How to cope with Coronavirus / Covid-19 and Self-Isolation or Quarantine (with print-outs)

We know that when humans live in situations where they are under a threat (like Coronavirus / Covid-19) it can have negative consequences on their psychological health. Those under threat might have disrupted thought processes and heightened risk perception, increased emotional reactions, increased perception of their own vulnerability, increased suspicion and distrust of others, reduced perceived control of situations and reduced social interactions. We also know that after ‘outbreaks’ of other diseases that depression rates go up and anxiety and panic can be triggered.

In response to these difficulties, we’ve collated a list of ways in which we can all look after our mental wellbeing, and that of those around us, from respected health authorities and sources.

How to Cope

Coping with coronavirus for the General Population

  • If you feel worried about coronavirus or Covid-19, then try not to watch, read or listen to news articles about it. If you must find out information, focus on what you can do to protect yourself and your loved ones and limit it to once a day for a short amount of time.
  • Look after yourself but also support others if they need help.
  • Share and talk about the stories of people who have recovered or who have supported someone with the virus. Offer appreciation for and celebrate those who are caring and supporting people affected.
  • The virus is affecting everyone from all ethnicities and walks of life. Be empathetic to anyone affected by it.
  • Don’t refer to people with the coronavirus as ‘victims’ or ‘cases’; they’re humans with their own identities who are a lot more than the virus that they have been unlucky enough to catch.
  • If you are healthy and have time, volunteer to support those who are self-isolating or those who are supporting people who are infected with Covid-19.

Coping with coronavirus for care-workers and health workers

  • It is normal to feel more stressed at times like these; it doesn’t mean you aren’t coping or you’re weak.
  • Take time to look after yourself physically and mentally.
  • Rest, eat, hydrate, stay active with exercise and maintain contact with people you love and trust, avoiding alcohol, tobacco or drugs.
  • Some people may want to avoid you because they think being in your presence might increase their risk of catching the virus. If this happens, try to stay in touch using digital methods and share your experiences with colleagues; they’re probably going through the same.

Coping with coronavirus for Managers

  • Communicate clearly and accurately in ways which everyone can understand.
  • Be a role model for self-care.
  • Rotate workers regularly, pair colleagues up so they have support, particularly when in the community.
  • Check that people are having enough breaks
  • Be compassionate to those whose families are affected; they might need more time out than others.
  • Signpost colleagues to places they can get physical and mental health support.
  • Ensure that colleagues are trained in basic psychological first aid.

Coping with coronavirus for those looking after children

  • Help children express their emotions through talking, play and art in a safe place; this will bring them relief.
  • Explain how to prevent infection in terms they understand, and explain why it is important. Use visual reminders and help them practice handwashing if needed.
  • Try to keep children with their parents or guardians if possible. If separated, then ensure they maintain contact through digital means or age-appropriate social media.
  • Try to be honest, in ways they can understand about what is happening and update them when there are changes to the situation as appropriate.
  • Try to keep their routine; ensure they have activities to keep them occupied.
  • Be a role model for how to cope in times of stress; they will often copy you, and if you are calm then they will reflect this.

Coping with coronavirus for those looking after older adults

  • At times of stress, older adults with physical or mental health conditions may become more anxious, agitated or withdrawn. Provide emotional support and consult local health services if needed.
  • Share information about what is going on and how to reduce risk of infection in ways which they can easily understand. Explain why it is important. Repeat if necessary, with patience.
  • Use visual reminders and help them practice handwashing if needed.

Coping with Self-isolation
Quarantine has been shown to prompt symptoms of post-traumatic stress, anger and confusion. After coming out of quarantine people have experienced stigma, financial difficulties and boredom. Even if you’re not in quarantine but are self-isolating, humans are not designed to live in social isolation.

Social isolation is linked with higher rates of depression, anxiety and mental and physical health conditions. If you are self-isolating, then you have probably changed your daily routine too; maybe you’re working from home, not going to college or school and not going to the same activities you used to. Reducing activity levels in this way is also linked with low mood and depression.

Below we’ve listed FIVE key principles of wellbeing which might help you cope with your self-isolation period.

Connect with others
Even though you’re not going to see people face to face, stay connected. Speak on the ‘phone, text, message, email, Skype or FaceTime. Maybe you can reach out to someone you haven’t spoken to for a long time. You can support each other emotionally, distract yourself from negative thoughts and emotions and still make plans for when the health risks have reduced.

Be Active
You might not be at the gym or ParkRun but it will help to stay active. Can you dance in your room to your favourite track? Can you do a yoga session you find on YouTube? Can you do a few sit-ups? Can you walk up and down stairs? If you Keep your body moving it will help your body stay in good condition and will lift your mood too. It’s also essential for a good night’s sleep.

Learn New Skills
You might feel bored at home without your normal routine. To avoid boredom and lift your mood, try learning a new skill. There are plenty of videos on YouTube for different hobbies and apps which can help you learn a language. Maybe you have some books which you always intended to read? Now might be the time to finally get round to practicing playing that instrument you started years ago! Learning a new skill gives us a sense of achievement and mastery which increases wellbeing.

Give to Others
This can be difficult when you’re not leaving your home but there are still ways to give back. You might want to volunteer for a charity helpline. You might want to offer your skills to a charity you support. Maybe there is some fundraising you can take part in. It might be as simple as helping someone you know solve a problem they have or simply listening to them on the ‘phone. Giving to others has been shown to make us happier than when others give to us.

Pay attention to the present moment
This is also known as mindfulness. It means practicing noticing what is happening right now rather than worrying about the past or the future. One way of doing this is to go through your sense one by one asking “What can I see? What can I hear? What can I feel (emotionally and physically, both inside your body and outside)? What can I smell? What can I taste?”. Take time to really find a range of different sensations, and notice when they change.

Here are some further tips which studies have shown will help you maintain mental wellbeing:
Eat regularly, and drink water: even if you don’t have an appetite, your brain needs fuel.
Keep a routine: by getting out of bed at the same time and going to bed at the same time you reduce the risk of sleep problems. Have a shower or bath just like you would normally. Get dressed for the day, even if people aren’t going to see you; the closer to normal your routine is, the easier it is for your mind and body to adjust.
Take time away from screens: Current advice is that we should turn off your screens and give your body and mind time to become less alert at least an hour before bed.

Advice Leaflets for printing

I’ve created some easy-to-read documents which you can print out and provide to any of your contacts you you think might need some tips on how to stay well, psychologically during the coronavirus outbreak.

For the general public: Coping with Covid19 Public

For staff: Covid19 Staff Advice for Coping

Sources:
World Health Organisation: BPS – COVID-19 Psych Perspectives
British Psychological Society: WHO – mental health considerations and COVID-19
Associations of Clinical Psychologists
NHS

Panic Disorder Management – a problem based learning case study

Often, when we are presented with a case it can be difficult to find a way forward. To aid clinical decisions, it is sometimes necessary to break down the decision making process into stages. The problem based learning task below does just that. Here I was given a case study and we methodically worked through the problem to get to a solution.

Reena fears that she is experiencing the precursors to a heart attack. Reena avoids going to the gym, or out of the house alone, other than to work. Reena carries out safety behaviours whilst driving. Her GP feels that physical symptoms are due to panic attacks and as such has recommended that Reena seek IAPT support. She has been assigned a PWP trainee which she is concerned about. She presents with mild depression and moderate anxiety symptoms.

Identify what you already know to work toward resolving the problem

  • Heart palpitations, racing and pounding are all symptoms of panic disorder (DSM-5, 2013)
  • Physical exertion (i.e. exercising at the gym) can bring on symptoms similar to those experienced when anxious or panicking
  • Avoidance of situations which may increase physical symptoms is common in clients who suffer from panic disorder (Richards & Whyte, 2011)
  • Seeking reassurance is common when facing an anxiety provoking situation
  • Reena has a supportive friend who she listens to, who may be able to support her in treatment if needed
  • It is a GP’s responsibility to investigate and ascertain whether the client’s heart is sound; a PWP, qualified or otherwise, is not able to make judgements regarding this
  • The recommended medications for panic disorder are SSRI and TCA antidepressants but psychotherapy should be he first port of call (NICE, 2011)

Identify what you need to know in order to work towards resolving the problems.

I would want to do a full assessment including:

  • Assessing risk
  • client’s history including triggers and previous incidences
  • how long symptoms have occurred
  • how quickly they peak and subside
  • nature of thoughts during palpitations
  • thoughts, emotions, physical sensations and behaviours during last instance of panic and whether this is typical
  • whether she worries about other health difficulties to assess for health anxiety
  • what thoughts go through her mind before going to go out to assess for agoraphobia
  • client’s goals and barriers to working towards those goals
  • the client’s attitude to starting to go to the gym, and going out alone again

I would also want a discussion with GP to understand extent of the investigations he has made, and also to collect a brief history to see if illness anxiety disorder could be evident

How and where you can access new information to lead towards the resolution of problems

  • Discussion with client
  • Discussion with GP
  • Mobile use when driving https://www.gov.uk/using-mobile-phones-when-driving-the-law

Treatment plan

  • Phone work initially if she felt unable to leave home
  • Full assessment
  • Psycho-education about the qualifications of PWP trainee and what they are trained for, education about tendency for catastrophisation, hyper-vigilance, avoidance and safety behaviours
  • Graded exposure to gym / going out alone / driving without safety behaviour
  • Behavioural Experiments if assessment indicated that self-monitoring or avoidance of gym was due to fear of symptoms
  • Cognitive Restructuring of catastrophic thoughts if detailed assessment indicated this would be necessary
  • Give educational material to housemate if permission given

Signposting

  • Education about law regarding mobile use while driving