By Rajnish Mago, MD (bio)
This is March 2020 and the coronavirus or COVID-19 pandemic has everyone worried and with good reason. Data from China suggest that the coronavirus epidemic has had a very significant psychological impact on the population, including significant levels of stress and anxiety (Wang et al., 2020). Also, persons who may have been exposed to coronavirus need to be quarantined. A review of the literature on the psychological effects of quarantine reported a variety of negative psychological effects including post-traumatic stress symptoms, confusion, and anger (Brooks et al., 2020). The psychological distress is related to fear of developing the infection, separation from loved ones, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma (Brooks et al., 2020).
Patients with mental health problems may be even more vulnerable than others to such stress and anxiety related to the coronavirus situation. For example, there are reports that some patients with OCD are “developing a new fixation on coronavirus” (Murray and Sherwood, 2020).
What role do we as mental health clinicians have to play in helping our patients deal with this stress and anxiety?
Please note that on this page, I will NOT discuss facts about coronavirus or precautions that are being recommended by infectious disease specialists. My goal is NOT to try to summarize medical information about coronavirus disease (COVID-19). I’m ONLY discussing what is specific to mental health clinicians. This falls into two broad categories:
1. How to educate ourselves and our patients
2. How to manage stress and anxiety related to coronavirus
How to educate ourselves and our patients
In a survey done in China, up-to-date and accurate information about particular precautionary measures, the status of the outbreak, treatment, etc., was found to be associated with lesser psychological impact from the outbreak and lower levels of stress, anxiety, and depression (Wang et al., 2020).
We should educate ourselves about the coronavirus so that if patients ask questions about it, we can answer those that we feel comfortable answering. We are medical professionals and patients look to us, to some extent, to answer their medical questions. We can use the same resources that are recommended for patients below.
But, we should not hesitate to admit that we are not experts on the topic and don’t know the answer to a particular question from a patient.
We should encourage patients to not believe everything they read on social media. This advice applies to us as well! Instead, we should encourage them to get the most up-to-date information from reliable sources. But, referring people to ten different resources is less helpful than giving them only a couple of the best resources for getting the relevant infectious disease information. (As you know, one of the strengths of this website is that we give only highly selected information about the topic we are discussing.) So, we may recommend just the two main sources of reliable education about coronavirus.
1. Probably, the best single place to refer patients to the is the Centers for Disease Control and Prevention’s INDEX PAGE for their information about the coronavirus, Encourage patients to start there and then follow links from that page to relevant pages about coronavirus. The list of relevant pages on their website appears as a menu on the left of each page, making it easy to navigate from one page to another. See the image below.
2. World Health Organization (WHO). The index page for their information is the following: Coronavirus disease (COVID-19) outbreak. See the image below.
With regard to education about coronavirus, the WHO notes that the “near-constant stream of news reports” can cause anyone to become worried (World Health Organization, 2020). So, it recommends that people should :
– Seek information mainly for the purpose of taking practical steps to protect themselves and their loved ones.
– Seek information updates only once or twice a day.
– Focus on getting the facts from reliable sources to help them to distinguish facts from rumors.
A related recommendation (from my colleague Donna Sudak, MD, Professor of Psychiatry, Drexel University College of Medicine, Philadelphia, Pennsylvania) is to preferably get news from written sources rather than TV because visual information may be associated with more of a visceral reaction than written information.
How to manage stress and anxiety about coronavirus
1. Normalize their feelings of stress and anxiety
Patients may feel embarrassed that they are worried about the risk of becoming infected or ill. We should discuss with patients that all of us can expect to feel some stress and concern about the coronavirus situation and the uncertainty surrounding it. That is, we should “normalize” this stress and encourage accepting it rather than trying to deny it. The situation is definitely stressful for all of us and we should acknowledge this with our patients.
2. Alleviate anxiety about medication supplies
Several of my patients have expressed worry about the possibility that they will run out of their medications and not be able to obtain it. What can we do about this?
– Refill medications a week earlier than when they are due. If this is done for a controlled substance, we should keep track of this and take it into account in subsequent refills.
– For some patients, consider giving them a 90-day supply of medication. But, there is a concern that if 90-day prescriptions are given to all patients, couldn’t this lead to shortages?
3. Identify and address cognitive distortions
Some of our patients may engage in “catastrophizing” about coronavirus. Some of them may overestimate both their chances of their getting the infection and of serious consequences from it. On the other hand, they may underestimate their ability to take precautions and to deal with. Standard cognitive-behavior therapy techniques should be used to address these cognitive distortions.
4. Use other cognitive therapy techniques to reduce anxiety
For example, for each worry that the patient has, ask them to specify whether they think there is something they can do about it or not. Helping patients to become clearly aware of which of their worries are something they can’t do anything about can be helpful in reducing distress related to those thoughts. Another anxiety reduction technique is to schedule time to worry (described on another page on this website).
5. Encourage patients to focus on what they can DO
To limit anxiety, we should encourage our patients to focus on what they can do to reduce the risk to themselves and their families. So, it may be helpful to ask what measures they are taking to mitigate the risk. This may reinforce to patients that they are doing all the right things that are being recommended by infectious disease experts.
6. Encourage patients to maintain their daily routine as much as possible
This is a standard recommendation for stressful times and applies to the coronavirus situation as well. It’s probably not helpful to spend all day talking about the coronavirus or watching news about it. We should encourage patients to maintain as many of their normal activities as possible. For example, if they can’t go to the gym, they should exercise at home. If they are visiting friends and family less often, they should call some of their friends and family every day.
7. Make time for fun and relaxation
Each person has some things they do for fun and relaxation that work for them. In this crisis, we should encourage our patients to fall back on things that have worked for them in the past. This may be watching a movie or show, listening to music, cooking, and so on.
8. Talk to their children about it as well
Parents should realize that during times of stress, children be more attached to their parents and demand more attention, and this is normal (World Health Organization, 2020). Just like other issues, we should recommend that parents should discuss the issues related to coronavirus—including the specific child’s questions and concerns—instead of avoiding the topic.
One good resource to recommend about how to help children deal with stress related to coronavirus is a free, five-page guide from The National Child Traumatic Stress Network (also available in Spanish and Chinese). Here’s the link to download that document: Parent/Caregiver Guide to Helping Families Cope With the Coronavirus Disease 2019 (COVID-19).
Next, please see these articles:
Warning about using psychotropic medications along with treatments for COVID-19
Could psychotropic medications affect the immune response to coronavirus?
This page was last updated on March 15, 2020
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References
Center for the Study of Traumatic Stress. Caring for Patients’ Mental Well-Being During Coronavirus and Other Emerging
Infectious Diseases: A Guide for Clinicians. Accessed March 15, 2020. Several other factsheets about coronavirus are available on this page on their website.
Murray J, Sherwood H. Anxiety on rise due to coronavirus, say mental health charities. In: The Guardian, March 13, 2020.
Psychiatric News. How Psychiatrists Can Help Patients During Coronavirus Outbreak. Accessed on March 15, 2020.
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health. 2020 Mar 6;17(5). pii: E1729. doi: 10.3390/ijerph17051729. PubMed PMID: 32155789.
World Health Organization (WHO). Mental Health Considerations during COVID-19 Outbreak. March 6, 2020. Accessed on March 15, 2020.
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I would like to ask if patients with psychiatric disorders have a greater chance to get more severe COVID forms or if the COVID itself could be associated with posterior development of psychiatric disorders.