The ABCD of Coronavirus Anxiety

This is a strange time we are living in. Here in the UK, it is likely that as you are reading this life is not so different to normal. There may be real, valid anxieties about what is coming – not just in responding to illness but in the changes that might come as a result. But it is possible to manage our anxiety and not let it overwhelm us. This week the news has been verging on the hysterical (often not just verging but way past the point of full panic). We humans aren’t very good at dealing with not knowing. Instead, we fill that space with imagined certainties. So anxiety increases.

At times like this, it can be helpful to find ways to contain our anxiety and focus on what is ok. Focus on what we can do and not what we can’t. Focus on what is happening right now and not what could happen (which we really just don’t know on any occasion).

One way of containing anxiety is better understanding how it is caused and maintained. Here’s an ABCD of some of the psychological processes we’ve been going through these past few days and weeks.

A is for Anxiety Equation

The Anxiety Equation, developed by Cognitive Behavioural Therapy guru Christine Padesky, demonstrates the two parts required for anxiety to form: our estimation of threat/our estimation at our capacity to cope.

So what is threat? Our vigilance to threat is a very helpful evolutionary tool but sometimes, in these less hunter-gatherer times, it can backfire on us.  Everyday we go around with our lovely integrated brains, our wise prefrontal cortex helping us think things through, make decisions, control our impulses, use complicated language. Making sure our more animalistic side is moderated so that we can be civilised human beings.

But when we are under threat, our prefrontal cortex goes off line, letting the more primitive limbic system take over. The limbic system – our monkey brain – deals with our emotions, memories and states of arousal. When we are really in danger, we don’t need to think, we just need to act. Our monkey brain kicks in, gets our fight, flight or freeze mode in gear. Our heart rate increases, pumping blood round our body, we feel sick (maybe we are sick or have to go to the toilet) to make sure our body doesn’t need to deal with digestion alongside fighting or fleeing, we breathe quickly helping oxygen get to our muscles, priming us to act. As our limbic system takes over and our prefrontal cortex becomes harder to access we get foggy headed, making it even harder to rationalise.

All super helpful when we have to deal with a predator in the wild, or a physical threat. Much less helpful when the threat is psychological and our thoughts and interpretations are the real threat.

What makes it doubly unhelpful of course is that anxiety can actually make us feel quite ill, leading to a vicious cycle where this can raise our anxiety further.

Often, we wildly over-estimate threat. We’re primed to do this (thanks to that good old negativity bias which has helped us survive for the last 200,000 years or so). It works to look out for threats when we need to be vigilant for rustling in the bushes. Less so when we actually don’t really know much about the threat we’re dealing with.

And we wildly under-estimate our capacity to cope. This might be our individual capacity to cope, but also our community response, and how our wider society, country or even global community are coping. We might be influenced by how we generally cope with things (how resilient we are) which has to do with our individual characteristics and past experience, our current resources, our support systems as well as the plans and actions of those around us. Examples of under-estimating our individual capacity to cope might include the assumption that we will not be able to survive unless we have 89 rolls of toilet paper in our homes. Examples of under-estimating our wider community’s capacity to cope might include assuming that national or global decisions are being made erroneously.

How can this knowledge help you now?

  • As anxiety is an evolutionary response to threat, use your body to reverse it. Shallow breathing tells your body you are in danger – so reverse this by taking long slow breaths and ensuring that your out breath is longer than your in breath. Make them audible if it helps to get your adrenaline levels down.

  • As the threat is, at present, largely psychological for many, use your thoughts to reduce the feeling of threat. Are you in danger right now? Look around you to ground yourself in the present – what can you hear, see, smell, taste, touch?

  • Increase your capacity to cope. Think about other times you have coped in difficult situations. Think about other crises or emergencies which have been managed by your government or community now and historically. You might even find it helpful to locate this as one of many times of crisis humanity has been through.

  • Getting the balance right can be so helpful to get us through the coming weeks and beyond. A little bit of anxiety can actually be very motivating. Too much and we just don’t function very well.

B is for Safety Behaviours, Black and White Thinking and Bias

Safety behaviours are coping mechanisms that we use which relieve our anxiety in the short term but in the long term keep our anxiety at the forefront of our minds and can end up making us more anxious in the long term. Examples include: avoidance (denial that there is a problem), preparing for worst case scenarios (stockpiling), compulsive behaviours (excessive hand washing), reassurance seeking (going to the GP or calling 111 when against advice).

I wanted to particularly talk about reassurance seeking as compulsive phone checking is one of these safety behaviours. Plus the media is really good at taking advantage of that anxiety equation – ramping up the threat and playing down our capacity to cope. When we refresh our news apps, or cycle through the same wheel of Facebook-Twitter-Instagram-News-repeat… what are we looking for? We’re looking for answers that no-one can give us. We’re looking for evidence that we’ll be ok. We’re looking for the likelihood of best and worst case scenarios. We think we’re preparing – actually we’re just causing ourselves psychological agony.

Black and White Thinking refers to the reasoning many of us use when we are feeling anxious. We think in opposite ends of the spectrum: ‘It’s all going to be ok’, ‘The worst is going to happen’. We might find ourselves wildly swinging  between these two polarised positions too ‘Maybe the UK government are brilliant geniuses’, ‘Maybe they are inept or psychopaths’. Or we choose a position and stick to it rigidly (see also, Cognitive Dissonance).

But reality often exists in the shades of grey.

Bias – I mentioned the negativity bias above. I also wanted to talk about how anxiety can increase the likelihood we may reveal our inherent bias against others. Social identity theory, developed by Henri Tajfel, explains this in psychological terms. Essentially humans are creatures and learn from each other what is acceptable and ‘normal’. We create groupings of those who feel more familiar to us (our ‘in-group’) which could be our football team, our region, our country, our culture, our gender etc. This can be positive of course because it enhances our sense of belonging and this can enhance our self-esteem. But what about the out-group?

We can really ‘bed down’ at times like this. Not just lockdown in reality but in our hearts and minds too. Look at Trump’s ‘foreign virus’, the increase in xenophobia or even people fighting over pasta in supermarkets. We also have cognitive biases in how we see thing because we are selective in the information we choose to take in, we respond to peer pressure, we assume we act for the best while seeing the worst in others’ actions…  These biases make life simpler for us but also can make us feel hostile towards others when we could be making new connections.

How can this knowledge help you now?

  • Think about whether you are doing anything which might be maintaining a high state of anxiety for you and find ways to minimise these behaviours. Ideally we are aiming for balance of sensible concern and planning without tipping over into anxiety or drifting into denial.

  • Put your phone away. Put it in a drawer if you need to. Switch it off and put it in a drawer even. Do what you can to break that compulsive cycle.

  • Think about what nuance you might be missing in your reasoning. Talk to people or seek information you know will give you a balanced viewpoint. Think about what you might be missing from your knowledge and find ways to accept that not-knowing state (see Distress Tolerance)

  • Question your biases. It can be all too easy to blame others when things go wrong, but we all have a personal and civic responsibility to those around us within and outside our communities.

C is for Cognitive Dissonance (see also, Capitalism)  and The Illusion of Control

Cognitive dissonance, a theory put forward by Leon Festinger,  is something you’re probably experiencing a lot at the moment. It’s when we get information which causes us to question our beliefs and attitudes, and this causes us discomfort. We might cope with this by changing our belief or attitude (often unlikely unless there is a lot of compelling evidence), or we adapt the information so that it can fit our belief by reducing its importance or finding other information to contradict it. A clear example would be the belief that the world is inherently a safe place. Something like Coronavirus comes along as a threat, and we can either shift our belief and start to see the world as a dangerous place, we can tell ourselves there are other things to focus on or we can look for information that proves the world is still a safe place.

There are some clear dissonant beliefs people might really be struggling with at the moment. The long held beliefs such as ‘I must be productive at all times’, ‘I musn’t let others down’, ‘once I make plans I stick to them’. Now we have new cognitions forming ‘It is better for me and/or my community if my working life changes and life significantly slows down’, ‘I need to cancel plans/events/gatherings’, ‘Plans must change’. Many people are waiting for external permission – added information – to be able to change their beliefs. It’s hard. One of the strongest for us in the West is that capitalist idea that we must be productive. This has meant that even people with symptoms will keep going to work, keep seeing others, not cancel plans because the belief in productivity may win out over the belief in community protection until proved otherwise.

The Illusion of Control.

As humans, we like to think that we can control the things around us, to the extent that we will assume we are in control of an outcome even when it is random. We are often driven by goals to feel in control of our environment – either directly or by using strategies to minimise feelings of chaos or uncertainty. This has been so evident in recent years, for those of us in privileged societies. Not only can we control our environment, we can control the food we eat down to its macronutrients, we can control our appearance in real life and digitally, we can control our homes, we carry devices in our hands through which we control many aspects of our lives.

It doesn’t take a lot to demonstrate how little control we actually have. Some of us know this already, having been through situations which have shown this clearly. For others, it’s a difficult lesson to learn.

So what is an alternative to control? One alternative is acceptance. It’s not surprising that, as our illusion of control has increased, anxiety has increased too because we know that we have a tenuous hold. Once we realise that actually, lots of life is random, surprising and pretty chaotic, we can find acceptance. We never knew what was going to happen tomorrow. Now, we just know we never knew.

How can this knowledge help you now?

  • Accept that it’s ok to be in this state of cognitive discomfort but that you might need to shift some beliefs

  • Think about the decisions you want to make based on the best available evidence for you, your family and your community

  • Look at ways of accepting the current situation. See…

D is for Distress Tolerance

So how do we sit with this? We can look for some things we can do, and then accept what we can’t change.

In general, we’re not great at sitting with distress. We like to zone out by watching Netflix, numb out with alcohol or substances, act it out by having a fight with a partner. So it can help to take steps just to make this particular moment feel easier. Mindfulness is a great way to develop acceptance. Or you can just look at some photos which make you feel good, smell your favourite scent, listen to an uplifting song and tell yourself you’re safe. Or, you might find it more helpful to have some distraction – trying to get yourself absorbed in a book, film or game. It may feel difficult at the moment but it’s a skill we can all learn.

Distress can’t harm us. Acceptance helps us bear the state that we are in, not the state we wish we were in.

May we be well, may we be happy, may we live with ease

And if you only want one thing to remember…. You won’t find what you’re looking for here on your phone/computer. Put it down and go and look at something or someone you love