3: Graduated exposure

Most of you will not remember the work of B.F. Skinner from the introduction to psychology class from university, however the man contributed a huge amount to our understanding of how we learn via stimulus and response. As it turns out, avoiding the things in life (response) that cause us anxiety (stimulus) strengthens the will and desire to avoid other difficult situations in the future (learning). As this pattern of response is repeated many times (daily in most cases) it becomes our default reaction to difficult circumstances. Two important things to remember from this section are:

  1. Anxiety, though difficult and uncomfortable to experience, has never killed one person that I have ever met.
  2. Attempting to avoid anxiety does not make it better. The anxiety often gets worse and spreads to other areas of your life. 

While the first point may seem a little cheeky, I promise that this is not my intention. It can be a helpful reminder, when we are in the depths of an anxiety attack, that this will not kill me. Part of the answer then, is to break the cycle of learning that we have adopted to deal with difficult situations (avoidance in particular). To do this, we need to turn towards the anxiety (in a controlled way) and stay with it until the anxiety subsides – because with enough time it always will. Due to the difficult nature of this exercise, I would highly recommend that you seek the services of a professional who can help to guide you through this process. What follows should be considered a rough overview of the process rather than a recommended plan of action per se.

The first part of the process is to identify different situations in which you reliably experience anxiety, and then attempt to rank these in terms of their anticipated difficulty and ability to generate the anxiety response. I find it helpful to think of these in terms of steps (see below) that get progressively more difficult as you ascend:     

A central component to this treatment is something called “Subjective Units of Distress or SUDS.” This can be thought of as your subjective anxiety score as you directly expose yourself to what is making you anxious. It is of vital importance that, if you choose to engage in exposure work, you remain with the anxiety until your SUD score reduces by at least half. If you expose yourself to the stressor, and then run because it is too anxiety provoking, you have just strengthened the exact response we are trying to remove.

So, returning to our real-world example of feeling anxious at the thought of leaving my home post-pandemic, part of our plan to re-engage with society is to engage in graduated exposure. We work to identify our steps and then start slow. As an example, I may choose to put on my shoes and then sit on the front step of my home (just outside the doorway). This may be sufficient to illicit the anxiety response. It is of vital importance that I stay with this anxiety until my SUDS score reduces by at least half, only then can I go back inside. When I engage in this activity daily something amazing starts to happen. The initial anxiety associate with leaving to sit on the front step reduces, and when arousal is not as high it makes it much easier to challenge some of the thoughts that I experience (catastrophizing in particular). When I get to this point, I make the exercise a little more difficult and resolve to walk to the end of the driveway and back daily. Again, this will likely illicit the anxiety response. Stay with it. Given time, the same outcome as before will happen. Once it does, repeat the process. I make it sound simple enough here, but I promise you this can be exceedingly difficult (though not impossible).  

The steps identified above form the bedrock of treatment for anxiety through Cognitive Behavior Therapy (CBT). These are the skills that I teach to my clients. They are incredibly powerful interventions, when combined, and often result in the complete remittance of social anxiety. As countries around the world begin the difficult process of emerging from the COVID pandemic, we all have the opportunity to re-engage with our lives in a deeper, more meaningful way. Do not let anxiety take that from you.

Have a great day everyone and thanks for reading.   

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