Everything feels rather upside down as we try to adapt to this new normal of life with the coronavirus pandemic. Most people seem to be at least a little bit unsettled by this outbreak. It’s not at all surprising for us to feel unease when there are so many unknowns and things are so up in the air. Many therapists are grappling with these feelings ourselves as we work to help our patients best manage their anxiety, restlessness, isolation, and relationship difficulties. The following are some initial thoughts I have on these subjects.

Most people are likely to feel some amount of anxiety but people who already struggle with underlying anxiety disorders or depression are particularly vulnerable to having difficulty coping. I recommend trying doable actions such as taking walks, running, meditation, deep breathing, guided visualizations and talking to friends and family for support. I strongly encourage people to limit the amount of time they spend listening to the news, as this can spike anxiety exponentially. In some ways, this crisis is similar to what it was like after 9/11 in terms of our collective anxiety. At that time, as now, limiting one’s exposure to tv was essential to maintaining health and wellness.

Many people are living alone and therefore quite isolated. Reaching out to people is crucial. Perhaps you have one or two close friends who are in a similar situation. Try making an agreement to connect with each other daily. Meeting via an online video platform such as Skype or Zoom is a great idea. I’ve been doing this for all my therapy sessions. While meeting in person is preferred, this is the next best option. Seeing a person face to face goes a long way. Having a pet is another great way to combat loneliness. Reportedly, there has been a rise of the number of people buying pets for this very reason. Now is also a good time to call your therapist if you have one. People need not wait for their appointment to reach out for help.

While some people are having a hard time with so much solitude, others are struggling with having their nerves frayed by spending so much time at home with their partners. Many of these couples were experiencing difficulties before, but even in the healthiest relationships “sheltering in place” can be a true test. If possible, I think it’s vital for individuals to find time alone by getting outside or going into a separate room. I’ve encouraged couples I work with to come up with a code word to signal to a partner they need a time out if things get too heated. Is it possible to call a “truce” to not bring up loaded discussions or arguments while we are bunkered down? Now is the time for us to be extraordinarily gentle with ourselves and others.

It may be hard to structure one’s time when trapped at home. I think it is important to treat one’s life much as you would if you were going to your job. Try getting dressed much as you might if you were going into the office. If working from home, try setting clear time boundaries. Make sure you have start and end times, schedule breaks, and aim to only address personal matters outside of these time boundaries. I suggest scheduling your personal time as well. You can break these down into chores, family time, and personal time. Children obviously require a lot of structured play and learning, but we also may benefit from scheduling our days so that we don’t find ourselves ruminating, festering with anxiety, and struggling to get anything done.

Thankfully, Blue Cross Blue Shield is allowing us to practice online psychotherapy during this pandemic. I foresee more people needing our services due to this crisis. My hope is that people won’t hesitate to reach out in such a trying time. While it certainly doesn’t take the place of seeing patients in the office, I am pleasantly surprised to see how effective remote psychotherapy can be. How very fortunate we are to be living in a time where such a thing is possible! Best wishes for health and calm as we navigate this unknown territory together.

There is a great deal of confusion between feelings and mood states. Feelings (or emotions) are normal, healthy aspects of being human. Sadness, anger, joy, and fear are all common feelings that every human experiences, often daily. Mood states are not feelings. Depression, anxiety, and Bipolar Disorder (often known as manic depression) are mood states and can be considered mental disorders when severe enough. This isn't necessarily the case, as most people have experienced some type of depression or anxiety in their life time without it being serious enough to constitute a mental illness. We can say that we "feel depressed" or "feel anxious," which adds to the confusion between feelings and mood states.

Mood states may be understood as defense mechanisms that serve to protect us from underlying feelings. For instance, if we experience our anger as unacceptable or threatening, we might "depress" it and end up being "numb," resulting in not being in touch with the underlying anger. People who suffer from depression often describe themselves as being lethargic, fatigued, hopeless, or despairing. We cannot be in touch with our emotions when we are depressed. Reversely, when we are in touch with our feelings, we are not depressed at that moment. Anxiety may also be a way to manage underlying emotions. If our anger becomes too intense, we might react by becoming highly anxious. In this case, the anxiety is in response to a perceived threat induced by our anger. To complicate this further, if our anxiety then becomes too intense, we might then clamp down on it and become depressed. I describe this to my patients as layers upon layers, with the root feeling (which is pure and healthy) being buried deep down. So in this example, anger is the pure, healthy emotion that the individual has come to believe is bad, dangerous, or unacceptable. So Anger -> Anxiety -> Depression. Freud described depression as "anger turned inward." I believe this is what he meant by that explanation. Thus, a person might only experience his depression or anxiety, having suppressed his anger to a point where it cannot be easily accessed. But if a person suppresses one emotion, he suppresses all emotions. So when a person is suffering from depression, he cannot fully inhabit his anger, joy, fear, or sadness.

In psychotherapy I help my patients explore what feelings they might be defending against by employing the defenses of depression or anxiety. By teaching people that their feelings are normal and healthy and not to be feared, they start to shift their relationships to their emotions. Over time, this helps people learn alternate ways to manage their feelings so that they no longer believe they have to push their feelings away at all costs. We may view depression and anxiety disorders as forms of "acting in," i.e. turning inward to try to manage difficult emotions. In my next blog post, I will address "acting out" behaviors that people may employ as alternate ways to attempt to manage internal emotional states.

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